Bruises may appear more severe because of medications, or as the result of circulation and skin changes. Practices, such as cupping or coining, can result in markings that look like bruises but are not caused by abuse. ***Instructors’ Note: The following information briefly describes cupping and coining practices – which are sometimes used as health remedies by some cultures. These practices can leave marks and bruises that look like elder abuse but may be part of an individual's health care routines. Cupping Cupping refers to an ancient Chinese practice in which a heated cup is applied to the skin so that the skin and superficial muscle layer is drawn into and held in the cup. Coining Coining is an alternative form of medicine most commonly practiced in Southeast Asia to reduce stress related symptoms in adults such as headaches, muscle aches and pain, low energy. The practice produces marks on the chest and back which can look like bruises and resolve over several days. Ask participants “What sources are available to assist in determining if a culturally based explanation for what appears to be abuse are valid?” Medical APS Cultural organization Internet Summary As in all cases, document physical injuries. Not all bruising may be from criminal actions. Transition : “In the next section, we will discuss strangulation.” Note: There is a participant handout associated with this slide.
Slides 7.27 – 7.29 (10:35 – 10:50) COLLECTING EVIDENCE IN NEGLECT CASES ***Instructors’ Note: Depending on time, either ask participants to list evidence they would consider collecting in a neglect cases (prior to showing the two slides on evidence collection) and use the slides as a summary OR show the slides and lecture through the evidence collection portion to close this module on time. On Scene Evidence Collection Photographs of suspect’s and victim’s living arrangements and conditions if suspect is living in a more comfortable way than the victim (to show the contrast) Evidence of restraints Soiled clothing Bandages (or absence of needed bandages) Bedding (or absence of bedding) Inappropriate clothing Lack of food, food that is inappropriate given the victim’s dietary needs, or spoiled food Medical records that show the caregiver (or others) have been told the victim’s health status and care needs Examine prescriptions and medicine bottles Assess how and for whom money is being spent
Potential Signs of Sexual Abuse Infections, pain, or bleeding in genital areas or mouth. Difficulty walking or sitting. Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings. Inappropriate (enmeshed) relationships between the older adult and the abuser.
Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs. Bite marks. Unexplained STDs or HIV.
What is Undue Influence? Undue influence is the substitution of one person’s will for the true desires of another. Undue influence occurs when one person uses his or her role and power to exploit the trust, dependency, and fear of another. The power is used to gain psychological control over the decision-making of a weaker person. Unlike common persuasion and sales techniques, fraud, duress, threats, or other deceits are often components of undue influence. Victims may or may not have capacity. Used as a means to commit a crime. Keep in mind that it is also true that older individuals have the right to marry who they want and give assets to anyone they choose. They have the right to make decisions that some may consider poor judgment. This is different than undue influence – where the judgment of another has been substituted for the older person’s wishes.
Who Commits Undue Influence? Family members, trusted friends, or others with an ongoing relationship with the victim. Caregivers. Fiduciaries who have gained an older adult’s trust and confidence. Opportunists. Career criminals.
Undue Influence: Common Tactics One way to understand the tactics of undue influence is on the diagram on slide # 10.15. This wheel was developed to help understand the tactics of undue influence. The center is the goal of the suspect—financial exploitation. The purpose of the manipulation may vary. Some suspects want to financially exploit; others desire to dominate or gain and maintain power and control. The outer spokes are the common tactics to exercise undue influence. These are drawn from a survey of expert research. The wheel illustrates that 1) tactics are not linear moving progressively in order from one to the next, instead, several may be used simultaneously. 2) The tactics are not random, instead, like domestic violence and stalking, are purposeful to achieve the suspect’s desired goal, financial exploitation; 3) like domestic violence and stalking, undue influence is not a single incident but is a process. Note: There is a participant handout associated with this slide.
From Silos to Bridges: Improving the Multidisciplinary Response to Elder Abuse 19 th Annual NAPSA Conference August 27, 2008 Chicago, Illinois