Elder Abuse

Question 1

elder abuse is a lethal crime

Answer 1

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.

Question 2

elder mistreatment definition

Answer 2

• 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

Question 3

Most common types of elder abuse

Answer 3

• Neglect 27%
• Fiduciary 26%
• Physical 23%
• Psychological 21%
• Abandonment 2%
• Sexual assault 1%

Question 4

Risk factors for elder mistreatment: victim and perpetrator

Answer 4

victim

• advanced age
• dependent for basic activities of daily living
• dementia
• combative behavior

perpetrator

• depression/mental illness
• alcohol or drug dependence
• financial dependence

Question 5

dementing illness and abuse

Answer 5

-simply having a dementing illness places a person at increased risk for mistreatment, particularly if the person with dementia displays disruptive behavior

Question 6

possible abuse indicators

Answer 6

• 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

Question 7

people among the least likely to report suspected abuse to Adult Protective Services

Answer 7

health care professionals (particularly physicians)

Question 8

factors suggestive of abuse

Answer 8

o Delay in seeking treatment
o Confusing or unlikely causes of injury
o A past history of suspicious incidents

Question 9

recognizing elder abuse

Answer 9

o	Physical Abuse
o	Financial Abuse
o	Neglect
o	Abandonment or Abduction
o	Self-Neglect
o	Sexual Assault
o	Domestic Violence in Late Life

Question 10

physical abuse

Answer 10

o Suspicious Fractures
o Bruising: Location, Dating of Bruises, Pattern Bruising
o Strangulation
o Restraints and Elder Abuse

Question 11

primary hallmarks of neglect

Answer 11

o Pressure Ulcers
o Malnutrition
o Dehydration
o Feces

Question 12

secondary hallmarks of neglect

Answer 12

o Delay in Seeking Care
o Rx Noncompliance
o Failure to Keep Medical Appointments
o Restraints

Question 13

malnutrition

Answer 13

o Physical findings: Temporal/Thenar Wasting, Weight Loss/ FTT
o Laboratory Documentation: Albumin, Prealbumin, Cholesterol

Question 14

dehydration

Answer 14

o Clinical Findings: Poor Skin Turgor, Dry Mucous Membranes

o Laboratory Findings: BUN, Sodium

Question 15

Pressure ulcers

Answer 15

o Risk Factor: Pressure, Friction, Moisture, Malnutrition
o Braden Scale
o Staging
o Treatment

Question 16

Abandonment or abduction

Answer 16

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.

Question 17

financial abuse

Answer 17

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
KNOW THIS INFO!!!

Question 18

the health care provider’s role in cases of undue influence

Answer 18

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

Question 19

lessons for health care providers

Answer 19

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

Question 20

why are elders at risk for sexual assault

Answer 20

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

Question 21

elder sexual assault: what we know

Answer 21

o Perpetrators often Male Caregivers

o Victims: Female, 70+, Suffer more severe genital trauma, Fail to report or seek medical care, Coded Disclosure

Question 22

sexual abuse of dependent adults

Answer 22

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

Question 23

self-neglect

Answer 23

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

Question 24

reporting elder abuse: 2 tracks

Answer 24

o Community: Adult Protective Services (APS)

o Institutional: Ombudsman

Question 25

How to report elder abuse: the SOC 341

Answer 25

o Suspicion is Key
o Call Immediately
o FAX Written Report within 48 Hours

Question 26

Forensic reporting of elder abuse

Answer 26

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

Question 27

elder abuse consultation

Answer 27

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

Question 28

elder abuse consultation: post abuse care

Answer 28

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

Question 29

elder abuse teams

Answer 29

o Multidisciplinary Team
o Elder Death Review Team
o FAST Team: Family Assertive Support Team (for emotional/psychological health)