Elder Abuse

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Information about Elder Abuse
Health & Medicine

Published on February 21, 2009

Author: Madrisa

Source: slideshare.net

Description

This presentation at a geriatrics conference is targeted at physicians. It raises awareness of elder abuse as a rarely examined cause of morbidity and mortality.

Elder Abuse: A Rarely Explored Cause of Mortality and Morbidity in Older Adults S.M. Straka, M.J. Yaffe, M. Lithwick, C. Wolfson, F. Jasserand, E. Podnieks Research Team on Elder Abuse Funded by CQRS

What is Elder Abuse? An act of commission or omission: physical abuse psychological abuse neglect active passive financial exploitation

An act of commission or omission:

physical abuse

psychological abuse

neglect

active

passive

financial exploitation

Common Perpetrators adult children spouses other relatives neighbours acquaintances strangers paid caregivers

adult children

spouses

other relatives

neighbours

acquaintances

strangers

paid caregivers

Prevalence commonly estimated at 4% to 15% underreported by as much as 80% many reasons for underreporting lack of awareness of the problem inadequate detection

commonly estimated at 4% to 15%

underreported by as much as 80%

many reasons for underreporting

lack of awareness of the problem

inadequate detection

Physicians and Elder Abuse Why should physicians be involved? How can they easily screen for and detect elder abuse in their family practice?

Why should physicians be involved?

How can they easily screen for and detect elder abuse in their family practice?

Mortality of Elder Abuse important study examined the mortality of elder abuse (Lachs et al., 1998) prospective cohort study: 2812 adults over age 65 living in the community compared to reports made to adult abuse agency over a 9-yr period

important study examined the mortality of elder abuse (Lachs et al., 1998)

prospective cohort study: 2812 adults over age 65 living in the community

compared to reports made to adult abuse agency over a 9-yr period

Survival Rates (Lachs et al., 1998) Survival rates in the 13 th year were: 40% of the non-abused group 9% of the abused/neglected group Adjusted for all possible factors that might affect mortality (i.e. demographic characteristics, chronic diseases, functional status, social networks, cognitive status, depression)

Survival rates in the 13 th year were:

40% of the non-abused group

9% of the abused/neglected group

Adjusted for all possible factors that might affect mortality (i.e. demographic characteristics, chronic diseases, functional status, social networks, cognitive status, depression)

Implications of Lachs et al.(1998) while social integration increases mortality, elder abuse could be an extreme form of negative social support the extreme intrapersonal stress experienced by abused older adults may confer an added death risk this is an important issue for physicians

while social integration increases mortality, elder abuse could be an extreme form of negative social support

the extreme intrapersonal stress experienced by abused older adults may confer an added death risk

this is an important issue for physicians

Clinical Presentation physical abuse: bruises, welts, lacerations, fractures, overmedication, undermedication, multiple injuries, etc. neglect: malnutrition, dehydration, decubitus ulcers, lack of compliance with medical regimes psychological Abuse: depression, stress, fear, mental anguish, social isolation, anxiety disorder, etc. financial exploitation: no physical signs, but can result in lack of finances for adequate care: food, medication, other necessities

physical abuse: bruises, welts, lacerations, fractures, overmedication, undermedication, multiple injuries, etc.

neglect: malnutrition, dehydration, decubitus ulcers, lack of compliance with medical regimes

psychological Abuse: depression, stress, fear, mental anguish, social isolation, anxiety disorder, etc.

financial exploitation: no physical signs, but can result in lack of finances for adequate care: food, medication, other necessities

Key Role of Family Physicians in Detection most older adults see physicians regularly physicians may be the only outside contact often the first to treat abuse and its sequelae

most older adults see physicians regularly

physicians may be the only outside contact

often the first to treat abuse and its sequelae

Risk Factors no definitive list of risk factors exists clinical wisdom and previous research suggest: dependency (in either direction) pathology of the abuser (substance abuse, cognitive deficits, mental health) caregiver stress frailty of the victim (physical, cognitive) family social isolation

no definitive list of risk factors exists

clinical wisdom and previous research suggest:

dependency (in either direction)

pathology of the abuser (substance abuse, cognitive deficits, mental health)

caregiver stress

frailty of the victim (physical, cognitive)

family social isolation

Underdetection by Physicians physicians rank 10 th among other professionals in reporting elder abuse only 2% of elder abuse referrals from service providers come from physicians

physicians rank 10 th among other professionals in reporting elder abuse

only 2% of elder abuse referrals from service providers come from physicians

Barriers to Physician Detection lack of awareness and knowledge lack of a clear definition of elder abuse lack of protocols time constraints ethical issues victim reluctance to report: denial, shame, blame, fear of retaliation, fear of placement lack of a screening instrument

lack of awareness and knowledge

lack of a clear definition of elder abuse

lack of protocols

time constraints

ethical issues

victim reluctance to report: denial, shame, blame, fear of retaliation, fear of placement

lack of a screening instrument

Problem of Differential Diagnosis ‘ geriatric’ presentation is often non-specific ageism in medical practice causes the dismissal of many abnormalities as “normal aging” signs and symptoms of elder abuse may be written off as inevitable or ascribed to other diseases (Lachs & Pillemer, 1995) Lachs (1995) suggests conceptualizing elder abuse as a ‘geriatric syndrome’ and using screening instruments for differential diagnosis

‘ geriatric’ presentation is often non-specific

ageism in medical practice causes the dismissal of many abnormalities as “normal aging”

signs and symptoms of elder abuse may be written off as inevitable or ascribed to other diseases (Lachs & Pillemer, 1995)

Lachs (1995) suggests conceptualizing elder abuse as a ‘geriatric syndrome’ and using screening instruments for differential diagnosis

Assessment and Diagnosis observations detailed medical history social history comprehensive medical examination laboratory tests cognitive evaluation interview and questions home visit screening instruments

observations

detailed medical history

social history

comprehensive medical examination

laboratory tests

cognitive evaluation

interview and questions

home visit

screening instruments

Screening Instruments Only two validated instruments exist: Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) Caregiver Abuse Screen (CASE) Neither is suitable for the brief screening of patients in the context of an office visit

Only two validated instruments exist:

Hwalek-Sengstock Elder Abuse Screening Test (HSEAST)

Caregiver Abuse Screen (CASE)

Neither is suitable for the brief screening of patients in the context of an office visit

The Need for a Physician’s Screening Tool routine screening for elder abuse by family physicians is widely called for CMA Task Force on the Periodic Health Examination (1994) Régie régionale de la Santé et des services sociaux ( 1998 ) American Medical Association (1992) geriatric and family practice literature a brief, practical screening tool, appropriate for physician use does not exist

routine screening for elder abuse by family physicians is widely called for

CMA Task Force on the Periodic Health Examination (1994)

Régie régionale de la Santé et des services sociaux ( 1998 )

American Medical Association (1992)

geriatric and family practice literature

a brief, practical screening tool, appropriate for physician use does not exist

Proposed Study The CQRS Research Team on Elder Abuse proposes: development and validation of a brief physician screening tool for elder abuse 3 sites (two Family Medical Centres affiliated with McGill Faculty of Medicine and a CLSC) physicians will routinely administer the EASI to patients over age 65 with Mini-Mental Scores over 23 sample size 1000 construct validity: HSEAST gold standard: full social worker home visit assessment

The CQRS Research Team on Elder Abuse proposes:

development and validation of a brief physician screening tool for elder abuse

3 sites (two Family Medical Centres affiliated with McGill Faculty of Medicine and a CLSC)

physicians will routinely administer the EASI to patients over age 65 with Mini-Mental Scores over 23

sample size 1000

construct validity: HSEAST

gold standard: full social worker home visit assessment

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