Elder Abuse: Health Implications
XinQi Dong, MD MPH
Director, Chinese Health, Aging and Policy Program
Associate Director, Rush Institute for Healthy Aging
Associate Professor of Medicine, Nursing and Behavior Sciences
Rush University Medical Center, Chicago, IL
&
Senior Policy and Research Advisor
Administration on Community Living
Department of Health and Human Services
Aristotle:384-322: BC
“Old people are pessimistic, distrustful, malicious, suspicious,
small minded, lacking in generosity, and cowardly.”
Physician <====> Patient
Historical Development – Patriarchal Roots
• Doctrine of Covertures- women loses separate legal identify once married
• Husbands both obligated and permitted to “chastise” wife and children to maintain discipline
• “a husband is responsible for the acts of his wife, and he is required to govern his household, and for that purpose, the law permits him to use towards his wife such a degree of force, as is necessary to control on unruly temper, and make her behave herself”
State vs. Black, 60 N.C. 262 (1864)
Burston GR. BMJ 1975:iii
Epidemiology
• 2-5 Million Cases/yr in the US
• Prevalence 3 - 25% : Incidence 3 – 15%
• 1 out of 14 Cases are Elder Abuse Reported
• 1 out of 25 Cases of Financial Exploitation Reported
• Utah 2009: 52 Million Lost
• Nationally: 2.9 Billion Lost Per Year
Pillimer, Gerontologist 1995, NCEA, 2005, Podeniek, JEAN 2008, Dong, JEAN 2009, Acierno, AJPH 2010, Lauman, JGSS 2009, Lachs, NYC
report 2011, MedLife Report 2011, Utah State Report 2010, Mosqueda & Dong, JAMA 2011, Beach, Gerontologist 2010
Dementia Course
Mini Mental State Examination
Risk Factors:
• Functional Impairment
• Cognitive Impairment
• Psychological Distress
• Personality Traits
• Psychiatric Disorder
• Social Wellbeing
• Medical Comorbidities
Tatara, NCEA 1990; Cooper, Int J Geri Psych 2007; Mouton, AJPH 2004(94), Wolf, NCPEA 1997; Paveza, Gerontologist 1992(32),
Lachs, JAGS 1994 (42); Dyer, JAGS 2000(48); Compton, Int J Geri Psych 1997 (12); Laumann, JGSC 2008(63); Bristowe, JEAN
1989(1), Homer, BMJ 1990(301), Fulmer, J Em Nursing 2000(26)
Consequences: • Premature Death
• Death Due to Heart Disease
• Nursing Home Placement
• Emergency Room
• Hospitalization
• Hospice Use
• Quality of Life
• Worsening Health Conditions
• Guardianship
Dong et al, JAMA 2009
Dong & Simon JAMA 2011
Dong et al, Jr Am Emerg Med 2011
Dong et al, JAGS 2011
Mosqueda & Dong, JAMA 2011
Dong et al, JGMS 2011
Dong, Clinics Geriatric Med, 2005
Dong et al Gerontology 2010
Halliday et al, Lancet 2000
Begal et al, Jr Interper Vio 2011
Schonfield Gerontologist 2006
Smith et al, Jr Nutrition 2006
Lach et al, JAMA 1998
Lach et al, Gerontologist 2002
Shield et al, Jr Forensic Sci 2004
Franzini et al, JAGS 2008
Baker et al. Jr Geri Soc Work 2009
Mouton et al, Ann Fam Med 2010
Pillemar, Gerontologist 1998
Screening for Elder Abuse:
• Are you afraid of anyone in your family?
• Has anyone close to you tried to hurt or harm you recently?
• Does someone in your family make you stay in bed or tell you that you are sick when you know you are not?
• Has anyone close to you called you names or put you down or made you feel bad recently?
• Has anyone forced you to do things you didn’t want to do?
• Has anyone taken things that belong to you without your Ok?
Research barriers
– Diversity
Traditional
開 圖 樂 學 Simplified
开 图 乐 学 Open Picture Happy Learn
Cantonese
Néih Hóu
Dōjeh Deui m̀h jyuh M̀h'gōi.
Mandarin
Nǐ Hǎo Xiè Xiè Duì Bu Qǐ Bú kèqì.
How are you?
Thank you.
Sorry. You’re welcome.
Chinese Exclusion Act 1882 – US Apology 2011
Advocacy:
Maslow’s Hierarchy of Needs
“For years, I suffered silently, unable to muster the courage to seek the help I knew I needed….I felt
trapped, scared, used and frustrated. And above all, when a man feels helpless, it's terrible. And I was
helpless.”
Mr. Mickey Rooney, Elder Abuse Victim
