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The Societal Challenges of Elder Mistreatment PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "The Societal Challenges of Elder Mistreatment” by Robert B. Wallace, MD, MSc.

This medical PowerPoint presentation is about elder mistreatment, also known as elder abuse. Elder mistreatment is a serious societal challenge that affects millions of elderly individuals around the world. It refers to any intentional or negligent act that causes harm or distress to an older person. This mistreatment can take many forms, including physical, emotional, sexual, financial, and neglect.

Addressing these challenges requires a multi-faceted approach that involves education, awareness-raising, and targeted interventions to prevent and respond to elder mistreatment. This includes efforts to promote healthy aging, support victims of elder mistreatment, and hold perpetrators accountable for their actions.

Tags : Elder Mistreatment, elder abuse, Geriatrics, Geriatric Medicine, Geriatrics PowerPoint presentation

Published on : May 02, 2023 | Views : 1012 | Downloads : 0

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Slide 1-

The Societal Challenges of Elder Mistreatment The Aging Population, Alzheimer’s and Other Dementias: Law & Public Policy University of Iowa College of Law Robert B. Wallace, MD, MSc University of Iowa College of Public Health
Slide 2-

Why “Mistreatment,” Not “Abuse?” Abuse has the connotation of overt violence, but most mistreatment is not physical violence Complexity of social behavior in the home or institution is more likely to have bi-directional elements “Abuse” is more likely to be used in legal language; not all mistreatment is a crime
Slide 3-

Counting “Cases” Requires Definitions: The Phenomena of Elder Mistreatment Physical abuse Physical force that may result in bodily injury, pain or impairment (includes: hitting, slapping, grabbing) Sexual abuse Non-consensual contact of any kind with an older person Emotional and psychological abuse Infliction of anguish, pain or distress Financial exploitation Illegal/improper use of funds, property or assets Neglect and Self--Neglect Refusal or failure to fulfill obligations or duties to an elder
Slide 4-

Three Components of Elder Mistreatment Trust relationship Intent and motivation Harm in some form
Slide 5-

Some Definitional Issues Assessing intent/ motivation of mistreatment and neglect The complexity of social behavior in trust relationships The (varying) role of legal and administrative definitions Is refusing to provide for someone else a personal crime or a social welfare issue? Iatrogenic events: e.g., inadequate care; restraint or psychotropic medication use; adverse events of appropriate treatment
Slide 6-

A Focus on the “Self-Neglect” Issue Have the capacities of the victim and caregivers been assessed? The role of disability, cognitive impairment and mental illness Economic means and resources Social access to information/ education Access to helping and clinical services
Slide 7-

Some Larger Contexts of Elder Mistreatment All interpersonal violence Domestic violence Violence against disabled persons Management of abusive psychiatric behaviors Criminal behavior Social welfare and unmet needs in society Codes of professional conduct in health and social professionals Funding and fiscal accessibility in health care Retirement and pension policies
Slide 8-

The Spectrum of Domestic Violence
Slide 9-

Possible Examples of EMIn the Institutional Setting? Forcing a resistant elder to wash her hair twice a week? Using chemical restraints (drugs) to improve patient safety? Not honoring holidays of all faiths in a long-term care facility? A capable family member who ignores an elder in a long-term care facility? Not providing a chapel in a long-term care facility?
Slide 10-

An Example: A Legal Issue Resulting from Elder Abuse Law Under-treatment of pain in clinical setting Abuse or malpractice? Multiple settings (home care, hospice, nursing homes, hospitals) Circumventing usual litigation pathways Lack of training in pain medicine Reticence to use pain medicine to the fullest
Slide 11-

The Complexities of Financial Exploitation(J Elder Abuse Neglect 23:304)
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A Quarter Century of (Little) Epidemiology of Elder Mistreatment: 1975-2000 Not clearly defined: Suspected 1-10% annual prevalence Are rates incidence or prevalence? No national surveys of older persons Relative occurrence of: abuse/ neglect/ exploitation unclear Mode of data collection: social service/ protective agency > clinical > small populations
Slide 13-

Data Sources for the Study of Elder Mistreatment Formal professional reports: a. Justice system & police (abuse, rape, murder) b. Forensic pathology reports c. Adult Protective Services d. Health professional screening and reporting e. Institutional reports (nursing homes; assisted living)
Slide 14-

Data Sources for the Epidemiological Study of Elder Mistreatment 2. Screening in clinical (emergency departments, out-patient facilities) 3. Surveys of professionals/ professional records; Emergency rooms; ambulatory care; hospitals; long term care 4. Household surveys (1 or multi-stage): Potential victims Potential perpetrators Biomarkers without questionnaires 5. Citizen reporting
Slide 15-

Staff Reports of Elder Mistreatment in Iowa(JAMDA DOI: 10.1016/j.jamda.2008.09.005) Work of McCool, Jogerst, et al. Two nursing homes: Questionnaire to 335 staff About 50% participation rate Have you seen/suspected adult abuse? Type of abuse Nursing/admin % Other staff % Physical abuse 21.4 10.0 Sexual abuse 0.0 0.0 Emotional abuse 32.1 5.0 Financial exploitation 28.6 0.0
Slide 16-

Family Members’ Reports of Abuse in Michigan Nursing Homes (J Elder Abuse & Neglect 21:105)
Slide 17-

A Plea for Citizen Reporting and of Abuse and Its Prevention Step 1: Evaluate the Situation Step 2: Report Abuse Step 3: Understand the Law Step 4: Help Prevent Abuse
Slide 18-

A Plea for Citizen Reporting of Abuse and Its Prevention -- American Humane Association Step 1: Evaluate the Situation Step 2: Report Animal Abuse Step 3: Understand the Law Step 4: Help Prevent Animal Abuse
Slide 19-

National Social Health and Aging Program:US National Survey of Mistreatment (JGSS 63B:S248) Validated items: In the past 12 months…. Is there someone who insults you or puts you down? (verbal mistreatment) Is there anyone who has taken your money or your belongings without your okay, or prevented you from getting them even when you ask? (financial mistr.) Is there anyone who hits, kicks, slaps or throws things at you? (physical mistreatment) ……Then asked the relation of the perpetrator
Slide 20-

National Social Health and Aging Program:US National Survey of Mistreatment (JGSS 63B:S248)
Slide 21-

First UK Prevalence Survey of Mistreatment(J Elder Abuse & Neglect 21:1)
Slide 22-

First UK Prevalence Survey of Mistreatment: Annual Prevalence (J Elder Abuse & Neglect 21:1)
Slide 23-

Consequences of Elder Abuse Physical Health Morbidity (skin wounds; fractures, etc.) Death Dysfunction and disability Psychological Health Depression; fear; guilt; shame; distrust; learned helplessness; withdrawal; post-traumatic stress syndrome Economic Status Loss of resources, possessions
Slide 24-

Mortality Associated with APS-Identified EM in a Defined Population [Lachs, JAMA 280:428]
Slide 25-

Risk Factors for Elder Abuse - I Victim dependency/ vulnerability Poor health; disability/functional impairment; poor personal defenses; poverty; possibly dementing illnesses (resp. to behav.) Gender--women Abuser dependency/deviance Alcohol and drug abuse; mental illness; poor employment record Social isolation Abuse undetected; lack of social support to buffer stress Living arrangements Shared living arrangements; greater opportunity for tension and conflict; long term care facilities
Slide 26-

Risk Factors for Elder Abuse – IIThe Disturbing Role of Childhood Experiences Childhood Sexual and Physical Abuse: Risk for Victimization in Adulthood [Lancet 358:450] -Unwanted sexual intercourse < 16 years: RR = 3.5 -Rape < 16 years RR = 2.6 -Severe beatings by parents or carers: RR = 3.6 Childhood Abuse and Attempted Suicide [JAMA 286:3089] -Emotional abuse RR = 5.0 -Sexual abuse RR = 2.8 -Battered mother RR = 2.6 -Mentally ill household member RR = 3.3 -Parents separated/divorced RR = 1.9
Slide 27-

Risk/ Vulnerability Model of Self Neglect(J Am Geriatr Soc 56:S271)
Slide 28-

A Gene Effect on Early Childhood Abuse and Adult Behavior [Science 297:851]
Slide 29-

“Indicators” of Elder Abuse[The Gerontologist 38:471-480] Abusive Caregiver Characteristics: Alcohol and substance abuse; Mental health problems: depression/ personality disorder; behavioral problems; care-giving reluctance, inexperience Generally poor interpersonal relationships; poor pre-morbid relations; current marital, family conflict; lack of empathy, understanding of care needs and issues; financially dependent on care
Slide 30-

The Clinical Recognition of EM:Possible Risk Factors 1. Frequent primary care or ER visits 2. Frequent or unexplained falls 3. Injuries inconsistent with explanations given 4. Evidence of neglect: malnutrition, dehydration, hypotherm. 5. Overmedication: poisoning, stupor 6. Undue physical restraint 7. Inappropriate clothing 8. Inadequate aids and devices 9. Lack of money, possessions; social isolation
Slide 31-

The Role of Forensic Science:A Midwestern Program Ten-Year Experience Cases over 60 including homicide and neglect Homicide (avg age 72.1) Neglect (avg age 79.7) Gunshot 42% Pneumonia 50% Beating 37 Sepsis 23 Stabbing 19 Dehydration 9 Asphyxia 10 Heart disease 9 Fall 4 Undetermined 4 [J. Forensic Sci. 49:122]
Slide 32-

The Role of Forensic Science:A Midwestern Program Ten-Year Experience - II “Homicide” cases (N =52) Perpetrators Spouse 15% Other family 10 Acquaintance 10 Undeterm. 73 “Neglect” cases (N = 22) Residence With family 32% Non-fam. caretaker 14 Alone; non-fam. caretaker 9 Nursing home 18 Unknown 27
Slide 33-

Findings from Autopsies of Patients Over 65 Years with Antemortem EM [Legal Medicine 5:7] 15 Causes of Death in a Japanese Prefecture -Subdural hemorrhage(4) -Starvation -Hypothermia -Suffication (4) -Drowning -Arson -Strangulation -Traumatic brain inj. -Traumatic pneumothorax Perpetrators -Sons (7) -Grandson -Son-in-law -Son and Daugh.-in-law -Grandson (2) -Neighbor -Unk. -Others
Slide 34-

Some Potential “Biomarkers” of Abuse/Neglect Blood biomarkers--examples for consideration: myoglobin; acute phase reactants Patterns of fractures; morphology Morphology and distribution of bruising Quick tests of malnutrition and dehydration Forensic testing—similar to assault and rape investigations
Slide 35-

Items to Assess Elder Abuse in Epidemiological Surveys [J Appl Gerontol 5:153] - I 1. Has anyone tried to hurt or harm you? 2. Have you been forced to do things you don’t want to do? Please give an example. 3. Have you been threatened with being placed in a nursing home? 4. Has anyone stolen from you or taken your possessions without permission? 5. Has anyone sworn at you or threatened you?
Slide 36-

Items to Assess Elder Abuse in Epidemiological Surveys [J Appl Gerontol 5:153] - II 6. Has anyone confined you at home against your will? 7. Has anyone refused to provide you with food or with your medications 8. Has anyone beaten or assaulted you? 9. Have you ever signed any documents that you didn’t understand? 10. Are you afraid of anyone in your home?
Slide 37-

“Brief Self-Report Screening Instrument”[Australian Longitudinal Study on Women’s Health, 2000] 1. Are you afraid of anyone in your family? 2. Has anyone close to you tried to hurt you or harm you recently? 3. Has anyone close to you called you names or put you down or made you feel bad recently? 4. Does someone in your family make you stay in bed or tell you you’re sick when you aren’t? 5. Has anyone forced you to do things you don’t want to do? 6. Has anyone taken things that belong to you without your okay?
Slide 38-

Some Potential Problems with EM Screening and Diagnostic Instruments in Surveys Items do not assess social/ family context of events Checklist response range excludes many real life situations Perpetrator information often incomplete Not responding to evidence-based practice guidelines
Slide 39-

Legal, Administrative Challenges to Effective Elder Mistreatment Services Divulging confidential information (e.g., caregiver support session; HIPAA) Different laws in various jurisdictions Inadequate responses/ resources by existing Adult Protective Services Disagreement on the fundamental mistreatment nature in various situations Remedies may make victim’s situation worse Fear of degrading existing elder services
Slide 40-

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Slide 41-

An Approach to Management of Confirmed EM [Adapted from Lachs & Pillemer Lancet 364:1263] Confirmed Case Patient Willing to Accept Services Patient Unwilling or Unable to Accept Services Context-specific Intervention -Educate -Implement -Referral Patient Lacks Capacity -Go to official agency -Financial asst. -Conservatorship/ guardianship -Special committee -Courts Patient has Capacity -Educate patient -Provide emergency numbers -Develop safety plan -Develop follow-up plan
Slide 42-

Examples of Approaches to Managing EM [Adapted from Lachs & Pillemer Lancet 364:1263] Potentially related to caregiver stress: -Respite care -Adult day care -Carer education -Family carers recruit. -Carer psychother. -Reduce carer soc. isol. Longitudinal spousal violence -Marital counseling -Support groups -Shelters -Protection orders -Victim advocacy
Slide 43-

Policy Approaches to Elder Mistreatment Mandatory Reporting Laws Improve Adult Protective Services: Investigation, assessment, care planning, case monitoring Better Educate Other Care Providers: Social service agencies; hospitals; long-term care insts. Law Enforcement-Criminal Justice System Victim assistance; perpetrator prosecution Comprehensive Community Services Multidisciplinary teams; community coalitions
Slide 44-

Des Moines Register 26Feb12
Slide 45-

Can Primary Elder Mistreatment Be Prevented? Depends on programs and political and administrative will: Better educating professionals Increasing community awareness Educate all older people and the those at risk Isolate and punish offenders where possible Protect vulnerable elders better? Very few actual trials of prevention programs