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Elder Abuse Elder Abuse
Elder AbuseElder Abuse
What Is Elder/Dependent Adult What Is Elder/Dependent Adult Abuse?Abuse?
Definitions VaryDefinitions Vary
Most often defined as Most often defined as an action by a person in an action by a person in a position of trust a position of trust which causes harm to which causes harm to an elderly person or an elderly person or dependent adultdependent adult
Target PopulationTarget Population
ElderElder: Any adult : Any adult age 65 and olderage 65 and older
Dependent AdultDependent Adult: : Any adult age 18-Any adult age 18-64 with physical or 64 with physical or mental impairments mental impairments that restrict ability that restrict ability to carry out normal to carry out normal activities or to activities or to protect their own protect their own rightsrights
Domestic Abuse vs. Institutional AbuseDomestic Abuse vs. Institutional Abuse
Domestic AbuseDomestic Abuse– occurs in the occurs in the homehome
– perpetrator has a special perpetrator has a special relationship with the elderrelationship with the elder
Institutional AbuseInstitutional Abuse– occurs in occurs in SNF, B&CSNF, B&C
– perpetrator has legal or perpetrator has legal or contractual obligation to contractual obligation to provide care.provide care.
Campaign Against Elder AbuseCampaign Against Elder Abuse
TimelineTimeline– Began in Began in 19651965 with enactment of Older with enactment of Older
Americans Act (OAA) of 1965, advocated the Americans Act (OAA) of 1965, advocated the rights of elderly population and provide funding rights of elderly population and provide funding for abuse prevention programsfor abuse prevention programs
– 19731973 established the Area Agency on Aging established the Area Agency on Aging (AOA)(AOA)
– 19861986 Institute of Medicine published Institute of Medicine published recommendations for preventing elder recommendations for preventing elder mistreatmentmistreatment
Campaign Against Elder AbuseCampaign Against Elder Abuse
TimelineTimeline– 19901990 elder abuse task force formed by the elder abuse task force formed by the
Secretary of the US Department of Health and Secretary of the US Department of Health and Human Services (DHHS)Human Services (DHHS)
– 1991 1991 National Institute on Elder Abuse (NIEA) National Institute on Elder Abuse (NIEA) was created to organize the campaign and was created to organize the campaign and provide a headquartersprovide a headquarters
– 19961996 National Center on Elder Abuse (NCEA) National Center on Elder Abuse (NCEA) funded to research the incidence of funded to research the incidence of domesticdomestic elder abuse in the USelder abuse in the US
Types of AbuseTypes of Abuse
Physical abuse/sexual abusePhysical abuse/sexual abuse Financial abuseFinancial abuse Psychological abuse Psychological abuse (not mandated to report)(not mandated to report)
NeglectNeglect Self-neglectSelf-neglect AbandonmentAbandonment IsolationIsolation
Definition of AbuseDefinition of Abuse
Physical abusePhysical abuse– assault, battery, or assault, battery, or
force likely to force likely to produce injuryproduce injury
– sexual assaultsexual assault– prolonged or prolonged or
continual continual deprivation of food deprivation of food or wateror water
– punitive/inappropri-punitive/inappropri-ate physical or ate physical or chemical restraint-chemical restraint-
Financial abuseFinancial abuse
– Taking, hiding, or Taking, hiding, or misappropriating of misappropriating of elder’s money or elder’s money or property for property for personal use or gain personal use or gain in violation of the in violation of the elder’s trustelder’s trust
Definition of AbuseDefinition of Abuse
Psychological abusePsychological abuse
– subjecting an elder to subjecting an elder to serious emotional serious emotional distress through threats, distress through threats, harassment, or other harassment, or other forms of intimidating forms of intimidating behaviorbehavior
NeglectNeglect
– failure of caregiver to failure of caregiver to exercise a reasonable exercise a reasonable degree of care e.g., failure degree of care e.g., failure to:to:
help provide food, help provide food, clothing, shelter, clothing, shelter, personal hygienepersonal hygiene
help elder obtain needed help elder obtain needed medical caremedical care
protect from health and protect from health and
safetysafety hazardshazards prevent malnutritionprevent malnutrition
Definition of AbuseDefinition of Abuse
Self-NeglectSelf-Neglect
– the inability of an the inability of an individual to individual to perform essential perform essential self-care tasks, self-care tasks, resulting in a great resulting in a great risk to his/her risk to his/her health or safetyhealth or safety
AbandonmentAbandonment
– The desertion or willful The desertion or willful forsaking of an elder by forsaking of an elder by anyone having the care anyone having the care or custody of that person or custody of that person under circumstances under circumstances under which a reasonable under which a reasonable person would continue to person would continue to provide careprovide care
Definition of AbuseDefinition of Abuse
IsolationIsolation
– Violation of personal Violation of personal rights, such as rights, such as
false imprisonment or false imprisonment or restraintrestraint
preventing delivery of preventing delivery of mail, telephone calls, mail, telephone calls, visiting, etc.visiting, etc.
REMINDERREMINDER Mandated to ReportMandated to Report
– Welfare Institutions CodeWelfare Institutions Code
– Penal Code 368Penal Code 368 failure to report is a failure to report is a
misdemeanor punishable bymisdemeanor punishable by 6 months6 months in jail and/or in jail and/or
$1000$1000 fine fine 12 months12 months in jail and/or in jail and/or
$5000$5000 fine if abuse results fine if abuse results in death or severe bodily in death or severe bodily harmharm
Types of AbuseTypes of Abuse
NeglectNeglect PhysicalPhysical FinancialFinancial EmotionalEmotional SexualSexual OtherOther
0% 8%
14%
12%
56%
10%
Sexual Emotional
Physical Financial
Neglect Other
Ages of Elder Abuse VictimsAges of Elder Abuse Victims
0102030405060708090
100
60-64 65-69 70-74 75-79 80 or older
Neglect Emotional Physical Financial Abandonment
Ethnicity of Elder Abuse VictimsEthnicity of Elder Abuse Victims
0
20
40
60
80
100
Black White Hispanic Other
Neglect Emotional Physical Financial Abandonment
Ability to Care For Self PhysicallyAbility to Care For Self Physically
48%
29%
23%0%
Not able to care for self Somewhat ableAble Don’'t know
Mental Status of the VictimsMental Status of the Victims
38%
28%
32%
2%
Not confused Sometimes confused
Very confused Don’t know
Perpetrators of Elder AbusePerpetrators of Elder Abuse
47%
6%19%
9%
9%6% 3% 1%
Child Sibling Spouse
Grandchild Other relative Friend
In-home service Other
Who Are the Victims?Who Are the Victims?
Advanced ageAdvanced age– elders 80 and above are abused elders 80 and above are abused
and neglected 2-3 times moreand neglected 2-3 times more
FemaleFemale– abused at a higher rate than abused at a higher rate than
malesmales
Physical and/or mental Physical and/or mental impairmentsimpairments– almost 1/2 substantiated abuse almost 1/2 substantiated abuse
cases elders were physically cases elders were physically unable to care for themselvesunable to care for themselves
IsolatedIsolated
Who Are the Abusers?Who Are the Abusers?
SAVEDSAVED– StressStress– AlcoholismAlcoholism– Violence historyViolence history– Emotional Emotional
disturbancedisturbance– Dependency (e.g. Dependency (e.g.
financial)financial)
Age of Perpetrators of Elder Abuse, The Age of Perpetrators of Elder Abuse, The “Sandwich Generation”“Sandwich Generation”
27%
39%
8%
12%
14%
40 or < 41 - 59 60 - 69 70 - 79 80 or >
How Can We Uncover Elder How Can We Uncover Elder Abuse?Abuse?
Screening Screening
History and Physical History and Physical ExaminationExamination
AssessmentAssessment
InterventionIntervention
Screening QuestionsScreening Questions
Has anyone at home ever hurt your? Or Has anyone at home ever hurt your? Or touched you without your consent?touched you without your consent?
Has anyone made you do things you didn’t Has anyone made you do things you didn’t want to do? Taken anything that was yours want to do? Taken anything that was yours without asking?without asking?
Has anyone ever scolded or threatened you?Has anyone ever scolded or threatened you? Have you ever signed any documents that Have you ever signed any documents that
you didn’t understand?you didn’t understand?
Screening QuestionsScreening Questions
Are you afraid of anyone at home?Are you afraid of anyone at home? Are you alone a lot?Are you alone a lot? Has anyone ever failed to help you take care Has anyone ever failed to help you take care
of yourself when you needed help?of yourself when you needed help?
First line of First line of entryentry
May be only May be only close contactclose contact
The History and Physical The History and Physical ExaminationExamination
Physical ExaminationPhysical Examination
Diagnostic Physical FindingsDiagnostic Physical Findings– features of features of physical abusephysical abuse
multiple injuries in various stages of multiple injuries in various stages of evolutionevolution
injuries without explanation or injuries without explanation or implausible explanationimplausible explanation
– Most commonMost common• bruises, lacerations, abrasions, head bruises, lacerations, abrasions, head
injuries, fracturesinjuries, fractures– Less commonLess common
• burns, sprainsburns, sprains
Physical ExaminationPhysical Examination
Diagnostic Physical FindingsDiagnostic Physical Findings– features of features of neglectneglect
the elder displaysthe elder displays gross inattention togross inattention to nutritionnutrition hygienehygiene established medical needs andestablished medical needs and
– has a caregiverhas a caregiver
Physical ExaminationPhysical Examination
Suggestive clinical presentationsSuggestive clinical presentations– Lacerations healing by second intentionLacerations healing by second intention– Healed but misaligned fracturesHealed but misaligned fractures– Severe malnutrition/dehydrationSevere malnutrition/dehydration– Disparity in histories between the patient Disparity in histories between the patient
and caregiverand caregiver– Implausible or vague explanationsImplausible or vague explanations– Frequent ER visitsFrequent ER visits
DocumentationDocumentation
Urgency of Adult Protective Services (APS) Urgency of Adult Protective Services (APS) InvestigationInvestigation– likelihood of imminent harmlikelihood of imminent harm
Description of suspected mistreatmentDescription of suspected mistreatment– medical or psychiatric consequencesmedical or psychiatric consequences
– other pertinent medial/psychosocial problemsother pertinent medial/psychosocial problems
Legible/no alterationsLegible/no alterations Pertinent positives Pertinent positives andand negative findings negative findings Report facts objectivelyReport facts objectively Use patient’s own wordsUse patient’s own words
DocumentationDocumentation
Source of informationSource of information– family memberfamily member– caregivercaregiver– collateral contactcollateral contact
Dates, names and timesDates, names and times Draw what you see (body diagram)Draw what you see (body diagram)
– characteristics of injuriescharacteristics of injuries size, shape, location, color changes, swelling, size, shape, location, color changes, swelling,
tendernesstenderness
DocumentationDocumentation
Note:Note:– abrasionsabrasions
– bite marksbite marks
– bruisesbruises
– burnsburns
– hematomashematomas
– puncturespunctures
– scratchesscratches
DocumentationDocumentation
Dating BruisesDating Bruises
– swollen, tenderswollen, tender 0-2 days0-2 days
– redred--blueblue 0-5 days0-5 days
– greengreen 5-7 days5-7 days
– yellowyellow 7-10 days7-10 days
– brownbrown 10-14 days10-14 days
PhotodocumentationPhotodocumentation
– use good camerause good camera
– far away and closefar away and close
– include faceinclude face
– identifier (name plate)identifier (name plate)
Assessment & InterventionAssessment & Intervention
Level of safetyLevel of safety Cognitive statusCognitive status
– MMSEMMSE
Emotional statusEmotional status– Geriatric Depression Scale Geriatric Depression Scale
(GDS)(GDS)
Health & functional statusHealth & functional status– ADL’s and IADL’sADL’s and IADL’s
Social and financial resourcesSocial and financial resources Frequency, severity andFrequency, severity and intentintent
Implement safety planImplement safety plan– safe home, protective safe home, protective
order, hospital admissionorder, hospital admission Provide assistanceProvide assistance
– rehab programs, respite rehab programs, respite care, home health care, home health homemaker services, homemaker services, referralsreferrals
Educate victim and Educate victim and familyfamily– frequency and severity frequency and severity
over timeover time
How Do We Stop Elder Abuse?How Do We Stop Elder Abuse?
REPORTREPORT REPORTREPORT REPORTREPORT
– Domestic AbuseDomestic Abuse Adult Protective Serv.Adult Protective Serv. 877 4-R-Seniors877 4-R-Seniors
– Institutional AbuseInstitutional Abuse Local OmbudsmanLocal Ombudsman, a , a
patient advocate for patient advocate for those in nursing those in nursing homes and assisted homes and assisted living facilitiesliving facilities
ADULT PROTECTIVE SERVICES (APS)
Program dedicated to prevent and remedy abuse, neglect or exploitation of elder and dependent adults
Maintain individual safety in their environment and strengthen their own capacity for self-maintenance
Provide provision of services or linkage to community based organizations
ADULT PROTECTIVE SERVICES (APS)
• Report of alleged abuse/neglect received
• Performs investigation within 10 days
• Abuse/Neglect is either:
• confirmed• inconclusive or• unfounded
