Transcript No Slide Title

Multidisciplinary Research and Response
Kerry Burnight, PhD
Associate Professor, Geriatric Medicine
University of California, Irvine
CATEGORIES OF ELDER ABUSE
• Physical abuse
• Abandonment
• Sexual abuse
• Abduction
• Emotional abuse • Financial
exploitation
• Neglect
• Self-neglect
RISK FACTORS
FOR ELDER ABUSE
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Isolation of caregiver-elder dyad
History of abuse in either
Abuser dependent on elder
Mental illness in either
Substance abuse in either
Elder’s vulnerability and frailty
Caregiver’s perceived distress
In a nutshell
Elder abuse is:
– Present in all demographics
– increasing prevalence
– often unrecognized by clinicians
– most effectively addressed through
multidiciplinary collaboration.
Multidisciplinary Response
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MDTs
FAST
Medical Response Teams
County Coalition
Elder Abuse Forensic Center
Elder Death Review Team
Center of Excellence in Elder Abuse and Neglect
Collaboration Building
MDT
WIC 15753.5-"Multidisciplinary personnel team" means any
team of two or more persons who are trained in the
prevention, identification, and treatment of abuse of elderly or
dependent persons and who are qualified to provide a broad
range of services related to abuse of elderly or dependent
persons. The team may include, but is not limited to: (a)
Psychiatrists, psychologists, or other trained counseling
personnel. (b) Police officers or other law enforcement agents.
(c) Medical personnel with sufficient training to provide
health services. (d) Social workers with experience or training
in prevention of abuse of elderly or dependent persons.
WIC 15754 A
• Notwithstanding any provision of law governing the disclosure of
information and records, persons who are trained and qualified
to serve on multidisciplinary personnel teams may disclose to
one another information and records which are relevant to the
prevention, identification, or treatment of abuse of elderly or
dependent persons
• Mission:
Identify and promote legal remedies for elder abuse through
collaborative evaluation, consultation, education and
research.
• Participating agencies:
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UCI Program in Geriatrics - Long-Term Care Ombudsman
– Older Adult Mental Health Services
Adult Protective Services
Law enforcement agencies ﹣ Human Options DV Services
District Attorney
Victim Assistance Program
Multidisciplinary Research
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Evaluation
Forensic Markers
Mistreatment of People with Dementia
Detecting Abuse and Neglect
Emotional Memory
Theoretical Modeling
Evaluation
• Medical Response Team
• Elder Abuse Forensic Center
Forensic Markers: Bruising
• Completed study: Bruising in the Geriatric
Population
• Ongoing study: Bruising as a Forensic Marker
of Physical Elder Abuse
Accidental vs. Inflicted Bruising
*Mosqueda, L., K. Burnight, et al. (2005).
J Am Geriatr Soc 53(8): 1339-43.
Accidental Bruising Study
• Objective: To determine common bruising
patterns in people over the age of 65 years,
including location, timing and sequence of color
changes, relationship to functional status, and
medications
• Funded by National Institutes of Justice
Forensic Markers
Location of Bruises
Finding: Nearly 90% of the
observed bruises were on
the extremities without a
single bruise on the neck,
ears, or genitals.
(108 bruises at Day 1)
Forensic Markers
Other Findings
• Only 20% of the subjects knew the
mechanism of injury.
• Those on medications (daily Prednisone, daily
ASA, Warfarin, Plavix)
– more likely to have multiple bruises
– not a significant correlation with duration of
bruises.
Forensic Markers
Bruising Associated with Physical Abuse
The research objectives:
1. Describe bruises associated with elder physical
abuse.
2. Compare bruises in older adults who have not
been abused with bruises inflicted on abused
elders.
Forensic Markers
Methodology
• Research nurse recruits APS clients reported
for physical abuse
• Skin examination & Interview
• LEAD* panel assesses presence of physical
abuse
• Preliminary findings: N=59, 50 with confirmed
physical abuse
*Longitudinal, Experts All Data
Forensic Markers
Forensic Markers: Pressure Ulcers
• Multisite study of bedsores occurring in nursing
homes under optimal conditions
• Comparable to accidental bruising study:
baseline for later study of bedsores associated
with neglect
• Data: Research Nurses examine pts. with stage
3&4 wounds; facility and pt. records.
• LEAD panel assesses Quality of Care
Funded by National Institutes of Justice
Mistreatment of People with Dementia
• Recently completed study: Abuse and Neglect of
People with Dementia by Caregivers
Funded by California Dept of Health Services
• New study: People with Dementia as Witnesses to
Emotional Events
Funded by National Institutes of Justice
Abuse and Neglect of People
with Dementia by Caregivers:
Characteristics of the Individuals and their Relationship
(potential “predictors”)
Care Recipient
Demographics
Caregiver
Demographics
Common
Living situation
recipeintCharacteristic
Alzheimer’s disease stage
Characteristics
Relationship
to CR
Characteristics
Outside
resource use
Depressive symptoms
s status
Functional
Medical status
Dementia-related Behaviors
Social network
Substance abuse
Conflict Behavior
Depressive symptoms
Anxiety (state)
Health status
Perceived burden
Social network
Substance abuse
Stress
Premorbid relationship
Duration of care giving
Findings: Caregiver characteristics
associated with psychological abuse
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Fewer years of education*
Living with the patient*
Longer duration of caregiving*
Caregiver perceived burden due to perceived
behaviors of the patient*
• Poor emotional status**
• Symptoms of depression*
• Anxiety**
*p<0.05
**p<0.01
Findings: Care Recipient characteristics
associated with psychological abuse
• Lower income*
• Physical assault behaviors***
• Psychological aggression behaviors****
*p<0.05
***p<0.005
****p<0.001
Detecting Elder Mistreatment
• Develop a survey with Experts, using the gold standard
for detecting DV and Child Abuse as the model
• Validate it in US elders (Caucasians & MexicanAmericans)
Funded by NIA and Archstone Foundation
Sample survey items:
In the past year, someone I know ….
(physical abuse)
• pinched or scratched me on purpose.
• used a knife or gun on me.
(psychological abuse)
• insulted or swore at me in anger.
• threatened to abandon me or put me in a nursing home.
(financial abuse)
• charged me for unnecessary work or work that was not
completed on my home.
• cashed my social security or pension check and kept the
money without my permission.
Laying the Foundation to Build a
Theoretical Model of Elder Abuse
Why does Elder Abuse and Neglect Occur?
 Ageism?
 Entitlement?
 Opportuism?
 Caregiver stress?
 Resentment?
 Power Differential?
 Lack of Empathy?
 Mutual Conflict?
 Learned Violence?
 Psychopathology?
Nothing so Practical as a Theoretical Model
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Caregiver Stress Model
Biomedical Model
Dydadic Discord Model
Power and Control Model
Ecological Model
Learned Violence
Our Collaborators
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The Elder Abuse Forensic Center
Orange County Adult Protective Services
Orange County Alzheimer’s Association
The Alzheimer’s Family Services Center
Orange County Senior Centers
UCI Institute for Brain Aging and Dementia
UCI Health Care Policy Research
UCI Physicians and Clinics
U Washington School of Nursing
U Wisconsin School of Medicine and Public Health
RESOURCES: NATIONAL
• AARP: www.aarp.org
• UCI Center of Excellence in Elder Abuse and Neglect:
www.centeronelderabuse.org
• Administration on Aging: www.aoa.gov
• National Center on Elder Abuse:
www.ncea.aoa.gov;
• American Bar Association Commission on Law
and Aging: www.abanet.org/aging
• American Society on Aging:
www/asaging.org; Generationsjournal.org
• Family Caregiver Alliance: www.caregiver.org
• Clearinghouse on Abuse and Neglect of the
Elderly: http://db.rdms.udel.edu:8080/CANE/
RESOURCES: NATIONAL
• Eldercare Locator: www.eldercare.org
• National Clearinghouse on Abuse in Later Life:
www.ncall.us
• National Committee for the Prevention of Elder Abuse:
www.preventelderabuse.org
• National Council on the Aging: www.ncoa.org
• Nursing Home Database:
www.medicare.gov/Nursing/Overview
RESOURCES: ORANGE COUNTY
• UCI Center of Excellence on Elder Abuse and Neglect
www.centeronelderabuse.org
• Adult Protective Services
800 451 5155
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714 834 3636
800 300 6222
800 510 2020
714 825 3087
Sheriff:
Long-Term Care Ombudsman
Office on Aging
Forensic Center Coordinator
Download form SOC 341 www.aging.ca.gov