Elder Mistreatment

Question 1

Elder mistreatment is a complex syndrome including actions such as?

Answer 1

abuse, neglect, exploitation, and abandonment of an elder person

Question 2

elders mistreatment in all forms involves what?

Answer 2

trusting relationship between an older person and another individual in which the trust is violated in some way

Question 3

what are the 4 patterns of abuse

Answer 3

physical, psychological, financial, neglect

Question 4

What is the epidemiology of Elder Mistreatment

Answer 4

prevalence is in the 2-5%
Estimated that only 1 in 14 domestic abuse cases come to attention of authorities
Elder mistreatment crosses all ethnic and socioeconomic boundaries

Question 5

what are the 3 main theories of elder mistreatment

Answer 5

trans-generational violence- abuse is learned
dependence theory-stressed caregiver
Psychopathology of the abuse theory- Focus shifts from the victim to the abuser who may have mental health or substance abuse issues

Question 6

Elder mistreatment risk factors

Answer 6

Very old
Female
poor mental or physical health
cognitive impairment
poor social support
low income
Hx of violence

Question 7

who are the most common perpetrators in elder mistreatment

Answer 7

spouses and adult children are most common

Question 8

who is more likely to be an abuser to elders sons or daughters?

Answer 8

they are equally likely

Question 9

what are some other characteristics of abusers

Answer 9

dependent on victim for financial or living support
substance abuse
mental health conditions
advanced age and poor physical/mental health

Question 10

abuse in nursing homes

Answer 10

less common now due to increased scrutiny, laws and regulations
resident on resident abuse is more common
residents assaulting employees (dementia)

Question 11

What characteristics may predict abuse in the nursing home setting

Answer 11

quality of care increases with # of beds
non profit homes superior to for profit
increased nursing home costs=better care
nureses/aides with lower levels of education tend to be more abusive
younger staff= increased negative attitudes towards the elderly
nurses more empathetic than aides
staff with longer time working with elderly have more positive attitudes toward elderly

Question 12

elder mistreatment patient presentation

Answer 12

difficult clinical challenge
many chronic disease have clinical manifestation that mimc abuse (Fractures, depression, malnutrition)
provider must have heightened awareness

Question 13

Challenges with elder mistreatment

Answer 13

environment may be a challenge like a hurried ED encounter
caregiver may be present
listen to input from ancillary staff or home healthcare providers

Question 14

what the easy approach in trying to find elder mistreatment

Answer 14

ask patient do you feel safe in your home

Question 15

These behaviors from the caregiver should raise an index of suspicion

Answer 15

Loss of control or fears losing control
Presents a contradictory hx that does not explain injury
Project cause of injury onto a third party
Delay in bringing pt in for care
Over/underreact to seriousness of situation
Complain about other issues unrelated to the injury
Refuse consent for procedures or tx
Remove a pt from a facility

Question 16

what is the management for elderly mistreatment

Answer 16

First and foremost ensure safety for the victim!!
Call 9-1-1 if necessary
- Intervention is critical-Elder mistreatment victims are at a three fold risk of death or nursing home placement

Question 17

other resources to help with elder management

Answer 17

Adult daycare
Financial Manager
Legal Guardian
Meals on Wheels
Support Groups
Nursing Home Placement 
Home Health Care

Question 18

Intimate partner violence (IPV)

Answer 18

Intentional controlling behavior consisting of physical, sexual, or psychological assaults in the content of an intimate relationship

Question 19

intimate partner violence stats

Answer 19

silent epidemic
-Available data underscores the magnitude of the problem
-28% of couples reported violence at some point in their relationship
-4% of women reported severe violence
-Est that 4 million women are subjected to violence in US
500,000 require medical tx
does not discriminate
similar in homosexuals
as providers we do a poor job detecting IPV

Question 20

what may double risk of IPV

Answer 20

pregnancy

Question 21

IPV diagnosis

Answer 21

may present with direct or indirect S/S of abuse

thorough hx

Question 22

what are red flags for IPV

Answer 22

-delay in seeking care
-illogical explanation of injury
-black eyes are not caused by door knobs
-multiple somatic complaints- fatigue, HA, chest pain
-depression and anxiety
-1 out of 10 attempt suicide
-pregnancy
-substance abuse
-recent dx of HIV
FHx of IPV
-overbearing partner

Question 23

IPV physical exam findings

Answer 23

Inappropriate behavior- fright crying, no eye contact
Multiple injuries-more extensive than trauma from a true accident
Injuries tend to occur to the center of the body:
Head, neck, chest, Abdomen, breasts
Injury to upper arms from fending off attacks
Bruises, lacerations, burns, bites, and Fractures
Injuries at different stages of healing

Question 24

screening for IPV ask difficult questions the right way

Answer 24

What happens when you have a fight with your partner?
Do you feel safe at home?
Do you ever feel afraid of your partner
Does your partner ever abuse your children?
If answers are vague or evasive more direct questioning is needed
Be supportive and non judgmental

Question 25

what are the 5 basic task for IPV Tx?

Answer 25

-Validate the problem
Assess patient safety
Document clearly and completely
Provide information and appropriate referrals
Reporting requirements

Question 26

IPV pitfalls

Answer 26

Do not try to control the victim’s behavior-Terminating relationship
Do not recommend couples therapy
Do not use the word alleged-perceived as not believing victim
Do not ask what provoked the violence

Question 27

IPV barriers for providers

Answer 27

Lack of provider training
Lack of institutional support
Lack of time
Provider discomfort

Question 28

IPV barriers for patients

Answer 28

fear
economic
psychological
social support
lack of options

Question 29

mandatory reporting

Answer 29

In MA-Depends on the mechanism of injury
Firearms, knife wounds or burns
In NH-Only if victim of GSW