Protecting Our Elders

Kelly Steagall

PAS 645

Spring 2007

Elderly Population is on the Rise

Baby Boom occurred 1946-1964 Of the 70 million people born during the baby

boom generation, 65 million are alive today. It is estimated that by the year 2030, the number

of Americans over the age of 65 will be 71.5 million (This is about 1 In 5)

With this increase in elderly population comes an increased likelihood of elder abuse

Elder Abuse

Under-diagnosed Estimated 2.1 million elderly adults are

abused each year Victims have decreased quality of life,

increased feelings of helplessness and increased stress and psychological disorders (results in increased ER visits, hospitalization, and higher mortality rates)

Forms of Elder Abuse

Physical Emotional Sexual Neglect & Self Neglect Abandonment Financial Exploitation

Physical Abuse

Any act that intends to cause physical injury

Shaking Improper Restraining Hitting Over-/Under- medicating Depriving the individual of food

Signs and Symptoms of Physical Abuse

Unexplainable/Questionable Injuries Sudden behavioral changes Patchy hair loss Broken eye glasses Check medications for any signs of

over/under use Be wary if the caregiver refuses to allow

the pt. to be examined alone!

Emotional Abuse

Infliction of mental anguish or fear

Belittlement Threatening acts of violence Treating the elder adult as if they were a child

Signs and Symptoms of Emotional Abuse

Changes in emotional state or attitude• Withdrawn• Evasive or fearful• Ambivalent attitude toward caregiver

* Many times emotional abuse is difficult to identify unless the abuse has been witnessed

Sexual Abuse

Can range from forcing elderly adults to view pornographic material to rape

Often overlooked in the elderly population

Signs and Symptoms of Sexual Abuse

Unexplained vaginal or anal bleeding Torn or bloody undergarments Bruising of the breasts, inner thighs, and/or

genital area Unusual/Unexplainable difficulty in walking or

sitting Presence of an STI, oral venereal lesions, or

bruising of the uvula and/or palate Insomnia

Signs and Symptoms of Sexual Abuse cont…

Behavioral changes• Withdrawn• Depressed• Angry• Frightened• Heightened interest in sex or elicit sexual or

aggressive behavior

Neglect

Neglect occurs when a caregiver refuses or is unsuccessful in their attempts to provide adequate care

The victims are often Denied: • Food • Water• Shelter

Signs and Symptoms of Neglect

Poor personal hygiene Multiple Deep Decubiti Weight loss Malnutrition and/or dehydration

Self Neglect

Self inflicted and often unintentional

Elderly may refuse to eat, drink or take medication

May become abusive to the caregiver and/or become destructive

Signs and Symptoms of Self Neglect

Poor personal hygiene Malnutrition and/or dehydration Untreated health conditions Unsanitary living conditions Soiled or ragged clothing Refuses to take medication Lacks basic necessities at residence Admits to or shows signs of depression

Financial Exploitation

Ranges from simply misusing funds to committing embezzlement

Forgery or even forcing the elder adult to unknowingly transfer their property over to the caregiver

Signs and Symptoms of Financial Exploitation

Sudden changes in bank accounts Abrupt changes to the elder’s will Funds or personal property disappearing without

explanation Unpaid bills

Financial Exploitation is uncommonly reported by health care providers simply because they are usually unaware of the patient’s financial affairs

Who is at risk?

Elder adults who are:• Frail• Unable to accomplish basic daily activities• Dependent on a caregiver

Nearly all victims live with their abuser Women>Men Occurs most frequently in individuals with:

• Short term memory loss• Psychiatric disorders• Alcohol abuse

Reporting Elder Abuse

All states have APS laws but they differ from state to state

All APS laws provide protection from liability for those who report in good faith and with no malicious intent

You DO NOT need to obtain the pt.’s permission to report suspected abuse

Nearly all states (44) have mandatory reporting of suspected cases

Conclusion

Our Physician Assistant Professional Oath states:

“I will hold as my primary responsibility the health, safety, welfare and dignity of all human beings.”

Failure to properly report suspected cases of elder abuse completely disregards our professional oath

References

www-medlib.med.utah.edu/kw/derm/mml www.seniorjournal.com www.elderabusecenter.org www.centeronelderabuse.org www.oceansidepolice.com/Images/Elder_abuse_pl (SAAAPA) Student Academy of the American Academy of Physician

Assistants. 2007 Feb. [cited 2007 Feb 13] Available from: http://saaapa.aapa.org/students/grad/oath.htm

Pearsall C. Forensic Biomarkers of Elder Abuse: What Clinicians Need to Know. J Foren Nurs. 2005: 1(4):182-186

Dong X. Medical Implications of Elder Abuse and Neglect. Clin Geriatr Med. 2005; 21(2):293-313. PreMedline Identifier: 15804552

References cont…

American Psychological Association (APA) Elder Abuse and Neglect: In Search of Solutions 2006 January [cited 2006 Sept 26] Available from: http://www.apa.org/pi/aging/elderabuse.html

 Herbers J., Wei GS. Reporting Elder Abuse: A Medical, Legal, and Ethical Overview. J Am Med Women’s Assoc. 2004; 59(4):248-54. PreMedline Identifier:16845753

The AGS Foundation for Health in Aging. Elder Mistreatment. 2005 Feb 28. [Cited 2006 Sept 26] Available from: http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=9

Geller A., Zenick H. Aging and the Environment: A Research Framework. Environ Health Perspect. 2005 Sept.; 113(9): 1257-1262

Mayo Clinic. Elder Abuse: When You Suspect A Loved One’s Mistreatment. 2005 Jan 13. [updated 2006 Jul 24; cited 2006 Oct 2] Available from: http://www.mayoclinic.com/health/elder-abuse/HA00041

Mangione C., Rodriguez M., Wallace S., Woolf N. Mandatory Reporting of Elder Abuse: Between a Rock and a Hard Place. Annals of Family Medicine: 2006 Sept-Oct: 4 (5): 403-409