Elder Abuse

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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

    1. 1. 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
    2. 2. What is Elder Abuse? <ul><li>An act of commission or omission: </li></ul><ul><li>physical abuse </li></ul><ul><li>psychological abuse </li></ul><ul><li>neglect </li></ul><ul><ul><li>active </li></ul></ul><ul><ul><li>passive </li></ul></ul><ul><li>financial exploitation </li></ul>
    3. 3. Common Perpetrators <ul><li>adult children </li></ul><ul><li>spouses </li></ul><ul><li>other relatives </li></ul><ul><li>neighbours </li></ul><ul><li>acquaintances </li></ul><ul><li>strangers </li></ul><ul><li>paid caregivers </li></ul>
    4. 4. Prevalence <ul><li>commonly estimated at 4% to 15% </li></ul><ul><li>underreported by as much as 80% </li></ul><ul><li>many reasons for underreporting </li></ul><ul><ul><li>lack of awareness of the problem </li></ul></ul><ul><ul><li>inadequate detection </li></ul></ul>
    5. 5. Physicians and Elder Abuse <ul><li>Why should physicians be involved? </li></ul><ul><li>How can they easily screen for and detect elder abuse in their family practice? </li></ul>
    6. 6. Mortality of Elder Abuse <ul><li>important study examined the mortality of elder abuse (Lachs et al., 1998) </li></ul><ul><li>prospective cohort study: 2812 adults over age 65 living in the community </li></ul><ul><li>compared to reports made to adult abuse agency over a 9-yr period </li></ul>
    7. 7. Survival Rates (Lachs et al., 1998) <ul><li>Survival rates in the 13 th year were: </li></ul><ul><li>40% of the non-abused group </li></ul><ul><li>9% of the abused/neglected group </li></ul><ul><li>Adjusted for all possible factors that might affect mortality (i.e. demographic characteristics, chronic diseases, functional status, social networks, cognitive status, depression) </li></ul>
    8. 8. Implications of Lachs et al.(1998) <ul><li>while social integration increases mortality, elder abuse could be an extreme form of negative social support </li></ul><ul><li>the extreme intrapersonal stress experienced by abused older adults may confer an added death risk </li></ul><ul><li>this is an important issue for physicians </li></ul>
    9. 9. Clinical Presentation <ul><li>physical abuse: bruises, welts, lacerations, fractures, overmedication, undermedication, multiple injuries, etc. </li></ul><ul><li>neglect: malnutrition, dehydration, decubitus ulcers, lack of compliance with medical regimes </li></ul><ul><li>psychological Abuse: depression, stress, fear, mental anguish, social isolation, anxiety disorder, etc. </li></ul><ul><li>financial exploitation: no physical signs, but can result in lack of finances for adequate care: food, medication, other necessities </li></ul>
    10. 10. Key Role of Family Physicians in Detection <ul><li>most older adults see physicians regularly </li></ul><ul><li>physicians may be the only outside contact </li></ul><ul><li>often the first to treat abuse and its sequelae </li></ul>
    11. 11. Risk Factors <ul><li>no definitive list of risk factors exists </li></ul><ul><li>clinical wisdom and previous research suggest: </li></ul><ul><ul><li>dependency (in either direction) </li></ul></ul><ul><ul><li>pathology of the abuser (substance abuse, cognitive deficits, mental health) </li></ul></ul><ul><ul><li>caregiver stress </li></ul></ul><ul><ul><li>frailty of the victim (physical, cognitive) </li></ul></ul><ul><ul><li>family social isolation </li></ul></ul>
    12. 12. Underdetection by Physicians <ul><li>physicians rank 10 th among other professionals in reporting elder abuse </li></ul><ul><li>only 2% of elder abuse referrals from service providers come from physicians </li></ul>
    13. 13. Barriers to Physician Detection <ul><li>lack of awareness and knowledge </li></ul><ul><li>lack of a clear definition of elder abuse </li></ul><ul><li>lack of protocols </li></ul><ul><li>time constraints </li></ul><ul><li>ethical issues </li></ul><ul><li>victim reluctance to report: denial, shame, blame, fear of retaliation, fear of placement </li></ul><ul><li>lack of a screening instrument </li></ul>
    14. 14. Problem of Differential Diagnosis <ul><li>‘ geriatric’ presentation is often non-specific </li></ul><ul><li>ageism in medical practice causes the dismissal of many abnormalities as “normal aging” </li></ul><ul><li>signs and symptoms of elder abuse may be written off as inevitable or ascribed to other diseases (Lachs & Pillemer, 1995) </li></ul><ul><li>Lachs (1995) suggests conceptualizing elder abuse as a ‘geriatric syndrome’ and using screening instruments for differential diagnosis </li></ul>
    15. 15. Assessment and Diagnosis <ul><li>observations </li></ul><ul><li>detailed medical history </li></ul><ul><li>social history </li></ul><ul><li>comprehensive medical examination </li></ul><ul><li>laboratory tests </li></ul><ul><li>cognitive evaluation </li></ul><ul><li>interview and questions </li></ul><ul><li>home visit </li></ul><ul><li>screening instruments </li></ul>
    16. 16. Screening Instruments <ul><li>Only two validated instruments exist: </li></ul><ul><li>Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) </li></ul><ul><li>Caregiver Abuse Screen (CASE) </li></ul><ul><li>Neither is suitable for the brief screening of patients in the context of an office visit </li></ul>
    17. 17. The Need for a Physician’s Screening Tool <ul><li>routine screening for elder abuse by family physicians is widely called for </li></ul><ul><ul><li>CMA Task Force on the Periodic Health Examination (1994) </li></ul></ul><ul><ul><li>Régie régionale de la Santé et des services sociaux ( 1998 ) </li></ul></ul><ul><ul><li>American Medical Association (1992) </li></ul></ul><ul><ul><li>geriatric and family practice literature </li></ul></ul><ul><li>a brief, practical screening tool, appropriate for physician use does not exist </li></ul>
    18. 18. Proposed Study <ul><li>The CQRS Research Team on Elder Abuse proposes: </li></ul><ul><li>development and validation of a brief physician screening tool for elder abuse </li></ul><ul><li>3 sites (two Family Medical Centres affiliated with McGill Faculty of Medicine and a CLSC) </li></ul><ul><li>physicians will routinely administer the EASI to patients over age 65 with Mini-Mental Scores over 23 </li></ul><ul><li>sample size 1000 </li></ul><ul><li>construct validity: HSEAST </li></ul><ul><li>gold standard: full social worker home visit assessment </li></ul>

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