Transcript This is the title lots of room for it here

Elder Abuse and Mistreatment:
Identifying Abuse
Barbara A. Reilley, PhD, Carmel B. Dyer, M.D. and
Kathleen Pace Murphy, PhD, GNP
The University of Texas Health Science Center at Houston (UTHealth)
Module 1 of 2
Learning Objectives
Successful participants will be able to:
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Describe three types of elder abuse.
List five signs and symptoms that raise suspicion of elder abuse.
Identify three factors for elder abuse and neglect.
Elder Abuse Definition
The National Center on Elder Abuse defines elder abuse as:
“intentional or neglectful acts by a caregiver or ‘trusted’ individual that lead to, or
may lead to, harm of a vulnerable elder”
The most common types are:
 Physical abuse
 Neglect, including self-neglect
 Emotional or psychological abuse
 Verbal abuse and threats
 Financial abuse and exploitation
 Sexual abuse
 Abandonment
Types of Elder Abuse
(which is also known as Elder Mistreatment)
For more information:
The National Center on Elder Abuse.
What type of abuse is this?
page 1 of 2
“Man Pleads Guilty to Biting Grandmother”
David Wilson pleaded guilty to biting his grandmother.
“And she told me she thought the beating would never
stop.
She yelled, begged, and it didn’t matter…”
Physical Abuse
Caregiver Neglect
Abandonment
Physical Abuse
page 2 of 2
“Man Pleads Guilty to Biting Grandmother”
Definition: the use of physical force that may result in
bodily injury, physical pain, or impairment. Physical abuse
may include but is not limited to such acts of violence as
striking (with or without an object), hitting, beating,
pushing, shoving, shaking, slapping, kicking, pinching, and
burning.
In addition, inappropriate use of drugs and physical
restraints, force-feeding, and physical punishment of any
kind also are examples of physical abuse.
Outrage at Care Worker’s Rape Penalty
Australia:
“An aged-care worker who raped an 85-year-old
woman will spend just six months behind bars,
sparking outrage.”
Sexual Abuse
Definition:
non-consensual sexual contact of any
kind with an elderly person.
Includes, but is not limited
to, unwanted touching, all
types of sexual assault or
battery, such as rape,
sodomy, coerced nudity
and sexually explicit
photographing.
Example:
sexual contact with any person
incapable of giving consent.
Neglect
Definition:
this is the failure to meet an elder’s basic needs.
May include failure of a
person who has fiduciary
responsibilities to provide
care for an elder or the
failure on the part of an
in-home service provider
to provide necessary care.
Examples:
refusal or failure to provide an
elderly person with such life
necessities as food, water,
clothing, shelter, personal
hygiene, medicine, comfort,
personal safety, and other
essentials included in an
implied or agreed-upon
responsibility to an elder.
Self-Neglect
Definition: a condition in which the older person is no
longer willing or able to provide basic care for him/herself
A refusal or failure to
provide himself/herself
with adequate food,
water, clothing, shelter,
personal hygiene,
medication (when
indicated), and safety
precautions.
Excludes a situation in which a
mentally competent older person,
who understands the
consequences of his/her decisions,
makes a conscious and voluntary
decision to engage in acts that
threaten his/her health or safety
as a matter of personal choice.
Caregiver Neglect
“Husband Let Wife Starve to Death”
England:
“A 71-year-old man has been jailed for allowing his mentally
ill wife to starve to death while he went to the pub and
visited the bookmakers. William Pottinger’s wife, Gillian, 61,
died on a flea-ridden couch in June 2006 weighing four-anda-half stone (Stone = a unit of weight equal to 14 pounds.
This woman weighed 63 pounds.)”
Caregiver Neglect
From Texas Elder Abuse and Mistreatment Institute Files
A Case of Caregiver Neglect
A woman reported to APS that she was being
neglected by her daughter, who was the primary
caretaker. The daughter frequently had to work out
of town, and left the mother (post-stroke) alone for
extended periods of time. The woman said that the
daughter did not turn or change her. APS called the
clinical elder mistreatment team.
Psychological or Emotional Abuse
Definition: the infliction of anguish, pain, or
distress through verbal or nonverbal acts.
In addition, treating an
older person like an
infant; isolating an elderly
person from his/her
family, friends, or regular
activities; giving an older
person the "silent
treatment;" and enforced
social isolation are
examples of emotional
/psychological abuse.
Examples are: verbal assaults,
insults, threats, intimidation,
humiliation, and harassment.
Abandonment
From Texas Elder Abuse and Mistreatment Institute Files
An elderly man was abandoned by his son in a motel.
The incident was reported to APS, who referred the case
to a team of clinicians knowledgeable about elder abuse.
The elderly man was found severely malnourished and
dehydrated, with contractures and decubitus ulcers. He
was placed in a safe environment.
What happened to the son is unknown.
Abandonment
Definition:
The desertion of an elderly person by an individual who has
assumed responsibility for providing care for an elder, or by a
person with physical custody of an elder.
Financial or Material Exploitation
Definition: the illegal or improper use of an elder's funds, property, or
assets for monetary or personal benefit, profit or gain.
It is estimated that one in
25 cases of elder abuse
involves financial
exploitation. Additionally,
the total number of
financial exploitation
cases is estimated to be at
least 5 million cases each
year in the United States
alone.
Wasik, John F. 2000. “The Fleecing of America’s
Elderly,” Consumers Digest, March/April.
Examples include, but are not
limited to, cashing an elderly
person's checks without
authorization or permission;
forging an older person's
signature; misusing or stealing an
older person's money or
possessions; coercing or deceiving
an older person into signing any
document (e.g., contracts or will);
and the improper use of
conservatorship, guardianship, or
power of attorney.
Financial or Material Exploitation
New York:
“Even those with great financial wealth become victims…”
In October 2009, Marshall Astor was convicted on 15 counts
of defrauding Mrs. Brooke Astor, his 105-year-old mother.
The Epidemiology
How Bad is the Problem of Elder Abuse?
National Prevalence of Elder Abuse
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Millions of Americans age 65 or older have been injured,
exploited, or otherwise mistreated by a caregiver or
someone they trust.
Frequency of elder abuse estimates range from 2 to 10
percent based on various sampling and survey methods
and case definitions.
Only 1 in 14 incidents of elder abuse in domestic settings,
excluding self-neglect, are brought to the attention of
authorities.
Self-neglect is the most commonly reported form of elder
abuse (mistreatment) and is increasing.
National Trends
National Center on Elder
Abuse (NCEA) Survey of
Adult Protective Services
(APS) reported an
increase in elder abuse of
20% from 2000 to 2004.
2004
2000
The NCEA surveyed 50
state APS offices, plus
Guam and the District of
Columbia.
National Trends
The 2004 NCEA Survey of APS also found:
42.8 % of
victims are 80
years or older.
15.6 %
increase in
substantiated
APS cases
since 2000.
Most victims
are female.
(65.7 %)
The vast majority of elder
abuse cases occurred in
domestic settings (89.3%)
Mortality and Elder Abuse
Status
Self-neglect
180
Elder mistreatment
78
No EAM
6649
Number Deaths
73
31
1303
%
40.3%
53.2%
17.3%
Self-Neglect and Mortality Risk
• In older adults who self-neglect, African-American older adults
had a higher mortality rate compared to whites.
• In a population-based cohort study of Chicago, Illinois residents
aged 65 years or older, elder reported and confirmed selfneglect and abuse was associated with an increased risk in
mortality.
– Mortality risk after one year remained significant for
confirmed elder self-neglect.
– Increased mortality was not restricted to older adults with
lowest levels of cognitive or physical function.
Elder Abuse Risk Factors
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Age
Dependency
Functional decline
Personality disorders
Isolation
Poverty
Cognitive impairment
Excessive use of drugs or alcohol
The Interprofessional Approach
Physicians may take an
interprofessional
team approach
using formal
and informal
relationships
with:
Amishsteve on flickr.com
Case Study – Mrs. F.
Patient Presentation
Mrs. F is an 89-year-old
woman brought into the
office by her niece for a
periodic check up.
Mrs. F lives alone, her niece
takes her to run errands
once a week.
Mrs. F asks her niece to wait
in the waiting room during
her exam, and her niece
readily agrees.
Case Study – Mrs. F.
Comprehensive Geriatric Assessment
Vital Signs: BP 190/96
Physical Exam: unremarkable except
for her toenails (see picture).
Medications: Anti-hypertensive
dosage was increased 6 months ago.
Upon questioning, she is not sure
when she had her last dose.
Her niece failed to obtain her
prescription from the pharmacy.
Amishsteve on flickr.com
Case Study – Mrs. F.
Questions to Consider
1.
What type of abuse would you consider that
Mrs. F is experiencing?
2.
What are the risk factors that you would note
for elder abuse in this case?
3.
What is her risk of dying in the next year?
Conclusions
Elder abuse is common. Self-neglect is currently the most
prevalent type of abuse.
An interprofessional
team approach to
identifying and
treating elder abuse
will help to
adequately address
an elder abuse case.
Elder abuse is associated with an increased
risk of mortality.
Elder abuse is a growing public
health problem.
References:
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Brandle, B., Dyer, C.B., Heisler, C.J., Otto, J.M., Stiegel, L.A., Thomas, R.W. (2007). Elder abuse detection and intervention: A
collaborative approach. New York: Springer Publishing Company.
Center for Disease Control and Prevention (2008). Understanding Elder Maltreatment: Fact Sheet. Retrieved on February 28, 2012
at http://www.cdc.gov/violenceprevention/pdf/em-factsheets-a.pdf
Dong, X.Q., Simon, M.A., de Leon, C.M., et al. 2010. Elder self-neglect and mortality between black and white older adults.
Journals of Gerontology: Series A, Biological Sciences & Medical Sciences. 66(6), pgs. 695-704.
Dong, X.Q., Simon, M.A., de Leon, C.M., Fulmer, T., Beck, T., Hebert, L., Dyer, C., Paveza, G., & Evans, D. 2009. Elder self-neglect and
abuse and mortality risk in a community-dwelling population. Journal of the American Medical Association, 302(5), pgs. 517-526.
Dyer, C.B., Hyman, D. J., Pavlik, V.N., Murphy, K.P., & Gleason, M.S. (1999). Elder neglect: A collaboration between a geriatrics
assessment team and adult protective services. Southern Medical Journal, 92(2), 51-62.
Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. 2003. Washington, DC: National Research Council
Panel to Review Risk and Prevalence of Elder Abuse and Neglect.
Lachs, Mark S., and Karly Pillemer. October 2004. “Elder Abuse,” The Lancet, Vol.364: 1192-1263.
Pavlik, V.N., Hyman, D., Festa, N., & Dyer, C.B. (2001). Quantifying the problem of abuse and neglect in adults: Analysis of a
statewide database. Journal of the American Geriatrics Society, 49, 45-48.
Pillemer, Karl, and David Finkelhor. 1988. “The Prevalence of Elder Abuse: A Random Sample Survey, “ The Gerontologist, 28:5157.
Teaster, P.B. A response to the abuse of vulnerable adults: the 2000 survey of statue adult protective services. 2000.
http://www.nceas.aoa.gov/ncearoot/main_site/pdf/research/apsreport030703.pdf.
The National Center on Elder Abuse (2005). Fact Sheet: Elder Abuse Prevalence and Incidence. Retrieved on February 29, 2012
from http://www.ncea.aoa.gov/Main_Site/pdf/publication/Finalstatistics05331.pdf
The National Center on Elder Abuse (2012). Elder Abuse Definition. Retrieved on February 29, 2012 from
http://www.ncea.aoa/gov/Main_Site/FAQ/Basics/Defincition.aspx
The National Center on Elder Abuse (2012). Types of Elder Abuse. Retrieved on February 29, 2012 from
http://www.ncea.aoa/gov/Main_Site/FAQ/Basics/Types_of_Abuse.aspx
Electronic Resources
http://www.ncea.aoa.gov?NCEAroot/Main_site/pdf/publications/FinalStatistics050331.pdf
http://www.census.gov?Pressrelease/www/releaes/archives/facts_for_feature_special_editions/006105.html
http://www.ncea.aoa.gov/Main_Site/pdf/021406_60FACTSHEET.pdf
Photographs used for the cover slide are allowed by the MorgueFile free photo agreement and the Royalty Free usage agreement at
Stock.xchng. They appear on the cover slide in this order:
Wallyir at morguefile.com/archive/display/221205
Mokra at www.sxc.hu/photo/572286
Clarita at morguefile.com/archive/display/33743
Brought to you by TEXAS. The Training Excellence in Aging Studies
(TEXAS) program promotes geriatric training from medical school
through the practicing physician level.
This project is funded by the Donald W. Reynolds Foundation to the
division of Geriatrics and Palliative Medicine within the department of
Internal Medicine at the University of Texas Health Science Center at
Houston (UTHealth).
TEXAS would also like to recognize the following for contributions:
Houston Geriatric Education Center
Harris County Hospital District
Memorial Hermann Foundation
Huffington Lecture Series
The TEXAS Advisory Board
Othello "Bud" and Newlyn Hare
UTHealth Medical School Office of the Dean
UTHealth School of Nursing
UTHealth Consortium on Aging
UTHealth Multimedia Scriptorium