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  1. 1. ELDER ABUSE for POLICE RECRUITS <ul><li>NYC Elder Abuse Training Project, 2004 </li></ul>
  2. 2. Elder Abuse <ul><li>the physical, sexual, emotional or financial abuse or neglect or abandonment of an older person by a family member, friend, fiduciary or caregiver </li></ul>
  3. 3. Elder Abuse <ul><li>Usually involves trust between victim and perpetrator </li></ul><ul><li>Occurs behind closed doors </li></ul><ul><li>Often undetected and unreported </li></ul>
  4. 4. Types of Abuse <ul><li>Physical abuse </li></ul><ul><li>Sexual abuse </li></ul><ul><li>Neglect </li></ul><ul><li>Emotional abuse </li></ul><ul><li>Financial exploitation </li></ul>
  5. 5. Physical Abuse <ul><li>Causing physical pain or injury </li></ul><ul><li>Hitting, slapping </li></ul><ul><li>Shoving </li></ul><ul><li>Cutting </li></ul><ul><li>Burning </li></ul><ul><li>Forcibly restraining </li></ul>
  6. 6. Sexual Abuse <ul><li>Any non-consensual sexual contact </li></ul><ul><li>Sexual contact with a person incapable of giving consent </li></ul><ul><li>Rape, sodomy, coerced nudity </li></ul>
  7. 7. Neglect <ul><li>Failure to carry out a caregiving responsibility </li></ul><ul><li>Passive neglect </li></ul><ul><ul><li>Unintentional failure to provide care </li></ul></ul><ul><ul><li>Can be well meaning caretaker who is unable to meet the older person’s needs </li></ul></ul><ul><li>Active Neglect </li></ul><ul><ul><li>Intentional failure to provide care </li></ul></ul>
  8. 8. Emotional Abuse <ul><li>Causing mental pain </li></ul><ul><li>Name calling </li></ul><ul><li>Insulting </li></ul><ul><li>Ignoring </li></ul><ul><li>Threatening </li></ul><ul><li>Isolating </li></ul><ul><li>Demeaning </li></ul><ul><li>Controlling behavior </li></ul>
  9. 9. Financial Exploitation <ul><li>Illegal or improper use of the resources of an older person for personal gain </li></ul><ul><li>Misuse of a power of attorney </li></ul>
  10. 10. More than One Form of Abuse May be Occurring <ul><li>Emotional abuse often accompanies physical abuse or financial exploitation </li></ul><ul><li>Physical abuse often accompanies financial abuse </li></ul>
  11. 11. The Perpetrators <ul><li>Often a family member </li></ul><ul><li>Adult child or grandchild </li></ul><ul><ul><li>Unemployed </li></ul></ul><ul><ul><li>Addicted to alcohol, drugs or gambling </li></ul></ul><ul><ul><li>Mentally ill </li></ul></ul><ul><li>Paid caregivers, neighbors, or friends </li></ul>
  12. 12. Why Is It Important? <ul><li>In 2000, 45 million people in U.S. were 60 or older </li></ul><ul><li>By 2030, number expected to double </li></ul><ul><li>As population grows, so will elder abuse </li></ul><ul><li>Physically or mentally impaired elderly more at risk </li></ul><ul><li>Early intervention can help prevent further abuse and further trauma </li></ul>
  13. 13. Keys to Effective Intervention <ul><li>Recognizing signs of abuse </li></ul><ul><li>Pursuing criminal investigation </li></ul><ul><li>Working jointly with social service agencies </li></ul>
  14. 14. Recognizing Elder Abuse <ul><li>Victim may be unable or unwilling to tell you abuse is occurring </li></ul><ul><li>Relationship to, or fear of, the abuser may affect willingness to pursue arrest </li></ul><ul><li>Recognition of signs crucial to successful investigation </li></ul>
  15. 15. Signs in the Victim <ul><li>Inadequately explained bruises, cuts, burns </li></ul><ul><li>Dehydration, malnutrition </li></ul><ul><li>Overly medicated or sedated </li></ul><ul><li>Unusual confinement </li></ul><ul><li>Lack of cleanliness, grooming </li></ul><ul><li>Fear of speaking for oneself </li></ul><ul><li>Shame, fear, embarrassment </li></ul>
  16. 16. Signs in the Abuser <ul><li>Gives conflicting stories or implausible explanations for victim’s injuries </li></ul><ul><li>Is reluctant to let you interview elderly person alone </li></ul><ul><li>Speaks for the elderly person </li></ul><ul><li>Handles elderly person roughly </li></ul><ul><li>Has a drug or alcohol problem </li></ul><ul><li>Has a previous history of abusive behavior </li></ul><ul><li>Appears indifferent or angry toward older person </li></ul><ul><li>Fails to assist the older person </li></ul>
  17. 17. Signs of Financial Exploitation <ul><li>Deviations in financial habits </li></ul><ul><ul><li>Large bank withdrawals or loans </li></ul></ul><ul><li>Numerous unpaid bills </li></ul><ul><li>Missing belongings, papers, credit cards </li></ul><ul><li>Elder unaware of monthly income </li></ul><ul><li>Frequent gifts from elder to caregiver </li></ul><ul><li>Caregiver’s refusal to spend money on elder </li></ul><ul><li>Checks made out to cash </li></ul><ul><li>Misuse of a Power of Attorney </li></ul><ul><ul><li>POA is not a health care proxy </li></ul></ul>
  18. 18. Environmental Signs <ul><li>Lack of food in the home </li></ul><ul><li>Lack of heat or electricity </li></ul><ul><li>A mistreated or malnourished pet </li></ul>
  19. 19. Responding to Elder Abuse Calls <ul><li>Respond as to other domestic violence calls </li></ul><ul><ul><li>Take same precautions </li></ul></ul><ul><ul><li>Be careful of hidden dangers </li></ul></ul><ul><li>Interview victim alone </li></ul><ul><ul><li>Maintain visual contact with other officers </li></ul></ul><ul><ul><li>Victim may not speak honestly if other family members can hear </li></ul></ul>
  20. 20. First Responsibilities <ul><li>To obtain needed medical services </li></ul><ul><li>To determine whether an offense has been committed </li></ul><ul><li>To make an arrest (if appropriate </li></ul><ul><li>To provide a basis for prosecution (if appropriate </li></ul><ul><li>To provide for the well being of the elderly person </li></ul>
  21. 21. Safety Check <ul><li>Can make the difference between life and death for an infirm elderly person </li></ul><ul><li>Is home clean and cared for? </li></ul><ul><li>Are there dangerous conditions? Hoarding? </li></ul><ul><li>Is there adequate food? </li></ul><ul><li>Is refrigerated food spoiled? </li></ul><ul><li>Are there dangerous objects in the home </li></ul><ul><li>Are there guns in the home of a person with dementia </li></ul>
  22. 22. Referral <ul><li>Community agencies can provide help with problems of daily living or counseling for distress </li></ul><ul><li>Community resources </li></ul><ul><ul><li>Local agency on aging </li></ul></ul><ul><ul><li>Home delivered meals programs </li></ul></ul><ul><ul><li>Adult Protective Services </li></ul></ul><ul><ul><li>Senior centers </li></ul></ul><ul><ul><li>Alzheimer’s programs </li></ul></ul><ul><li>For safety planning: </li></ul><ul><ul><li>Domestic Violence agencies </li></ul></ul><ul><ul><li>Sexual assault agencies </li></ul></ul><ul><ul><li>Crime victim programs </li></ul></ul>
  23. 23. Victim May Not Testify <ul><li>Reluctant to testify against family member or caregiver </li></ul><ul><li>May be unable to testify due to mental or physical impairments, or death </li></ul><ul><li>Stop perpetrators before they cause death </li></ul>
  24. 24. Seniors Can Be Fragile <ul><li>A shove can cause them to fall and break a major bone </li></ul><ul><li>If abusers are not prosecuted, it could become murder </li></ul><ul><li>Services are available for victim and abuser </li></ul><ul><li>Victims need to know that there is help </li></ul>
  25. 25. Charges Must be Proved Without Victim’s Testimony <ul><li>If victim testifies, evidence will corroborate the allegations </li></ul><ul><li>Each charge and identity of abuser must be proven </li></ul>
  26. 26. Photograph <ul><li>Victim, victim’s injuries </li></ul><ul><ul><li>Remove bandages for photos (if serious injury, get doctor’s guidance) </li></ul></ul><ul><ul><li>Take photo of victim’s injuries that shows face for identification </li></ul></ul><ul><li>Alleged abuser’s injuries or lack of injuries </li></ul><ul><li>All bloody/blood stained items </li></ul><ul><li>Property damage </li></ul><ul><li>Entire home/crime scene </li></ul><ul><li>Any property taken into custody </li></ul>
  27. 27. Voucher and Safeguard Evidence <ul><li>Weapons </li></ul><ul><li>Containers of corrosive liquids </li></ul><ul><li>Drugs or drug paraphernalia </li></ul><ul><li>Bottles/cans from alcoholic </li></ul><ul><li>Damaged property </li></ul><ul><li>Items used to restrain or gag the victim </li></ul><ul><li>Victims and/or abusers diary documenting abuse </li></ul><ul><li>Letters with envelopes </li></ul><ul><li>Answering machine, voice mail messages </li></ul>
  28. 28. Voucher and Safeguard continued <ul><li>Clothing, sheets, blankets with blood stains </li></ul><ul><ul><li>Place in paper bag </li></ul></ul><ul><li>Clothing, sheets, blankets with feces or urine stains </li></ul><ul><li>Bloody torn clothing of victim and alleged abuser </li></ul><ul><li>Martial arts paraphernalia </li></ul><ul><li>Financial documents </li></ul><ul><li>Everything </li></ul>
  29. 29. Eye, Ear and Nose Witnesses <ul><li>To crime charged </li></ul><ul><li>To previous instances of abuse </li></ul><ul><li>Speak to person who called 911 </li></ul>
  30. 30. Excited Utterances <ul><li>Document excited utterances of victim </li></ul><ul><li>Document victim’s demeanor </li></ul><ul><li>Check for excited utterances to friends, neighbors, EMS, nurses, doctors, 911 caller </li></ul>
  31. 31. Document Abuser’s Statements <ul><li>All statements, no matter how insignificant they seem </li></ul><ul><li>Check statements made to neighbors, landlord, friends, family, employer, EMS, hospital personnel, jail or parole officers </li></ul><ul><li>Read alleged abuser his/her Miranda rights and get a statement </li></ul>
  32. 32. Expert Medical Opinion <ul><li>Ask for a release from victim to obtain medical records </li></ul><ul><li>To explain force required to inflict injury </li></ul><ul><li>To give expert opinion as to how injuries were sustained </li></ul>
  33. 33. Documentary Evidence That May be Relevant <ul><li>Prison records </li></ul><ul><li>Home and cell phone records </li></ul><ul><li>Parole/probation records </li></ul><ul><li>Court records </li></ul><ul><li>Previous 911 calls </li></ul><ul><li>Police/court records from other jurisdictions </li></ul><ul><li>If alleged abuser has been Power of Attorney for other seniors, this could be evidence of targeting seniors </li></ul>
  34. 34. Document Medical Information <ul><li>Get contact information for all treating physicians and hospitals </li></ul><ul><li>Look for repeated injuries or lack of medical attention </li></ul><ul><li>Get information about past and present medications </li></ul><ul><li>Seize all medications </li></ul><ul><ul><li>If victim or caretaker says they are needed, consult a doctor to determine if the medications or combinations are dangerous </li></ul></ul>
  35. 35. Animal Abuse <ul><li>Has alleged abuser ever injured or killed a family pet? </li></ul><ul><li>Animal abuse can be used to terrorize a victim </li></ul><ul><li>If pet is neglected, may mean elder is also </li></ul>
  36. 36. Alleged Abuser’s Background <ul><li>Psychiatric history/hospitalization </li></ul><ul><li>Drug/alcohol abuse </li></ul><ul><li>Special medications </li></ul><ul><li>Has suspect ever threatened other family members? </li></ul>
  37. 37. Be Accurate in Documenting <ul><li>Can refresh your memory </li></ul><ul><li>Avoids cross-examination problems at trial </li></ul>
  38. 38. Be Creative <ul><li>Use your common sense </li></ul><ul><li>Evidence of abuse is not always obvious </li></ul><ul><li>Ask yourself why this situation bothers you. Why do you suspect abuse? </li></ul>
  39. 39. Arrest Charges <ul><li>Some states have special laws to protect the elderly </li></ul><ul><li>In New York arrests are usually made using conventional charges </li></ul>
  40. 40. Four Statutes Refer to Elderly and Disabled <ul><li>Endangering the welfare of an incompetent or physically disabled person, P.L §260.25 </li></ul><ul><li>Endangering the welfare of a vulnerable, elderly person in the second degree, P.L. §260.32 </li></ul><ul><li>Endangering the welfare of a vulnerable, elderly person in the first degree, P.L. §260.34 </li></ul><ul><li>The Hate Crimes Act of 2000 includes age (over 60) and disability as targeting factors that lead to increased penalties. </li></ul>
  41. 41. Conventional Charges <ul><li>Elder Abuse is not a specific crime or charge </li></ul><ul><li>A collection of harmful behaviors that may rise to the level of a crime or violation </li></ul>
  42. 42. Physical Abuse and Neglect <ul><li>Criminal Possession of a Weapon 4 </li></ul><ul><li>Trespass </li></ul><ul><li>Coercion </li></ul><ul><li>Criminal Contempt (includes violation of an order of protection) </li></ul><ul><li>Assault 1 </li></ul><ul><li>Intimidation of/Tampering with a Witness </li></ul><ul><li>Sex Offenses </li></ul><ul><li>Reckless Endangerment </li></ul>
  43. 43. Physical Abuse and Neglect continued <ul><li>Unlawful Imprisonment </li></ul><ul><li>Kidnapping </li></ul><ul><li>Rape </li></ul><ul><li>Murder </li></ul>
  44. 44. Financial Exploitation <ul><li>Petit Larceny </li></ul><ul><li>Grand Larceny </li></ul><ul><li>Grand Larceny by Extortion </li></ul><ul><li>Forgery </li></ul><ul><li>Scheme to Defraud </li></ul><ul><li>Burglary </li></ul>
  45. 45. Emotional Abuse <ul><li>Disorderly Conduct </li></ul><ul><li>Harassment </li></ul><ul><li>Stalking </li></ul><ul><li>Arrest is seldom made for emotional abuse alone. Emotional abuse frequently accompanies other types of abuse </li></ul>
  46. 46. Family Offenses <ul><li>Family Court Act, Section 812 </li></ul><ul><ul><li>Defines family as legally married, formerly married, related by blood, related by marriage (including in-laws) or having a child in common </li></ul></ul><ul><ul><li>“Family” members may have specified “family offenses” adjudicated in family court </li></ul></ul>
  47. 47. Family Offenses continued <ul><li>NYPD expanded definition adds 2 categories </li></ul><ul><ul><li>Currently living together in a family type relationship </li></ul></ul><ul><ul><li>Formerly lived together in a family type relationship </li></ul></ul><ul><li>Family courts do not recognize these categories, cases proceed to criminal court </li></ul>
  48. 48. Family Offense Charges <ul><li>Menacing </li></ul><ul><li>Assault </li></ul><ul><li>Disorderly conduct </li></ul><ul><li>Reckless Endangerment </li></ul><ul><li>Aggravated Harassment </li></ul><ul><li>Stalking </li></ul><ul><li>Harassment </li></ul>
  49. 49. Charges for Violating an Order of Protection <ul><li>Criminal Contempt 2 </li></ul><ul><li>Criminal Contempt 1 </li></ul><ul><li>Aggravated Criminal Contempt </li></ul><ul><li>Violations of an order of protection are among the easiest to prove in court </li></ul><ul><ul><li>Police officer can witness the order was violated </li></ul></ul><ul><ul><li>No further evidence may be needed </li></ul></ul>
  50. 50. Mandatory Arrest Policies <ul><li>Must arrest in </li></ul><ul><ul><li>Instances of felonies </li></ul></ul><ul><ul><li>Violation of an Order of Protection </li></ul></ul><ul><ul><li>Any violation committed in your presence </li></ul></ul><ul><li>May use your discretion </li></ul><ul><ul><li>In case of misdemeanor, IF victim spontaneously says she does not want the offender arrested </li></ul></ul><ul><ul><li>May arrest if there is a potential for continued violence </li></ul></ul>
  51. 51. Domestic Incident Report <ul><li>Required to complete a DIR in all instances that involve members of the same family/household </li></ul><ul><ul><li>Including the NYPD expanded definition </li></ul></ul><ul><ul><li>To track all domestic incidents even if no arrest is made </li></ul></ul>
  52. 52. Complaint Report Must Be Prepared <ul><li>If an offense is alleged </li></ul><ul><li>If you are aware that an offense has been committed </li></ul><ul><li>Offenses include </li></ul><ul><ul><li>Felony </li></ul></ul><ul><ul><li>Misdemeanor </li></ul></ul><ul><ul><li>Violation </li></ul></ul><ul><ul><li>Violation of an order of protection </li></ul></ul>
  53. 53. Orders of Protection <ul><li>Use for elder abuse victims </li></ul><ul><ul><li>Stay away orders </li></ul></ul><ul><ul><li>Refrain orders </li></ul></ul><ul><ul><li>Exclusionary orders </li></ul></ul><ul><li>Can order perpetrator to enter a substance abuse program </li></ul><ul><ul><li>If son or daughter, this is what victim usually wants </li></ul></ul>
  54. 54. Financial Exploitation <ul><li>Perpetrator often an unemployed relative </li></ul><ul><ul><li>Usually a child or grandchild </li></ul></ul><ul><ul><li>Financially dependent on victim </li></ul></ul><ul><ul><li>May be substance abuser, addicted to gambling and/or mentally ill </li></ul></ul><ul><li>Sometimes use emotional and physical abuse to coerce victim </li></ul><ul><li>Cases should be referred to detectives </li></ul>
  55. 55. Power of Attorney <ul><li>Principal designates an agent to act on their behalf </li></ul><ul><li>Can be very effective tool if held by a caring person </li></ul><ul><li>POA does NOT mean agent can make ALL decisions. </li></ul><ul><li> -- Not a health care proxy </li></ul><ul><ul><li>You can still investigate to insure that the elder is being cared for and that POA is not being abused </li></ul></ul>
  56. 56. Power of Attorney continued <ul><li>If agent uses Power of Attorney (POA) for own benefit it could be larceny </li></ul><ul><li>Not legal if </li></ul><ul><ul><li>Coercion was used </li></ul></ul><ul><ul><li>Principal was already losing mental capacity when signed </li></ul></ul><ul><li>It is a criminal case, not civil, if </li></ul><ul><ul><li>POA was obtained illegally </li></ul></ul><ul><ul><li>Agent is misusing principal’s funds </li></ul></ul>
  57. 57. Aging and Intimate Partner Violence <ul><li>Domestic Violence not limited to young </li></ul><ul><ul><li>Violence can worsen or change pattern </li></ul></ul><ul><ul><li>New partner may be abusive </li></ul></ul><ul><ul><li>Sudden onset in long-term partner can be caused by dementia </li></ul></ul><ul><ul><li>All laws and regulations that relate to domestic violence remain regardless of age of victim or perpetrator </li></ul></ul>
  58. 58. Older women have difficulty admitting domestic violence <ul><li>Socialized to marry “for better or worse” </li></ul><ul><li>Divorce rarely seen as an option </li></ul><ul><li>Shame of being labeled a “battered” wife </li></ul><ul><li>Often isolated </li></ul><ul><li>May have little external support </li></ul><ul><li>May be uncomfortable using a shelter </li></ul><ul><li>May have no financial resources </li></ul><ul><li>May depend on batterer for physical care </li></ul><ul><li>May fear nursing home placement </li></ul>
  59. 59. Interviewing Elderly Victims <ul><li>Can be complex </li></ul><ul><ul><li>Victim may be traumatized by abuse </li></ul></ul><ul><ul><li>May be ambivalent about reporting abuse </li></ul></ul><ul><ul><li>May be confused about what happened </li></ul></ul><ul><li>Older adults see police as “good guys” </li></ul><ul><ul><li>Most associate police with safety and security </li></ul></ul><ul><ul><li>Can build on this to gain trust </li></ul></ul><ul><ul><li>May NOT be true for immigrants who came from countries where police are feared </li></ul></ul>
  60. 60. Protect Dignity of Victim <ul><li>Treat with respect </li></ul><ul><li>Ask permission to enter the home and to sit while interviewing </li></ul><ul><li>Compassion and caring can have a profound effect </li></ul>
  61. 61. Strategies for Interviewing <ul><li>Sit at eye level </li></ul><ul><li>Keep weapon out of sight </li></ul><ul><li>Be attentive as to whether victim is tired </li></ul><ul><li>Begin with orienting information </li></ul><ul><li>Address victim by his/her last name </li></ul><ul><ul><li>Do not use first names </li></ul></ul><ul><ul><li>Do not call dear or honey </li></ul></ul><ul><li>Indicate immediately you are there to help </li></ul>
  62. 62. Interviewing Strategies (continued0 <ul><li>Begin with friendly questions to help elder relax </li></ul><ul><li>If you question elder’s mental capacity ask about date, time and place to get idea of mental functioning </li></ul><ul><li>Speak slowly and clearly </li></ul><ul><ul><li>One question at a time </li></ul></ul><ul><ul><li>Patient questioning can help elder focus </li></ul></ul><ul><ul><li>Be patient waiting for a response </li></ul></ul>
  63. 63. Interviewing Strategies (continued) <ul><li>Conduct a focused interview to get answers to specific questions </li></ul><ul><li>Listen carefully </li></ul><ul><ul><li>Ask for clarification when needed </li></ul></ul><ul><ul><li>Do not interrupt </li></ul></ul><ul><li>Use memory cues if person is having difficulty remembering </li></ul><ul><ul><li>Where you watching TV? What program? </li></ul></ul>
  64. 64. Hearing Impaired Person <ul><li>If you suspect hearing loss </li></ul><ul><ul><li>Ask if he/she is having difficulty hearing </li></ul></ul><ul><ul><li>Do not assume hearing loss </li></ul></ul><ul><ul><li>Ask if they have a hearing aid </li></ul></ul><ul><li>People with hearing loss use visual cues </li></ul><ul><ul><li>Need to see your lips, facial expressions, hands </li></ul></ul><ul><ul><li>Don’t cover your mouth or chew gum </li></ul></ul><ul><li>Ask if person would prefer written communication </li></ul>
  65. 65. Hearing Impaired (continued) <ul><li>Eliminate background noise </li></ul><ul><li>Position self between 3 and 6 feet away </li></ul><ul><li>Establish eye contact before speaking </li></ul><ul><li>Do not speak directly into person’s ear </li></ul>
  66. 66. Hearing Impaired (continued) <ul><li>Speak SLIGHTLY louder, do not yell </li></ul><ul><li>Speak clearly at normal rate </li></ul><ul><ul><li>Do not over-articulate </li></ul></ul><ul><li>Use short simple sentences </li></ul><ul><li>Avoid a condescending tone </li></ul><ul><li>If person doesn’t understand, rephrase the sentence. </li></ul><ul><li>If you can’t understand, ask person to repeat or rephrase </li></ul><ul><li>Use visual aids </li></ul>
  67. 67. Visually Impaired Person <ul><li>Ask if they need reading glasses </li></ul><ul><li>Use large print </li></ul><ul><li>Keep message short and simple </li></ul><ul><li>Move text between edge and center of person’s field of vision to find position where he/she can read it </li></ul><ul><li>Some visually impaired will not look directly at you because they see better in peripheral zones </li></ul>
  68. 68. Dual Sensory Impairment <ul><li>Many elders have both poor vision and poor hearing </li></ul><ul><li>All strategies for interviewing hearing impaired apply except visual cues </li></ul><ul><li>If blind and deaf </li></ul><ul><ul><li>Use an interpreter who knows hand spelling </li></ul></ul><ul><ul><li>Do not use family member or caregiver </li></ul></ul><ul><ul><ul><li>Likely to bias interpretation </li></ul></ul></ul>
  69. 69. Dementias <ul><li>Deterioration in cognitive functioning </li></ul><ul><ul><li>Impaired memory and perception </li></ul></ul><ul><ul><li>Decreased decision making ability </li></ul></ul>
  70. 70. Alzheimer’s disease <ul><li>Most prevalent form of dementia </li></ul><ul><li>Culminates in total dependency for care </li></ul><ul><li>In mid to late stages, most patients show signs of psychosis </li></ul><ul><ul><li>Paranoia (i.e., pervasive distrust and suspicion) </li></ul></ul><ul><ul><li>Delusion (e.g., thinking someone stole items) </li></ul></ul><ul><ul><li>Hallucinations (i.e., seeing or hearing things that are not real) </li></ul></ul>
  71. 71. Dementia is NOT a Normal Part of Aging <ul><li>Age is greatest risk factor for Alzheimer’s </li></ul><ul><li>Some dementia-like symptoms can be reversed </li></ul><ul><li>Alzheimer’s and cerebral vascular disease are irreversible </li></ul><ul><li>Medical exam rules out other causes for changes in cognition and behavior </li></ul>
  72. 72. Progress of Alzheimer’s <ul><li>Similar for all sufferers </li></ul><ul><li>Early stage – routine tasks difficult to recall and accomplish </li></ul><ul><li>May respond to questions by “masking” </li></ul><ul><ul><li>Saying “I don’t have time for this” </li></ul></ul><ul><ul><li>Having difficulty with word retrieval </li></ul></ul><ul><ul><li>May be aware of change, but fears acknowledging </li></ul></ul><ul><ul><li>Directs question back to questioner </li></ul></ul>
  73. 73. Quick Check of Mental Status <ul><li>What is your name? </li></ul><ul><li>Where do you live? </li></ul><ul><li>What is the month? </li></ul><ul><li>Who is the President? </li></ul>
  74. 74. Interviewing Persons with Dementia <ul><li>Can provide useful information in early stages </li></ul><ul><li>Receptivity to interview may vary throughout the day </li></ul><ul><li>Family member or service provider who is NOT a suspect can recommend </li></ul><ul><ul><li>Time of day when person is more alert </li></ul></ul><ul><ul><li>Ways to approach for optimum cooperation </li></ul></ul>
  75. 75. Strategies for Interview <ul><li>Keep area quiet, free of distractions </li></ul><ul><li>Begin with orienting information </li></ul><ul><li>Offer words of assurance </li></ul><ul><li>Relax and be yourself </li></ul><ul><ul><li>Your calmness or anxiety will be sensed </li></ul></ul><ul><li>Acknowledge the person’s feelings </li></ul><ul><ul><li>Communicates your concern for them </li></ul></ul><ul><li>Speak slowly in soothing tone without infantilizing </li></ul>
  76. 76. Interview Strategies (continued) <ul><li>Give ample time to respond </li></ul><ul><li>Repeat questions as needed </li></ul><ul><li>Use simple, concrete words </li></ul><ul><li>Give simple directions, one step at a time </li></ul><ul><li>Distraction may help to calm the person if upset </li></ul>
  77. 77. Closely Observe Reactions <ul><li>Emotional responses may reveal what words do not </li></ul><ul><li>If person becomes agitated, frightened or mute when asked about someone </li></ul><ul><ul><li>This is a cue </li></ul></ul><ul><ul><li>It is important to document the reaction </li></ul></ul>
  78. 78. Safe Return Program <ul><li>Nationwide identification program </li></ul><ul><li>Persons with memory deficit registered </li></ul><ul><li>Identifiers such as bracelets or necklaces </li></ul><ul><ul><li>State that person is memory impaired </li></ul></ul><ul><ul><li>Give phone number 1-800-572-1122 </li></ul></ul><ul><li>Safe Return can notify family or police precinct of found person </li></ul>
  79. 79. Safe Return (continued) <ul><li>If you find a lost, confused elder, </li></ul><ul><li>call 1-800-572-1122 </li></ul><ul><li>Advise families of people with Alzheimer’s or other dementia to register them with Safe Return </li></ul>
  80. 80. Cultural Issues <ul><li>Ethnic minority population growing </li></ul><ul><li>Diversity of ethnic groups increasing </li></ul><ul><li>Victim and perpetrator may be from culture different from yours </li></ul><ul><li>Cultural factors influence victim and family </li></ul>
  81. 81. Language <ul><li>Many elders who live in insular ethnic communities do not speak English </li></ul><ul><li>Use an impartial translator </li></ul><ul><li>Family, friend or neighbor </li></ul><ul><ul><li>May be involved in abuse </li></ul></ul><ul><ul><li>May give biased translation </li></ul></ul><ul><ul><li>May inhibit victim </li></ul></ul>
  82. 82. Cultural Factors may Inhibit Cooperation with Police <ul><li>Norms of quiet endurance valued </li></ul><ul><ul><li>Also associated with victimization </li></ul></ul><ul><ul><li>May not see selves as abuse victims </li></ul></ul><ul><ul><li>May deny or minimize problems </li></ul></ul><ul><li>Great value placed on family interdependence </li></ul><ul><ul><li>Fear social consequences of bringing shame to family </li></ul></ul><ul><ul><li>Maintaining community’s or family’s honor </li></ul></ul><ul><ul><li>Authorities should not be involved in “family matters” </li></ul></ul>
  83. 83. Fears of Immigrants <ul><li>May not know they have rights in this country regardless of immigrant status </li></ul><ul><li>May not know the abuse is against the law </li></ul><ul><li>May fear deportation </li></ul><ul><li>May see police as unfair or threat based on experiences in native country </li></ul><ul><li>Likely to be dependent on abuser </li></ul><ul><ul><li>Fearful of consequences of elder abuse investigation </li></ul></ul><ul><li>Important to be reassuring </li></ul>
  84. 84. Other Cultural Factors <ul><li>Touch may be viewed as an intrusion </li></ul><ul><li>Some think it disrespectful to make eye contact with police officers </li></ul><ul><li>May be reluctant to reveal injuries covered by clothes </li></ul><ul><ul><li>Due to cultural or religious beliefs </li></ul></ul><ul><ul><li>Unwillingness to show does not mean there are no injuries </li></ul></ul>
  85. 85. Culture Plays a Significant Role in Shaping Behavior <ul><li>Is not an automatic predictor of a given victim’s response </li></ul><ul><li>Each case is unique </li></ul><ul><li>Assess keeping relevant aspects of culture in mind </li></ul>
  86. 86. Conclusion <ul><li>Elder abuse is a complex problem </li></ul><ul><li>Comprehensive response strategy needed </li></ul><ul><ul><li>Early detection </li></ul></ul><ul><ul><li>Abuser accountability </li></ul></ul><ul><ul><li>Victim support </li></ul></ul><ul><li>Police often first responders </li></ul><ul><ul><li>Can detect the crimes </li></ul></ul><ul><ul><li>Can bring perpetrators to justice </li></ul></ul><ul><ul><li>Can prevent further abuse </li></ul></ul>
  87. 87. Response requires sensitivity <ul><li>Victim may be unwilling or unable to be helpful </li></ul><ul><li>Abuser often a family member and may be caretaker </li></ul><ul><li>Must assure that victim will be both safe and cared for </li></ul>
  88. 88. Community Response Network <ul><li>Is in place to help </li></ul><ul><li>Can protect abused elders </li></ul><ul><li>Can help overwhelmed families care for elder </li></ul><ul><li>Grows stronger through efforts of community agencies and individuals including police officers </li></ul>
  89. 89. Parting Thoughts <ul><li>Your action can protect a vulnerable older adult </li></ul><ul><li>Your empathic approach can facilitate a more satisfactory outcome to a difficult situation </li></ul>