Geriatrics: elder abuse

Question 1

what is the prevalence of elder abuse in the US?

Answer 1

2 million older adults in the US each year

Question 2

screening for elder abuse?

Answer 2

AMA suggests screening geriatric patients, even in the absence of symptoms

Question 3

Only through ________, ________ and __________are physicians able to detect elder mistreatment.”

Answer 3

awareness, a healthy suspicion and the performing of certain procedures

Question 4

what are the two types of elder abuse?

Answer 4

domestic and institutional

Question 5

APS: 4 requirements for Validity (of elder abuse report)

Answer 5

1. Adult must be 60 years or older OR age 18-59 and incapacitated
2. Adult must be living and identifiable
3. Circumstances must allege abuse, neglect, or exploitation; and
4. The local department must be the agency of jurisdiction.

Question 6

6 types of elder abuse

Answer 6

Physical
Emotional
Sexual
Exploitation
Neglect
Abandonment

Question 7

what pt population is most likely to experience elder abuse?

Answer 7

old white women living alone

Question 8

what type of abuse accounts for the majority of reports to APS?

Answer 8

self-neglect

Question 9

4 reasons for elder abuse

Answer 9

1. Physical and mental impairment of the patient
2. Caregiver stress
3. Transgenerational violence
4. Psychopathology in the abuser: Drug and alcohol addiction, Personality disorders, Mental retardation
   Dementia

Question 10

two types of assessment for elder abuse

Answer 10

1. Hwalek-Sengstock Elder Abuse Screening Test
   (H-S/EAST)
2. Indicators of Abuse (IOA) Screen

Question 11

Hwalek-Sengstock Elder Abuse Screening Test
(H-S/EAST)
versus
Indicators of Abuse (IOA) Screen

Answer 11

H-S/EAST: Direct questioning of the elder person aimed at eliciting disclosure of abusive behaviors by caregivers or others
IOA: identification of risk factors

Question 12

two of the biggest risk factors for elder abuse

Answer 12

1. Cognitive impairment
2. A need for assistance with activities of daily living (functional debility)
   * both render the pt very vulnerable

Question 13

interviewing the pt, what questions to start with? what to follow up with?

Answer 13

Start with general questions about the patient’s sense of safety at home
Move to questions about who is responsible for helping the patient

Question 14

three things to note on PE?

Answer 14

General appearance/interaction with alleged abusers
Size, location, and number of skin lesions
Mental status  (dementia is a risk factor for abuse)

Question 15

lab workup, what should we look for (kinda weeds)

Answer 15

Evaluate for evidence of infection, dehydration, electrolyte abnormalities, malnutrition, improper medication administration and substance abuse.

Question 16

who are “mandated reporters”?

Answer 16

“any person licensed, certified, or registered by health regulatory boards…”

Mandated reporters must report immediately when suspected while performing official job duties.

Question 17

what 3 things must mandated reporters report?

Answer 17

1. Age of abused individual
2. Identity of the adult or location of the adult about whom the report is being made
3. Circumstances about the risk or suspected abuse, neglect and exploitation

Question 18

3 places where mandated reporters can report?

Answer 18

1. APS Unit of your local DSS in which the adult resides or in which the abuse occurred
2. If appropriate, to law enforcement and ME
3. 24-hour VA DSS Adult Abuse Hotline
   1-888-83-ADULT

Question 19

3 rights of mandated reporters

Answer 19

1. Immunity from civil and criminal liability
2. Protection of identity
3. Permitted to release confidential information without penalty

Question 20

what is the “main determinant of capacity” is …

Answer 20

cognition, and any condition or treatment that affects cognition may potentially impair decision-making capacity.