Multidisciplinary Research and Response

Kerry Burnight, PhDAssociate Professor, Geriatric MedicineUniversity of California, Irvine

CATEGORIES OF ELDER ABUSE

• Physical abuse

• Sexual abuse

• Emotional abuse

• Neglect

• Abandonment

• Abduction

• Financial exploitation

• Self-neglect

RISK FACTORS FOR ELDER ABUSE

• Isolation of caregiver-elder dyad

• History of abuse in either

• Abuser dependent on elder

• Mental illness in either

• Substance abuse in either

• Elder’s vulnerability and frailty

• Caregiver’s perceived distress

In a nutshellElder abuse is:

– Present in all demographics– increasing prevalence– often unrecognized by clinicians– most effectively addressed through most effectively addressed through

multidiciplinary collaboration.multidiciplinary collaboration.

Multidisciplinary Response

• MDTs• FAST• Medical Response Teams• County Coalition• Elder Abuse Forensic Center• Elder Death Review Team• Center of Excellence in Elder Abuse and Neglect• Collaboration Building

MDT

WIC 15753.5-"Multidisciplinary personnel team" means any team of two or more persons who are trained in the prevention, identification, and treatment of abuse of elderly or dependent persons and who are qualified to provide a broad range of services related to abuse of elderly or dependent persons. The team may include, but is not limited to: (a) Psychiatrists, psychologists, or other trained counseling personnel. (b) Police officers or other law enforcement agents. (c) Medical personnel with sufficient training to provide health services. (d) Social workers with experience or training in prevention of abuse of elderly or dependent persons.

WIC 15754 A

• Notwithstanding any provision of law governing the disclosure of information and records, persons who are trained and qualified to serve on multidisciplinary personnel teams may disclose to one another information and records which are relevant to the prevention, identification, or treatment of abuse of elderly or dependent persons

• Mission:Identify and promote legal remedies for elder abuse through

collaborative evaluation, consultation, education and research.

• Participating agencies:– UCI Program in Geriatrics– Adult Protective Services– Law enforcement agencies– District Attorney– Victim Assistance Program

- Long-Term Care Ombudsman

– Older Adult Mental Health Services

﹣ Human Options DV Services

Multidisciplinary Research

• Evaluation

• Forensic Markers

• Mistreatment of People with Dementia

• Detecting Abuse and Neglect

• Emotional Memory

• Theoretical Modeling

Evaluation

• Medical Response Team

• Elder Abuse Forensic Center

Forensic Markers: Bruising

• Completed study: Bruising in the Geriatric Population

• Ongoing study: Bruising as a Forensic Marker of Physical Elder Abuse

Accidental vs. Inflicted Bruising

*Mosqueda, L., K. Burnight, et al. (2005). J Am Geriatr Soc 53(8): 1339-43.

Accidental Bruising Study

• Objective: To determine common bruising patterns in people over the age of 65 years, including location, timing and sequence of color changes, relationship to functional status, and medications

• Funded by National Institutes of Justice

Forensic Markers

Location of Bruises

Finding: Nearly 90% of the observed bruises were on the extremities without a single bruise on the neck, ears, or genitals.

(108 bruises at Day 1)Forensic Markers

Other Findings

• Only 20% of the subjects knew the mechanism of injury.

• Those on medications (daily Prednisone, daily ASA, Warfarin, Plavix) – more likely to have multiple bruises– not a significant correlation with duration of

bruises.Forensic Markers

Bruising Associated with Physical Abuse

The research objectives:

1. Describe bruises associated with elder physical abuse.

2. Compare bruises in older adults who have not been abused with bruises inflicted on abused elders.

Forensic Markers

Methodology

• Research nurse recruits APS clients reported for physical abuse

• Skin examination & Interview

• LEAD* panel assesses presence of physical abuse

• Preliminary findings: N=59, 50 with confirmed physical abuse

Forensic Markers*Longitudinal, Experts All Data

Forensic Markers: Pressure Ulcers

• Multisite study of bedsores occurring in nursing homes under optimal conditions

• Comparable to accidental bruising study: baseline for later study of bedsores associated with neglect

• Data: Research Nurses examine pts. with stage 3&4 wounds; facility and pt. records.

• LEAD panel assesses Quality of Care

Funded by National Institutes of Justice

Mistreatment of People with Dementia

• Recently completed study: Abuse and Neglect of People with Dementia by Caregivers

Funded by California Dept of Health Services

• New study: People with Dementia as Witnesses to Emotional Events

Funded by National Institutes of Justice

Abuse and Neglect of People with Dementia by Caregivers:

Characteristics of the Individuals and their Relationship (potential “predictors”)

Care Recipient

recipeintCharacteristic

s

Caregiver

Characteristics

Common

Characteristics Demographics Demographics Living situation

Alzheimer’s disease stage Relationship to CR Outside resource use Depressive symptoms Depressive symptoms Premorbid relationship

Functional status Anxiety (state) Duration of care giving Medical status Health status

Dementia-related Behaviors

Perceived burden Social network Social network

Substance abuse Substance abuse Conflict Behavior Stress

Findings: Caregiver characteristics associated with psychological abuse

• Fewer years of education*• Living with the patient*• Longer duration of caregiving*• Caregiver perceived burden due to perceived

behaviors of the patient*• Poor emotional status**• Symptoms of depression*• Anxiety**

*p<0.05**p<0.01

Findings: Care Recipient characteristics associated with psychological abuse

• Lower income*

• Physical assault behaviors***

• Psychological aggression behaviors****

*p<0.05***p<0.005****p<0.001

Detecting Elder Mistreatment

• Develop a survey with Experts, using the gold standard for detecting DV and Child Abuse as the model

• Validate it in US elders (Caucasians & Mexican-Americans)

Funded by NIA and Archstone Foundation

Sample survey items:

In the past year, someone I know ….(physical abuse)• pinched or scratched me on purpose. • used a knife or gun on me.(psychological abuse)• insulted or swore at me in anger.• threatened to abandon me or put me in a nursing home.(financial abuse)• charged me for unnecessary work or work that was not completed on my

home.• cashed my social security or pension check and kept the money without my

permission.

Laying the Foundation to Build a Theoretical Model of Elder Abuse

Why does Elder Abuse and Neglect Occur?

Ageism? Entitlement? Opportuism? Caregiver stress? Resentment? Power Differential? Lack of Empathy? Mutual Conflict? Learned Violence? Psychopathology?

Nothing so Practical as a Theoretical Model

• Caregiver Stress Model

• Biomedical Model

• Dydadic Discord Model

• Power and Control Model

• Ecological Model

• Learned Violence

Our Collaborators

• The Elder Abuse Forensic Center • Orange County Adult Protective Services• Orange County Alzheimer’s Association• The Alzheimer’s Family Services Center • Orange County Senior Centers• UCI Institute for Brain Aging and Dementia• UCI Health Care Policy Research• UCI Physicians and Clinics• U Washington School of Nursing• U Wisconsin School of Medicine and Public Health

RESOURCES: NATIONAL • AARP: www.aarp.org• UCI Center of Excellence in Elder Abuse and Neglect:

www.centeronelderabuse.org• Administration on Aging: www.aoa.gov

• National Center on Elder Abuse: www.ncea.aoa.gov; • American Bar Association Commission on Law and Aging: www.abanet.org/aging• American Society on Aging:

www/asaging.org; Generationsjournal.org• Family Caregiver Alliance: www.caregiver.org

• Clearinghouse on Abuse and Neglect of the Elderly: http://db.rdms.udel.edu:8080/CANE/

RESOURCES: NATIONAL• Eldercare Locator: www.eldercare.org• National Clearinghouse on Abuse in Later Life:

www.ncall.us• National Committee for the Prevention of Elder Abuse:

www.preventelderabuse.org• National Council on the Aging: www.ncoa.org• Nursing Home Database:

www.medicare.gov/Nursing/Overview

RESOURCES: ORANGE COUNTY• UCI Center of Excellence on Elder Abuse and Neglect

www.centeronelderabuse.org

• Adult Protective Services 800 451 5155

• Sheriff: 714 834 3636

• Long-Term Care Ombudsman 800 300 6222

• Office on Aging 800 510 2020

• Forensic Center Coordinator 714 825 3087

Download form SOC 341 www.aging.ca.gov