Elder Abuse Flashcards
elder abuse is a lethal crime
o After adjustment for age, socio-demographic factors and co-morbidity, elder abuse victims had a 3X greater risk of dying compared to unabused seniors.
elder mistreatment definition
- intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other persion who stands in a trust relationship to the elder
- failure by a caregiver to satisfy the elder’s basic needs to protect the elder from harm
Most common types of elder abuse
- Neglect 27%
- Fiduciary 26%
- Physical 23%
- Psychological 21%
- Abandonment 2%
- Sexual assault 1%
Risk factors for elder mistreatment: victim and perpetrator
victim
- advanced age
- dependent for basic activities of daily living
- dementia
- combative behavior
perpetrator
- depression/mental illness
- alcohol or drug dependence
- financial dependence
dementing illness and abuse
-simply having a dementing illness places a person at increased risk for mistreatment, particularly if the person with dementia displays disruptive behavior
possible abuse indicators
- weight loss
- dehydration
- poor hygiene/elongated toenails
- depression
- inappropriate attire
- abrasions/lacerations
- hematomas
- traumatic alopecia
- bruises in unusual locations
- welts
- burns
- pressure ulcers
- rectal/vaginal bleeding
- signs of sexually transmitted diseases
people among the least likely to report suspected abuse to Adult Protective Services
health care professionals (particularly physicians)
factors suggestive of abuse
o Delay in seeking treatment
o Confusing or unlikely causes of injury
o A past history of suspicious incidents
recognizing elder abuse
o Physical Abuse o Financial Abuse o Neglect o Abandonment or Abduction o Self-Neglect o Sexual Assault o Domestic Violence in Late Life
physical abuse
o Suspicious Fractures
o Bruising: Location, Dating of Bruises, Pattern Bruising
o Strangulation
o Restraints and Elder Abuse
primary hallmarks of neglect
o Pressure Ulcers
o Malnutrition
o Dehydration
o Feces
secondary hallmarks of neglect
o Delay in Seeking Care
o Rx Noncompliance
o Failure to Keep Medical Appointments
o Restraints
malnutrition
o Physical findings: Temporal/Thenar Wasting, Weight Loss/ FTT
o Laboratory Documentation: Albumin, Prealbumin, Cholesterol
dehydration
o Clinical Findings: Poor Skin Turgor, Dry Mucous Membranes
o Laboratory Findings: BUN, Sodium
Pressure ulcers
o Risk Factor: Pressure, Friction, Moisture, Malnutrition
o Braden Scale
o Staging
o Treatment
Abandonment or abduction
o Abandonment: vulnerable elder left in an unsafe, unrealistic situation.
o Elder equivalent of latch-key kids
o Abduction: vulnerable elder removed from safe environment, with or without their consent.
financial abuse
o Greatest Transfer of Wealth Ever Seen is in the Next Decade: Rich vs poor, Old vs young
o Vulnerability Factors: Isolation, Loneliness, Financial Management Inexperience
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the health care provider’s role in cases of undue influence
o Substantiation of Cognitive Status: Mental Status Documentation, The Receptionist’s Role
o Substantiation of Vulnerability
o Inconsistencies and Foibles
o The Role of Romance
o Capacity Declarations
o Every note should contain notes on capacity
lessons for health care providers
Cognitive Assessment must Include Judgment
Victim Vulnerability
- Loneliness of Caring for a Partner with Dementia
- Belief that money will help guarantee a safe old age
- Hope that money will help heirs
- Romantic Involvement with Perpetrator
why are elders at risk for sexual assault
o Women Passive Historically o Physically Weak/Disabled o Lonely o Shame o Trusting o “This can never happen to me” o Thought Paranoid if Crime Reported
elder sexual assault: what we know
o Perpetrators often Male Caregivers
o Victims: Female, 70+, Suffer more severe genital trauma, Fail to report or seek medical care, Coded Disclosure
sexual abuse of dependent adults
o Only 3% Reported
o Prosecutions Difficult
o 86% of Women have been Sexually Assaulted
o 50% of these had been Sexually Assaulted > 10 Times
self-neglect
o Hoarding “The Diogenese Syndrome”: also known as senile squalor syndrome, is a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage or animals, and lack of shame. Sufferers may also display symptoms of catatonia.
o Self-Neglect and Depression
o Home Health and APS Home Visits
reporting elder abuse: 2 tracks
o Community: Adult Protective Services (APS)
o Institutional: Ombudsman
How to report elder abuse: the SOC 341
o Suspicion is Key
o Call Immediately
o FAX Written Report within 48 Hours
Forensic reporting of elder abuse
o OES 602 and how to find it:
o Key elements: Careful documentation of multiple forms of abuse, Cognitive and functional assessment, Body Diagrams, Documentation of underlying conditions, Establish pain and suffering
o Laboratory Evidence: Chemistry to document malnutrition and dehydration, Drug levels of prescribed/suspected drugs to assess caregiver’s excessive or failure to properly administer drugs
o Photodocumentation
elder abuse consultation
o Abuse Assessment: usually by SWS
o Geriatric Assessment: Functional Status, Cognitive Status. Environmental Evaluation, Housecalls, Capacity Assessment/Declarations
o Elder Abuse Reporting
o Capacity Assessments and Declarations
o Coordination with Aging and Adult Services: Adult Protective Services, In Home Supportive Services, Community Agencies
o Ombudsman
o Coordination with Law Enforcement: Police, Sheriff, Coroner, District Attorney
o Court Appearance as Expert
elder abuse consultation: post abuse care
Elder Abuse is a Repetitive Crime
- Coordination with Community Agencies
- Ongoing Surveillance
- Continuity of Care
Victim Care and Support
- Ongoing Social Observation
- Post-traumatic Stress Disorder Expertise
- Dementia and Depression Expertise
elder abuse teams
o Multidisciplinary Team
o Elder Death Review Team
o FAST Team: Family Assertive Support Team (for emotional/psychological health)
