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Elder Abuse

Elder Abuse



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.

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.



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Elder Abuse Elder Abuse Presentation Transcript

  • 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
  • Common Perpetrators
    • 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
  • Physicians and Elder Abuse
    • 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
  • 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)
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Assessment and Diagnosis
    • 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
  • 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
  • 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