Transcript Healthy Aging - Academy on Violence and Abuse

Elder Mistreatment
Laura Mosqueda, M.D.
Director of Geriatrics
Interim Chair & Professor of Family Medicine
University of California, Irvine
Think about our expectations
and perceptions of aging.
How do these expectations
and perceptions influence
our interest in elder abuse?
How do these expectations
and perceptions influence
our understanding of elder
abuse?
Child & Elder Differences
• Death
– Unusual/unexpected in kids
– Common/expected in older adults
• Autonomy
– Not recognized in children
– Assumed in older adults
• Social networks
– Almost all children are in schools and in
some contact with people other than their
parents
– An elder may easily remain isolated
Child & Elder Differences
• Training
– Most police officers, health care providers,
social workers have received specific
training in child abuse
– Most police officers, health care providers,
social workers have received NO training
in elder abuse
• Vulnerability
– Will likely decrease over time for children
– Will likely increase over time for elders
Why is understanding elder
abuse important?
“People with dementia don’t
feel pain.”
E.R. nurse
“She did the best she could.”
Primary Care Doctor
“I see old people who die in this
condition all the time.”
Coroner Investigator
“He was just doing it to annoy
me so I finally hit him - it’s not
my fault.”
Daughter
Normal & Common Changes
• Renal: decrease in creatinine clearance
• Integument
– thinner epidermis
– capillary fragility
– Less elasticity
• Sensory system
– presbycussis
– slower reaction time
– macular degeneration, cataracts
Normal & Common Changes
• Musculoskeletal
– sarcopenia
– osteopenia/osteoporosis
• Cardiovascular
– orthostatic hypotension
– congestive heart failure
• Function
– gait/falls
– ADLs
Effects of Decrease in Reserve
• Greater susceptibility to illness
• More difficulty in recovering from illness
• Sensitivity to side effects of medication
• Vulnerability to abuse
Vulnerability
• Emotional: fear of losing independence,
more susceptible to threats
• Physical: more difficult to defend oneself
• Cognitive
• More assistance is required
– Change in dynamics of relationships
– More people involved in intimate aspects
Research
Markers
Instruments
Models
Technical Assistance
Forensic Center
CoE
EAN
Training Institute
Conferences
Products
Pocket Doc
FC manual
OCEAPC
VAST
EDRT
Policy
Objective
To summarize the occurrence,
progression, and resolution of accidentally
acquired bruises in a sample of adults
aged 65 and older.
The systematic documentation of
accidentally occurring bruises in older
adults could provide a foundation for
comparison when considering suspicious
bruising in older adults.
Design
Between April 2002 and August 2003, a
convenience sample of 101 seniors was
examined daily at home (up to 6 weeks) to
document the occurrence, progression
and resolution of accidental bruises that
occurred during the observation period.
Setting and Participants
Three community-based settings and two
skilled nursing facilities in Orange County,
California.
One hundred and one adults over the age of
65.
Measures
Age, gender, ethnicity, functional status,
handedness, medical conditions,
medications, cognitive status, depression,
history of falls, bruise size, bruise location,
initial bruise color, color change over time.
Each day, bruises were visually inspected,
recorded in subject files, and digitally
photographed.
Bruising II
• To document the bruises of elders who
have been physically abused and compare
them with ‘normal’ bruising
• Worked in partnership with Adult
Protective Services to gain access to
physical abuse cases
Bruising Associated
With Physical Elder Abuse
• Subjects: 67 older adult APS clients seen
within 30 days of a physical abuse incident
• Compared with 101 older adults from the
earlier accidental bruising study
Findings
• (At least) 72% of physically abused older
adults had bruises
• Of 155 bruises found, they reported that
(at least) 89 were inflicted, 26 accidental
and 40 unknown
Findings & Clinical Significance

Inflicted bruises are larger.
 Be suspicious if >5 cm.

Abused elders are more likely to have
bruises on head, neck, lateral right arm.
 Pay attention to the location.

People who were abused are more likely
to remember the cause of the bruise.
 Ask.
Caregiver Research Study
• Can we predict who is at risk?
• Interviewed 140 dyads at home
• Incidence of abuse by caregiver
– Psychological 42%
– Physical 9%
– Neglect 17%
– Any 47%
Care Recipient Characteristics
•
•
•
•
Dependent
Dementia
Physically aggressive
Verbally abusive
Caregiver Characteristics
• Mental Illness
• Substance Abuse
• Perceived stress
Physical Abuse Predictors
• Caregiver Characteristics:
– Depressive symptoms
– Felt they had a poor emotional status and had role
limitations in activities and/or work as a result of
caregiving role
• Patient Characteristics:
– Physical assault toward caregiver
– Psychological aggression toward caregiver
Predictors statistically significant at p < .05
High Risk Caregiving Situations
• People with inadequately treated mental
health and/or substance abuse problems
are more likely to be abusive
• People who feel stressed/burdened are
more likely to be abusive
• Providing care for an older adult who is
physically combative and/or verbally
abusive
Medical Education
Medical Education: Students
• MS IIIs: one week geriatrics (required)
• at APS headquarters to learn about calls,
triage
• half day at the EAFC
– Video
– Meet with gerontologist coordinator
– Attend IDT meeting
– Debrief after meeting
Medical Education: PGs
• Geriatrics rotation (required) for all FM and
IM residents
• half-day with APS in the field
• half day at the EAFC
– Video
– Meet with gerontologist coordinator
– Attend IDT meeting
– Debrief after meeting
Medical Education: electives
• Medical students
• Residents
• Fellows
• Opportunities for combined elective in
family violence being explored
The Importance of Good Science
• To understand the issues and generate
appropriate hypotheses
• To study outcomes
• To evaluate effectiveness of interventions
• To avoid costly, albeit well-intentioned,
mistakes
• To understand consequences of elder
abuse
Sherrie’s Mom
To promote aging with joy
and eliminate aging in fear
www.centeronelderabuse.org