Elder Abuse

Question 1

What is elder abuse according to MT law? Who does this apply to?

Answer 1

• the infliction of physical or mental injury or the deprivation of food, shelter, clothing, or services necessary to maintain the physical or mental health of an older person or persons w/ developmental disability w/ lawful authority
• applies to senior citizens (60 and older), and vulnerable adults (person 60 or over or person who is 18 and older with a disability) who are being abused, neglected or exploited

Question 2

Who are the usual victims? Who are the usual perps?

Answer 2

• victims: women are 35% more likely to be abused than men
• perps:
  33% of alleged perps are adult kids, 22% are other family members, and 11% spouses/partners, 16% are strangers, close to 90% are known by victims

Question 3

RFs for being a victim?

Answer 3

• age
• social isolation
• extreme dependence and frailty
• severe mental and/or physical illness
• female gender
• low to modest financial resources

Question 4

What are barriers to reporting abuse?

Answer 4

• fear
• protecting the abuser
• social isolation
• self-blame/denial
• inability to report:
  mental impairments, physical impairments

Question 5

What are red flags in senior citizens that point to abuse?

Answer 5

• personality changes
• sudden physical changes in appearance and abilities
• they seem nervous or afraid
• confusion about transactions or withdrawals
• unable to remember signing documents
• property is transferred or missing
• level of care they are receiving is inconsistent w/ their resources
• signs of substance abuse

Question 6

Who are the alleged perps?

Answer 6

• tend to be opportunists
• tend to be predators
• may believe they are entitled to take victim’s assets
• perps generally fall into 2 categories:
  persons unknown to victim
  persons known to victim

Question 7

Common crimes against the elderly?

Answer 7

• sweepstakes/lottery scans: must may taxes/fees up front to collect winnings, canadian lottery
• confidence crimes: uses deception to gain another’s confidence - annuity scams, charity scans, home repair scams, telemarketing scams
• identity theft
• sweetheart swindles and fortune telling schemes: uses loneliness and perception that something is missing in victim’s life to exploit
• predatory lending: unscrupulous and aggressive lending practices that take advantage of vulnerable borrowers

Question 8

What are sample questions to ask if you are suspicious of abuse?

Answer 8

• do you feel safe at home?
• follow up with “because there is help available for my pts who are being abused, I now ask everyone about the possibility if it is occurring?
• other ?s”
  are you afraid of anyone?
  Are you made to stay in your room or left alone often?

Question 9

Define physical abuse? Usual perps?

Answer 9

• physical force that results in bodily injury, pain or impairment. It includes assault, battery, and inappropriate restraint
• behavioral: delay b/t onset of injury and seeking emdical care
• victims taken to different medical facilities for tx
• explanations for injuries differ
• perps: family, kids, spouse, intimate partners trying to gain control over victim

Question 10

What is domestic violence? Perps? Indicators?

Answer 10

• escalating pattern of violence or intimidation by an intimate partner, which is used to gain power and control - domestic violence grown old, late onset domestic violence
• perps: spouse or partners
• indicators: intense confusion and disassociation
• questions to ask: does anyone threaten to hurt or abuse you?

Question 11

What is sexual abuse? Perps, indicators, questions to ask?

Answer 11

• non-consensual sexual contact of any kind w/ an older person
• perps: caregivers, family members, facility residents
• indicators: fear of being touched, strange bruising, unexplained STD
• questions to ask: does anyone force you to have sex or make you do things related to sex that make you feel uncomfortable?

Question 12

What is neglect? self neglect?

Answer 12

• failure to fulfill a person’s obligatios or duties to an elder. Can be willful/intentional such as withholding food/medicine or unintentional (Caregiver burnout)
• self neglect: failure by oneself to provide goods or services to avoid serious threat to physical or mental health

Question 13

Perps, indicators of neglect?

Answer 13

• perps: family members, caregivers, acquaintances
• indicators: physical - unclean
• question to ask: tell me about your hygiene schedule?

Question 14

Indicators, questions to ask for self neglect?

Answer 14

• indicators: isolated, no family contact, wt loss
• questions:
  who does the shopping or prepares your meals?
  Do you get out often w/ family or friends?

Question 15

Why do people hoard?

Answer 15

• extreme emotional attachment
• difficulty w/ decision making
• perfectionism
• responsibility
• fear of making a mistake

Question 16

What is hoarding?

Answer 16

• condition of the home may prevent repairs from taking place
• possible loss of heat, running water, electricity, and refrigeration
• social service agencies not being able to provide services
• greater risk for falls
• medical emergency teams unable to gain access to home

Question 17

What is psychological/verbal abuse? Perps, indicators, ?s?

Answer 17

• infliciton of mental or emotional anguish by threat, humiliation or other verbal or nonverbal conduct
• perpetrators: family, caregivers
• indicators: wt loss, no eye contact when asking ?s’
• questions: are you afraid of anyone?

Question 18

What is financial exploitation? Perps, indicators, ?s?

Answer 18

• illegal or improper use of an older persons funds, property or resources
• perps: family members, scammers
• indicators: concerned about costs
• questions: who handles your checkbook?

Question 19

What is decisional capacity?

Answer 19

• ability to adequately process info in order to make a decision based on that info

Question 20

Factors that may affect mental capacity?

Answer 20

• Illness (UTI) or disease
• tx factors:
  poor nutrition/malnutrition
  dehydration
  depression
  med interactions
  sleep deprivation
• time of day

Question 21

What is an undue influence and how does it work?

Answer 21

• persuasion, pressure, or influence short of actual force, but stronger than mere advice, that so overpowers that dominated party’s free will or judgement that he or she cannot act intelligently and voluntarily, but acts instead subject to the will or purposes of the dominating party
  How it works:
• victim and exploiter are often in an ongoing relationship
• exploiters may target and groom their victims
• exploiters are generally subtle in their exploitation of their victims
• they are often charming manipulators
• exploiters justify their actions through various excuses
• victims often appear as willing paricipants

Question 22

What is consent? what are legal elements of consent?

Answer 22

• it is when someone accepts or agress to something that somebody else proposes. For consent to be legal and proper - the person consenting needs to have sufficient mental capacity to understand the implications and ramifications of his or her actions
• legal elements:
  mental capacity
  knowledge of true nature of act/transaction
  act freely and voluntarily

Question 23

Why is dementia and alzheimers a RF for exploitation?

Answer 23

b/c:
unable to report
may not be believed
may not be able to recognize financial exploitation

Question 24

What is polyvictimization?

Answer 24

• exposure to multiple types of violence or victimization (if there is 1 abuse going on - likely at least 1 more also occurring)

Question 25

What is guardianship?

Answer 25

• legal process, utilized when a person can no longer make or communicate self or sound decisions about his/her person and/or property or has become suscpetible to fraud or undue influence. Because est. a guardianship may remove considerable rights from an individual, it should only be considered after alt. to guardianship have proven ineffective or are unavailable

Question 26

Reporting guidelines for adult protective services?

Answer 26

• authorized and budgeted through the state (6 regions around the state)
• reporting guidelines:
  abuse doesn’t need to be confirmed
  provide as much detail as possible
  reports are confidental and reporter not disclosed to victim, family or abuser

Question 27

What happens once you make referral to adult protective services?

Answer 27

• conduct investigation
• solicit victim cooperation
• conduct interviews
• fxnl and cognitive assessmnets
• releases of informaton
• review records
• compile evidence
• discuss/coordinate services
• refer to law enforcement (if needed)

Question 28

Other reporting agents other than Adult protective services?

Answer 28

• law enforcement: when appropriate or in case of emergency, get specific info such as names, dates, and times
  tell whay you saw or heard, give as much detail of situation as you can
• long term care ombudsman: nursing home