Elder Mistreatment

1. Elder Mistreatment “Current issues related to elder abuse and abusers in the United States of America” ___________________ Presented by Dr. Maria J. Park, Professor of Nursing at Kkotongnae Hyundo University On October 13th, 2008

2. Elder Mistreatment • This presentation includes discussion of: • National Incidence and Prevalence of Elder Abuse in the U.S.A. • Institutions and Agencies that are responsible for handling Elder Abuse and Abusers in the U.S.A. • Theories, etiology, types of abuse, signs & symptoms of abuse and neglect. • Best Tools: the Elder Assessment Instrument (EAI) • Mandatory report: Who is responsible, the process, and what need to be included in the report.

3. Elder Mistreatment • National Incidence and Prevalence of Elder Abuse in the U.S.A.

4. Categories of Elder Abuse • Where does elder abuse take place? And by whom? • Domestic setting. • Institutional setting–similar types of abuse as domestic, plus, polypharmacy problems • Self-neglect– neglect by dose who are mentally competent but engage in behaviors that threaten their own safety.

5. Types of Abuses and Definitions • The Panel to Review Risk & Prevalence of Elder Abuse /Neglect (’02) has defined the following: • Physical abuse • Psychological/Emotional abuse • Sexual abuse • Financial exploitation • Caregiver neglect • Self-neglect • Abandonment • Institutional mistreatment

6. According to the NEAIS report: • More than 1.5 million older adults experience abuse/neglect in domestic setting. • Half of the cases were neglect • 35% were psychological abuse • 30% were financial exploitation • 25% were physical abuse

7. Theories of the Etiology of Elder Abuse • Psychopathology of the abuser–Care givers who have preexisting conditions. • Transgenerational violence –Part of the family violence continuum • Situational theory-Caregiver stress, burden • Isolation theory–Abuse is prompted by a dwindling social network

8. Ten(10) Risk Factors associated with the Elder Abuse • 1. Gender: Men–victim of physicalviolence. Women –more neglected. • 2. Age:75 and older are more likely abused. • 3. Dependent elder/Caregiver burden • 4. Alcohol Abuse in the family • 5. Hx of family violence–cycle may continue • 6. Isolated elder–seldom noticed by others

9. Ten Risk Factors: cont. • 7. Physical/mental Impairment • 8. Provocative Behavior • 9. Living with family/Relatives • 10. Cognitive impairments.

10. Ten(10) Risk Factors Associated with Abusive Caregivers: • 1. Alcohol / drug abuse. 2. Mentally ill unstable • 3. Unemployed. 4. Hx. Of Child abuse • 5. Excess stress. 6. Lack of supportive network • 7. Duration of care-giving • 8. Dependence on the elder • 9. Reluctance or inexperience • 10. Hx of violence outside the family – criminal

11. Signs and Symptoms of Elder Abuse • General considerations • Assessment of signs and symptoms of elder abuse: Warning signs of specific types of elder abuse. • Best Tools: • The Elder Assessment Instrument (EAI)

12. The Elder Assessment Instrument • The Best Tools: The Elder Assessment Instrument (EAI). 41-item, 7 sections that reviews SS and subjective complaints of abuse/neglect, exploitation, & abandonment. • No “score”. A victim should be referred to appropriate social services if the following exists: • Next slide

13. Base on EAI findings • Report to social services: • If there is any evidence of mistreatment without sufficient clinical explanation. • Whenever there is a subjective complaint by the elder of mistreatment. • Whenever the clinician believes there is high risk or probable abuse, neglect, exploitation, or abandonment.

14. Elder Assessment Instrument: EAI • 1. General assessment: 4 items • 2. Possible physical abuse indicators: 6 • 3. Possible neglect indicators: 13 items • 4. Possible exploitation indicators: 5 • 5. Possible abandonment indicators: 3 • 6. Summary: event of abuse, neglect, exploitation, abandonment, additional comments: • 7. Comments and follow-up

15. Assessment of the Victim • Physical appearance and behavior • Physical condition: Malnutrition? Bruises? Laceration?Scars? Burned marks?Fractures Hematomas? Sign of internal injuries? • Emotional and Mental:, Level of anxiety • usual defense mech. Sign of depression (sense of hopelessness, low self-esteem), cognitive /sensory functions • Assess risk for further abuse/neglect.

16. Reporting Elder Abuse • How to report suspected elder abuse: • Agencies associated with elder abuse care: • National Center on Elder Abuse(NCEA) • Area Agency on Aging (AoA) • Adult Protective Services (APS) • National Eldercare Locator (NEL)

17. Legal & Ethical Issues • Victim’s concerns about reporting. • Controversy re: mandatory reporting by • The neighbor • Healthcare providers

18. Emergency calls • 911 call • Paramedics, the emergency response crews • Home assessment for elder abuse/neglect • Emergency treatment: • Victim assessment: • – suspicion of abuse • –Preparing a report of findings ( documentation according to the hospital’s protocol),

19. Victim Interview: • Provide privacy - l:l is important • Communicate mater- of - factly • Non-threatening manner- general to specific • Question the victim direct to the point if abuse is suspected. • Reporting and Documentation of the finding • Pay extreme caution when confronted with suspected batterers.

20. Process of screening for elder abuse • If mistreatment suspected • Report to Adult Protective Services and/or other public agencies as mandated by your states. • If there is no immediate danger • Find out whether full, private assessment can be done now? If no, • Discuss safety issues. Schedule for full assessment, if possible, in appropriate –geriatric, assessment unit. • If there is a immediate danger, Create safety plan. Options include: hospital admissions, court protective order, safe home placement. • -Cont. to next slide

21. The Process. Cont. • If full, private assessment can be done now, let the responsible person initiate assessment: safety, access, cognitive status, emotional status, health and functional status, social and financial resources, frequency, severity, and intent • If there is reasons to believe that mistreatment has occurred, plan interventions • If no mistreatment found, dismiss the case

22. Intervention for Abused Elderly • Coordinate approach with Adult Protective Services as mandated in your state • If patient is willing to accept voluntary services: • 1) Educate patient about incidence of elder abuse and tendency for it to increase in frequency and severity over time. • 2) Implement safety plan e.g., safe home placement, court protective order, hospital admission. • 3) Provide assistance that will alleviate causes of mistreatment, e.g., refer to drug or alcohol rehab for addicted abusers. • 4) Provide education, home health, homemaker services for overburdened caregivers. Cont. next page

23. Intervention: cont. • 5) Referral of victim and/or family members to appropriate service, e.g., social work, counseling services, legal assistance and advocacy. • If victim is unwilling to accept voluntary services or lacks capacity to consent, • Person lacks capacity: • Discuss with Adult Protective Services the following options: • Financial management assistance, conservatorship, guardianship, committee, special court proceedings, e.g., orders of protection. • Cont. to next page

24. Intervention: cont. • If person has capacity, but unwilling to accept, ( Self neglect case) • Voluntary services: • Educate person about incidence of elder mistreatment and tendency for it to increase in frequency and severity over time. • Provide written emergency numbers and appropriate referrals • Develop a follow-up plan

25. Home Assessment for Elder Abuse/Neglect • Environmental Conditions: • Heating, lighting, furniture, cooking utensils • Food in the refrigerator ( old? Locked?) • Blocked stairways, doors. • Victim lying in urine, feces, or food • Unsanitary living cond. -pile of garbage. • Medical Attention / Medication.

26. Family Therapy • Family members are the primary caretakers • Abusers are usually the caretakers • Family therapy can assist with: • elderly person’s functional status • function of the family system. • Supportive services • family therapy for maladaptive behavior

27. References & Resources re: Elder Mistreatment • National Center on Elder Abuse (NCEA)www.elderaabusecenter.org • Area Agency on Aging (AoA)–Check local directory. • Statewide Agencies include: • The eldercare locator – Sponsored by AoA • The Adult Protective Service (APS): • The Division of Aging (DOA) • The Dept of Aging • The Dept of Social Services

28. Resources: cont • Elder abuse and neglect. Archives of Family Medicine, 2(4).371-388. • National Center on Elder Abuse at the American Public Human Services Association ( formerly the American Public Welfare Association) in collaboration with Westat (1998). The National Elder Abuse Incidence Study: final report: September 1998. Washington, DC: Natl Aging Information Center. • Omnibus Budget Reconciliation Act (1987). Public Law 100-203. Subtitle C: Nursing home reform. Washington, DC: U.S. Department of Health and Human Services:52 Fed. Reg. 38583.38584