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Flashcards in Elder Abuse Deck (29):

elder abuse is a lethal crime

o After adjustment for age, socio-demographic factors and co-morbidity, elder abuse victims had a 3X greater risk of dying compared to unabused seniors.


elder mistreatment definition

-intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other persion who stands in a trust relationship to the elder
-failure by a caregiver to satisfy the elder's basic needs to protect the elder from harm


Most common types of elder abuse

-Neglect 27%
-Fiduciary 26%
-Physical 23%
-Psychological 21%
-Abandonment 2%
-Sexual assault 1%


Risk factors for elder mistreatment: victim and perpetrator

-advanced age
-dependent for basic activities of daily living
-combative behavior

-depression/mental illness
-alcohol or drug dependence
-financial dependence


dementing illness and abuse

-simply having a dementing illness places a person at increased risk for mistreatment, particularly if the person with dementia displays disruptive behavior


possible abuse indicators

-weight loss
-poor hygiene/elongated toenails
-inappropriate attire
-traumatic alopecia
-bruises in unusual locations
-pressure ulcers
-rectal/vaginal bleeding
-signs of sexually transmitted diseases


people among the least likely to report suspected abuse to Adult Protective Services

health care professionals (particularly physicians)


factors suggestive of abuse

o Delay in seeking treatment
o Confusing or unlikely causes of injury
o A past history of suspicious incidents


recognizing elder abuse

o Physical Abuse
o Financial Abuse
o Neglect
o Abandonment or Abduction
o Self-Neglect
o Sexual Assault
o Domestic Violence in Late Life


physical abuse

o Suspicious Fractures
o Bruising: Location, Dating of Bruises, Pattern Bruising
o Strangulation
o Restraints and Elder Abuse


primary hallmarks of neglect

o Pressure Ulcers
o Malnutrition
o Dehydration
o Feces


secondary hallmarks of neglect

o Delay in Seeking Care
o Rx Noncompliance
o Failure to Keep Medical Appointments
o Restraints



o Physical findings: Temporal/Thenar Wasting, Weight Loss/ FTT
o Laboratory Documentation: Albumin, Prealbumin, Cholesterol



o Clinical Findings: Poor Skin Turgor, Dry Mucous Membranes
o Laboratory Findings: BUN, Sodium


Pressure ulcers

o Risk Factor: Pressure, Friction, Moisture, Malnutrition
o Braden Scale
o Staging
o Treatment


Abandonment or abduction

o Abandonment: vulnerable elder left in an unsafe, unrealistic situation.
o Elder equivalent of latch-key kids
o Abduction: vulnerable elder removed from safe environment, with or without their consent.


financial abuse

o Greatest Transfer of Wealth Ever Seen is in the Next Decade: Rich vs poor, Old vs young
o Vulnerability Factors: Isolation, Loneliness, Financial Management Inexperience


the health care provider's role in cases of undue influence

o Substantiation of Cognitive Status: Mental Status Documentation, The Receptionist’s Role
o Substantiation of Vulnerability
o Inconsistencies and Foibles
o The Role of Romance
o Capacity Declarations
o Every note should contain notes on capacity


lessons for health care providers

Cognitive Assessment must Include Judgment

Victim Vulnerability
-Loneliness of Caring for a Partner with Dementia
-Belief that money will help guarantee a safe old age
-Hope that money will help heirs
-Romantic Involvement with Perpetrator


why are elders at risk for sexual assault

o Women Passive Historically
o Physically Weak/Disabled
o Lonely
o Shame
o Trusting
o “This can never happen to me”
o Thought Paranoid if Crime Reported


elder sexual assault: what we know

o Perpetrators often Male Caregivers
o Victims: Female, 70+, Suffer more severe genital trauma, Fail to report or seek medical care, Coded Disclosure


sexual abuse of dependent adults

o Only 3% Reported
o Prosecutions Difficult
o 86% of Women have been Sexually Assaulted
o 50% of these had been Sexually Assaulted > 10 Times



o Hoarding “The Diogenese Syndrome”: also known as senile squalor syndrome, is a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage or animals, and lack of shame. Sufferers may also display symptoms of catatonia.
o Self-Neglect and Depression
o Home Health and APS Home Visits


reporting elder abuse: 2 tracks

o Community: Adult Protective Services (APS)
o Institutional: Ombudsman


How to report elder abuse: the SOC 341

o Suspicion is Key
o Call Immediately
o FAX Written Report within 48 Hours


Forensic reporting of elder abuse

o OES 602 and how to find it:
o Key elements: Careful documentation of multiple forms of abuse, Cognitive and functional assessment, Body Diagrams, Documentation of underlying conditions, Establish pain and suffering
o Laboratory Evidence: Chemistry to document malnutrition and dehydration, Drug levels of prescribed/suspected drugs to assess caregiver’s excessive or failure to properly administer drugs
o Photodocumentation


elder abuse consultation

o Abuse Assessment: usually by SWS
o Geriatric Assessment: Functional Status, Cognitive Status. Environmental Evaluation, Housecalls, Capacity Assessment/Declarations
o Elder Abuse Reporting
o Capacity Assessments and Declarations
o Coordination with Aging and Adult Services: Adult Protective Services, In Home Supportive Services, Community Agencies
o Ombudsman
o Coordination with Law Enforcement: Police, Sheriff, Coroner, District Attorney
o Court Appearance as Expert


elder abuse consultation: post abuse care

Elder Abuse is a Repetitive Crime
-Coordination with Community Agencies
-Ongoing Surveillance
-Continuity of Care

Victim Care and Support
-Ongoing Social Observation
-Post-traumatic Stress Disorder Expertise
-Dementia and Depression Expertise


elder abuse teams

o Multidisciplinary Team
o Elder Death Review Team
o FAST Team: Family Assertive Support Team (for emotional/psychological health)