CHP 425 case study on Elder Abuse

CHP 425 525Case Study #4: Elder Abuse
Directions:
Read the assigned chapters in the course textbooks (for the week’s covered by
this case study). Read the following information (statement and scenario).
Answer the questions at the end of the Scenario for E.A. using your textbooks,
the supplemental readings and other sources that you find to support your
statements. This case study should use the APA guidelines (title page (with
author notes), body (with your specific headings/subheadings),
citations/references, and graphs/tables/charts as appropriate). Please spell and
grammar check your submission prior to submitting via Blackboard –
Communications – Course Messages. No other forms of submission will be
accepted or graded.
Abuse of Older Adults can be verbal, emotional, financial or physical (National Council
on Aging, 2016). According to the NCOA (2016), abuse can also include not providing
necessary care or restraining Older Adults against their will. The lack of care or the
abuse of Older Adults’ resources constitutes a need for interventions to safeguard
elders’ health (Health in Aging, 2014). Often the abuse is at the hands of someone who
is entrusted with the Older Adults’ care and wellbeing, such as a family member (90% of
the time) or care provider (National Council on Aging, 2016). Often these Older Adults
are dependent upon these individuals for their care due to mental or physical
impairments (California Courts, 2016).
References
California Courts. (2016). Elder and Dependent Adult Abuse. Retrieved from
http://www.courts.ca.gov/selfhelp-elder.htm
Health in Aging. (2014, Mar 4). Preventing Elder Abuse and Neglect in Older Adults.
Retrieved from
http://www.healthinaging.org/files/documents/tipsheets/elder_abuse.pdf
CHP 425 525
National Council on Aging. (2016, Feb 24). Elder Abuse Facts. Retrieved from
https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/
Scenario
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E.A. is a 85 year old male who has been diagnosed with the following health
conditions:
o Hypertension (diagnosed at 55 years old)
o Arthritis (diagnosed at 65 years old)
o Dementia (diagnosed at 80 years old)
•
The following medications have been prescribed:
o Hydrochlorothiazide (HCTZ) – Refill 90 tabs/1x per month.
o Naproxen – Refill 90 tabs/1x per 3 months
o Haloperidol – Refill 90 tabs/1x per month
•
E.A. had been affluent during his working life and had been generous with his
income (even assisting his niece with the completion of her education through a
master’s degree).
•
E.A. had transferred the bulk of his estate (house and savings) over to his niece
(five years ago) in order to qualify for Medicaid spend down to eventually move to
a nursing home.
•
E.A. is currently living with his niece, since he is widowed (10 years ago) with no
children of his own, and is entirely dependent upon her for his care.
•
E.A. is seen at the emergency department at least once a month. According to
his niece he is accident prone and falls or bumps into things (resulting in sprains,
bruises or slight fractures). Fall prevention measures have been discussed.
CHP 425 525
•
E.A. has Medicare and Medicaid for his insurances due to minimal assets and
only social security income (from the Medicaid spend down).
•
E.A. has meals prepared by his niece who often feeds him whatever she has
available. His diet contains very little protein and mostly fast-food or junk food
nutritionally based.
•
Mostly, E.A. is confined to the house and doesn’t go out unless his niece is with
him. He is given a small allowance ($10/week) for groceries and other little
needs.
•
E.A. is considered underweight for his height (111 lbs. for 5’9”). A normal weight
would be between 128-175 lbs.
Questions for Case Study
1. What concerns do you have for E.A. regarding Elder Abuse? (Note: Explain
what conditions E.A experiences that may lead to abuse.)
2. What individuals/agencies should be involved in addressing these
concerns? (Note: Who should be included in the discussion or be
consulted regarding elder abuse? What risk factors would indicate
intervention was necessary?)
3. How would you develop an intervention/care strategy of reducing the
potential risks for E.A. experiencing elder abuse? (Note: What steps should
be taken to address the elder abuse that is occurring.)
4. What can E.A. do to reduce the potential for being a victim of elder abuse?
(Note: What changes may be necessary to reduce preventable elder
abuse?)
CHP 425 525
5. What other agencies can assist with improving E.A.’s potential for elder
abuse minimize adverse health effects? (Note: Think about what types of
policies or procedures are in place to protect Older Adults from abuse.)
6. What processes or procedures are necessary to safeguard E.A. from
experiencing further elder abuse? (Be specific as to policy and agencies
that need to be contacted – in what order of importance?)
N ATIONAL
A SSOCIATION
OF S TATE
U NITS ON
A GING
ISSUE BRIEF
N AT I O N A L C E N T E R O N E L D E R A B U S E
Domestic Violence in Later Life: A Guide to the Aging Network
for Domestic Violence and Victim Service Programs
AS THE “BABY BOOM” GENERATION born between 1946 and 1964 ages, it is likely more
victims of late life violence and abuse will seek out or be referred to the specialized
services provided by domestic violence programs. This potential calls for increased
collaboration between aging and domestic violence networks to assure maximum
support and safety for victims and survivors of abuse in later life.
The national aging network of State Units on Aging, Area Agencies on Aging, Tribal
and Native organizations, and direct service providers—especially long term care
ombudsman programs, adult protective services, legal services, and information and
referral/assistance—has a key role to play in speaking out for older victims.
With this Issue Brief we hope to encourage expanded dialogue and connections with
allied partners.
The Common Issue: Domestic Violence in Later Life
Domestic violence in later life occurs when older individuals are physically, sexually, or
emotionally abused, exploited, or neglected by someone [with whom] they have an ongoing
relationship. . . . Abusers intentionally use coercive tactics, such as isolation, threats,
intimidation, manipulation, and violence to gain and maintain control over the victim.
— National Clearinghouse on Abuse in Later Life
No matter what the victim’s age, abusers’ tactics are remarkably similar. Abusers
frequently look for someone they can dominate, people believed to be weak, people
unlikely or unable to retaliate. With respect specifically to abuse in later life, the
aggressors include spouses and former spouses, partners, adult children, extended
family, and in some cases caregivers.
As victims’ advocates know well, abusive behaviors such as punishing,
isolating, or depriving are at root about a desire for power and control. Power is used
to control where the victim goes, who the victim sees, what the victim can or cannot
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do; decision-making is curtailed; property and financial resources are exploited. A
sense of entitlement often underlies the abusive behavior.
The problem of abuse in later life occurs in all communities and affects people of all
ethnic, cultural, racial, economic, and religious backgrounds. Although most victims are
female, older men can be harmed, too.
Domestic abuse in later life and elder abuse often go hand in hand, and the
consequences on lives are very similar. Elder abuse, broadly speaking, includes physical,
emotional, sexual abuse, financial exploitation, neglect, self-neglect, and abandonment
of older persons — terms defined by law in state adult protective services (APS) statutes.
APS laws in most states address the needs of vulnerable adults over the age of 18 who
are living alone or with family and who are at risk of abuse, neglect, or exploitation. The
network on aging is charged with the responsibility under federal law to serve as a
visible advocate for older Americans age 60 and over.
About the Aging Network
The national aging network, established by Congress under the Older Americans Act
(OAA), is composed of 56 State Units on Aging, over 600 Area Agencies on Aging, and
thousands of public and private local service providers across the country. The U.S.
Administration on Aging, an office within the Department of Health and Human Services,
administers most OAA programs at the federal level.
The aging network serves as a main gateway to OAA programs and to the many
services supported by other federal, state and private sources. As a focal point, the
network coordinates access, community long-term care, and supportive services for
older Americans and their families. The array of services offered through the aging
network varies from state to state and county to county; however, the basic structure of
the aging service system is consistent throughout the country.
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State Units on Aging (SUAs) are agencies of state and territorial governments
designated by governors and state legislatures to administer, manage, design and
advocate for benefits, programs, and services for the elderly and their families and,
in many states, for adults with physical disabilities.
In addition to overseeing Older Americans Act-funded programs, SUAs have
significant policy, planning and advocacy roles in leveraging other federal, state,
local, public, and private funds to support programs on aging. Two-thirds of the
SUAs administer their state’s Medicaid waiver program (often called a home and
community-based service waiver), a program which aims to help people in need of
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significant daily activity support and health services to receive care at home. In over
half the states, the SUA administers adult protective services.
Some SUAs are members of state domestic violence councils. Some convene or
participate in intergovernmental working groups focused on older victims. Each SUA
has a staff member who has been designated the elder abuse contact at the state
level. State elder abuse contacts can provide consultation on the development of
aging network partnerships and collaborations. To locate the SUA in your state, visit
www.nasua.org/SUA_members.cfm.
Area Agencies on Aging (AAAs) play a pivotal role in communities across the country
in planning and developing services to respond to local needs. The AAAs support a
range of services in the community including legal assistance, in-home services,
information and referral/assistance, client assessment and care management, senior
centers, adult day care services, transportation, caregiver support, congregate meals,
meals on wheels, chore and homemaker services, telephone reassurance, and friendly
visiting.
In some states, AAAs are responsible for the delivery of adult protective services.
These services include receiving and investigating reports of elder abuse. Most AAAs
conduct elder abuse prevention activities such as public education campaigns, training
for mandated reporters and educational conferences. Guardianship and money
management programs, supported by AAAs in some areas, are examples of services
intended to protect those most at risk of abuse.
The AAA is the principal contact point for domestic violence programs interested in
local collaboration. Visit www.n4a.org/aboutaaas.cfm to learn more.
Use the National Eldercare Locator 1 800–677-1116 or visit www.eldercare.gov to
identify the AAA for your area. The Locator is a national, toll-free telephone referral
service connecting callers with state and local agencies on aging and community
services.
Aging Network Services at a Glance
The services available through the aging network offering support to victims of late life
domestic violence and elder abuse fall under four broad categories:
1. Access services
2. Elder rights
3. Services in the community
4. In-home services
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Access services
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Information and Referral Assistance (I&R/A). Millions of older people and their
families around the country receive assistance each year from a network of more
than 3,000 aging I&R/A programs and services. Many state agencies on aging have
toll-free 800 aging I&R help lines—and in some areas state and local Long Term Care
Ombudsman programs share a common intake line with the aging I&R/A.
Individuals can also call the AAA for information on services and resources available
locally.
Most aging I&R/A databases provide information on a wide variety of critical health
and human services. Increasingly, these databases are readily available to the public
online. Find out if the aging I&R/A in your area has information about domestic
violence services. If not, request to have local contact information included.
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State Health Insurance Counseling and Assistance Programs. The State Health
Insurance Counseling and Assistance Program, or SHIP, has trained volunteer
counselors in every state and several territories who are available to provide free oneon-one help with Medicare questions or problems. To locate a program in your area,
visit www.medicare.gov/contacts/static/allStateContacts.asp
SHIP services can be especially helpful for late life domestic violence victims —in
particular adults with disabilities under age 60 who have experienced problems with
Medicare, and those not yet enrolled.
Elder rights
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Legal Assistance. Legal services help those who could not otherwise afford an
attorney to obtain advice, information, and limited representation in civil law
matters such as financial abuse and exploitation, consumer problems, advanced
directives, and guardianship. These services are primarily provided by local legal
services entities in the community funded by AAAs.
At the state level, every SUA has a State Legal Service Developer on staff to
coordinate the provision of legal assistance. State and area agencies on aging work to
expand legal service availability through coordination with state/local bar
committees, the development of pro bono or reduced-fee panels and through
coordination with grantees of the Legal Services Corporation. Many states also
operate statewide legal hotlines.
Older Americans Act-funded legal services are free; however, the demand for
services far exceeds the dollars available. To meet the needs in the community, many
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programs establish case intake priorities. The AAA can provide more information
about legal resources for older persons in the area.
The following are examples of possible legal remedies for victims of late life violence
or elder abuse:
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Assisting a victim to enter into a new power of attorney arrangement and/or
revoke authority of an existing attorney in fact (the individual who holds a power
of attorney).
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Terminating the powers of a guardian who has abused his or her role.
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Providing defense for a proposed ward in a guardianship proceeding if an abuser is
attempting to gain control without looking out for the ward’s best interests.
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Returning title to a victim’s name for property, vehicles, certificates of deposit,
or bank accounts that were taken by a perpetrator.
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Filing an action to recover property or money wrongfully taken.
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Obtaining a restraining order or injunction to stop a perpetrator.
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Establishing a trust to protect the resources of a victim.
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Changing a will back to a testator’s/victim’s wishes from the changes made by a
perpetrator.
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Appealing a denial of public benefits, Social Security, or disability decision.
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Filing for a name change.
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Filing an order for removal of a perpetrator from a victim’s property.
The American Bar Association’s Law & Aging Guide can help you find a senior legal
services program in your area. You can search by state online at
www.abanet.org/aging/statemap.html For a listing of State Legal Services
Developers see www.tcsg.org/lsd_01.pdf
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SOURCE: Deanna Clingan-Fisher, “Elder Abuse and the Legal Services Connection,” National
Center on Elder Abuse Newsletter, Vol. 7, No. 7, May 2005.
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Long Term Care Ombudsman Program. Long term care ombudsmen at both the
state and local levels advocate for and protect the rights of residents in nursing and
care homes. Ombudsmen investigate and work toward resolution of complaints
about care voiced by residents or their family members. Federal law requires all
states to have a Long Term Care Ombudsman Program. A contact directory of state
ombudsman offices is available on the National Long Term Care Ombudsman
Resource Center Web site www.ltcombudsman.org
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Domestic violence doesn’t necessarily stop when a victim enters a nursing, assisted
living, or care home. In many instances, the ombudsman can identify and respond to
these situations. The ombudsman can also be a resource to a victim of domestic
violence who has a family member in a nursing home.
Similar to domestic violence intervention, the ombudsman focus is to clarify and
carry out the wishes of the resident. All communications between the resident and
the Ombudsman are confidential. Ombudsmen and domestic violence programs will
likely benefit from joint training to promote greater understanding and collaboration.
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Elder Abuse Prevention and Coalitions. Community and state advocates all around
the country are working to educate the public and increase understanding about
elder abuse. In addition to offering various resources on elder abuse such as
brochures, wallet cards with reporting numbers, posters, and service directories,
state and area agencies on aging help sponsor and organize multidisciplinary
conferences, training, and outreach presentations for community leaders, advocates,
allied professionals, and concerned citizens.
Aging network agencies also lead, coordinate, and participate in state and local elder
abuse coalitions. Membership in these coalitions includes law enforcement;
prosecutors; adult protective services; representatives from the health care sector;
emergency medical services; and other key partners. Often the coalitions develop
community projects to increase understanding and outreach to elder abuse victims.
Elder abuse prevention activities are mandated by the Older Americans Act. Domestic
violence programs, if not already involved in a state or local elder abuse coalition,
are encouraged to inquire about becoming a member. Similarly, to promote
collaboration and exchange, invite participation of elder abuse partners in state and
local domestic violence task forces and coordinating councils.
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Adult Protective Services. Adult protective services are authorized under state law.
Support is provided to both older and at-risk vulnerable adults who are in danger of
being abused or neglected, or who are unable to protect themselves and have no one
to assist them. Services include but are not limited to receiving and investigating
reports of abuse, neglect or exploitation, legal advocacy, and providing or arranging
for community services such as emergency shelter. Service plans are developed for
victims who agree to receive help. If the victim is unable to make decisions because
of mental illness or dementia and is at risk of continuing harm, adult protective
services may provide emergency services and/or petition the court for the
appointment of a guardian advocate.
The AAA in some areas of the country is the local provider of adult protective services; in
most states, however, the county social service agency is assigned responsibility.
Domestic violence programs seeking to improve services for victims of late life
violence and abuse are encouraged to coordinate with both sectors.
Ideally, opportunities would be offered for advocates in the aging, domestic violence,
and adult protective services sectors to participate in joint training so that each
better understands the other’s mandates, philosophies, challenges, and professional
cultures. To learn more, visit the National Center on Elder Abuse Web site
www.elderabusecenter.org.
Services in the community
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Senior Employment and Volunteer Opportunities. Senior employment services are
designed to link mature job seekers 55 and over with job opportunities. Incomeeligible persons are recruited, trained, and referred to job openings with local
employers. Funding for the Senior Community Service Employment Program, or
SCSEP, comes from the U.S. Department of Labor. SCSEP is operated by national,
state, and local agency sponsors. The ultimate goal is to place mature and older
workers in permanent, non-subsidized employment.
Volunteer opportunities abound in the aging network. Examples include friendly
visiting to shut-ins, volunteer ombudsmen service, home meal delivery, benefits
counseling, and senior companion services for developmentally disabled children
and adults.
SCSEP may be a source of help for older domestic violence victims who need job
coaching and a gradual, supportive entry into the world of work. According to AARP,
more than one quarter of SCSEP positions are filled by job seekers 55–59.
Volunteer opportunities in service to older persons may be particularly important for
domestic violence victims who feel isolated and for whom such experience would
enhance a sense of independence and self-worth. Volunteer opportunities can be
explored through contact with the AAA information and referral/assistance service.
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In-Home Supportive and Personal Care Services. A wide range of supporting inhome, homemaker, and chore services are available to assist older adults who need
help with everyday activities. These services are non-medical and may include such
things as light housekeeping, laundry, personal care, shopping and cooking,
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transportation, friendly visiting and telephone reassurance, respite, repair or yard
work, and case management. The AAA provides information and assistance in
accessing these services.
In-home supportive services help prevent social isolation and may help to reduce the
likelihood of elder abuse, neglect, and exploitation by family members.
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Senior Centers. There are now thousands of senior community centers around the
country. These community gathering places serve a variety of purposes, including
functioning as meal sites, screening clinics, recreational centers, social service agency
branch offices, mental health counseling clinics, older worker employment agencies,
volunteer coordinating centers, and community meeting halls.
Senior centers are key locations for reaching victims, or potential victims, of late life
domestic violence. They offer a convenient meeting place for community education
and discussion/support groups on domestic violence/elder abuse. They can also be a
resource for finding community volunteers. Local senior centers offer different types
of programs and services based on population needs and resource availability. For
more information, contact your local AAA.
Working with the Aging Network
As with other human service systems, the national aging network is diverse. At the same
time, however, members of the network share a common set of values and a single
vision: to protect the inherent dignity, security, and equal rights of all older Americans.
The key unifying values are these:
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Self-determination. The value of self-determination is based on a belief that all older
Americans, including residents of nursing and care homes, are entitled to plan and
manage their own daily lives: where they live, how they spend their money, what
services they receive, and other important daily decisions. Respect, active listening,
and open communication are essential tools for empowering choice and
independence. If a person loses decision-making capacity due to dementia or other
mental health need, a legal guardian or surrogate decision-maker may be appointed
(by the individual or court) to make decisions in his or her behalf.
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Advocacy. Uniquely in federal law, Older Americans Act authorizing legislation
requires state and area agencies on aging to be “visible and active advocates” for
older persons. In their role as “systems advocates” they speak out on policy issues;
testify at federal/state/local hearings; and identify unmet needs and gaps in
services. In parallel step, elder rights programs such as long-term care ombudsman
and legal assistance serve an individual advocacy role, speaking out for those who are
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without voice. There may be distinctions in how the aging network and the domestic
violence programs view their advocacy roles. This may be a fruitful place to start
identifying similarities and distinctions.
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Elder rights. The term “elder rights” reflects the aging network’s belief that older
people have a right to the many benefits, services, and protections promised in
law—not just aging statutes, but statutes covering the population at large. Older
persons’ needs are often ignored and access to important services denied. By
providing stepped-up information about benefits to help cut through red tape, legal
representation to solve problems, and protective services for those who are most
vulnerable, the aging network plays a key role in promoting elder rights. Typically,
the states’ elder rights systems focus on the coordination of adult protective, long
term care ombudsman, legal assistance services.
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Community-based long term care. This term encompasses the effort within the
aging network to offer elders with long term care needs health and supportive
services in their own homes and community. Homemaker, home-health aide, day
care, and personal attendant care are among the services provided. Medicaid
waivers fund a large proportion of these services. Caregiver support services (such
as respite care) are provided to help families maintain the elder in non-institutional
settings.
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Eligibility and fees. Other than age, there are no eligibility criteria restricting
services under the Older Americans Act. Other senior services, especially those
funded by special state appropriations and federal Medicaid waivers, may have
financial criteria for eligibility, require cost sharing, or be offered on a sliding fee
schedule. For many in-home services (home-delivered meals, homemaker and chore
services, for example) individual needs assessments establish service priorities.
There are waiting lists for many services. Under the Older Americans Act, priority in
home and community service delivery is given to those who are determined to be in
greatest need.
About the Older Victim: Common Indicators of Domestic Violence in
Later Life
New collaborations benefit from dialogue and common understanding. Not
surprisingly, the behavioral indicators of late life domestic violence parallel victim/
abuser scenarios found in other forms of domestic violence and are likely well known by
domestic violence staff. The chart on the next page, developed by experts in elder abuse,
is included here to underline the importance of recognizing potential victim and abuser
actions.
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Victim and Abuser Behaviors»
A Victim May . . .
Have injuries that do not match the explanation
of how they occurred
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An Abuser May . . .
Minimize or deny the victim’s injuries or
complaints
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Attempt to convince others that the victim is
incompetent or crazy
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Have repeated “accidental injuries”
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Blame the victim for being clumsy or difficult
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Appear to be isolated
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Physically assault or threaten violence against the
victim or victim’s family, friends, pets, in
home provider(s) or social worker
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Forbid the victim from contacting family, friends,
or service providers
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Threaten or harass the victim
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Stalk the victim
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Say or hint that she is afraid
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Act overly attentive towards the victim
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Give coded communications about what is
occurring
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Act loving, kind, and compassionate to the victim,
especially in presence of others
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Consider or attempt suicide
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Consider or attempt suicide
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Have a history of alcohol or drug abuse
(including prescription drugs)
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Have a history of alcohol or drug abuse
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Be “difficult” or hard to get along with
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Refuse to allow an interview with the victim to
take place without being present
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Speak on behalf of the victim, not allow the
victim to participate in the interview
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Have vague, chronic, non-specific complaints
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Say victim is incompetent, unhealthy or crazy
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Be emotionally and/or financially dependent
on the abuser
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Be emotionally and/or financially dependent on
the victim
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Miss appointments
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Cancel the victim’s appointments or refuse to
provide transportation
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Delay seeking medical help
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Cover up the abuse by taking the victim to
different doctors, hospitals, or pharmacies
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Refuse to purchase needed prescriptions,
medical supplies, and/or assistive devices
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Turn family members against the victim
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Talk about the victim as if he or she is not
there or not a person (dehumanize victim)
Show signs of depression (mild or severe),
stress, or trauma
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Excerpted and adapted with permission from Elder Abuse: A Multidisciplinary Approach (in press), by
Bonnie Brandl, Carmel Dyer, Candice Heisler, Joanne Otto, Lori Stiegel, and Randy Thomas. New York:
Springer
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Responding to and Working with Older Victims
Ending a relationship is always difficult, particularly when it is a loved one. Most
victims of abuse in later life prefer to maintain some type of relationship with their
spouse/partner, family member, or caregiver – they simply want the abuse to end.
Some older victims will choose to stay with an abuser, often for religious, cultural,
generational, or financial reasons. These victims can benefit from support, information,
safety planning and strategies to break isolation.
Personal values formed by an individual’s background, experience, and beliefs also
play a role. It is important to respect the victim’s values, decisions, and cultural heritage.
Some cultural groups may be more willing to report abuse or talk to professionals about
family problems than others. Race, culture, or ethnicity may influence body language,
eye contact, and expressions of emotion.
Generational values are also involved. Many older persons may be uncomfortable
talking about personal, private matters with strangers. They may fear younger
professionals imposing their own generational values about divorce or women’s roles
onto them and judging their decisions.
Some tips for establishing rapport are:
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The setting. Establish comfort. Choose a quiet place and face the person directly.
Pay attention to lighting; reduce glare from outside sources.
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The conversation. Use respectful and formal terms of address: Mrs., Mr., and so
on. Introduce yourself clearly. To help reduce stress, start with a non-threatening
topic. Speak calmly and clearly in a normal tone. Avoid jargon.
•
Active listening. Show from the start that you accept the person and understand.
Listen for meaning. Restate, “Let’s see if I’m clear about this.” Reflect, “This seems
to be really difficult for you.” Validate, “I appreciate your willingness to talk
about such a difficult issue.”
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The plan. Engage the victim in deciding what the next steps should be. “Let’s
explore the options.” Reinforce steps that have been taken so far. Recognize that
decisions may take time. Don’t rush. Slow down to give the victim time to sort
out what he or she has heard.
Domestic Violence/Aging Network Collaborations
The aging network and domestic violence programs are natural allies in the fight against
violence in all its forms. Examples of collaboration include participation on
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multidisciplinary teams, involvement in coalitions, joint training, joint referral protocols,
public education, and policy development.
The National Center on Elder Abuse Promising Practices Database
www.elderabusecenter.org/default.cfm?p=toolsresources.cfm contains a listing of several
projects around the country that provide services in collaboration with domestic
violence programs. These projects may serve as examples for aging network staff
seeking to form new partnerships.
The Wisconsin Coalition Against Domestic Violence, National Clearinghouse on
Abuse in Later Life also has compiled profiles of several elder specific services that are
provided by domestic violence programs. A summary can be viewed at
www.ncall.us/docs/NCALL_Directory.pdf
State and National Resources on Late Life Violence
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National Domestic Violence Hotline 1-800-799-SAFE (7233) or 1-800-787-3224 (TTY)
www.ndvh.org/ Help is available to callers 24 hours a day, 365 days a year.
Assistance is available in English and Spanish with access to more than 140
languages through interpreter services.
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Domestic Violence and Sexual Assault State Coalitions work with statewide
systems and agencies on behalf of the needs and interests of victims of
abuse/assault. Coalitions are membership organizations comprised of local domestic
violence and sexual assault agencies and other organizations and individuals
dedicated to the elimination of abuse. Most do not provide direct services to victims
of abuse.
Areas where they can help include: public awareness, professional training,
community education, information and referral, resource and materials
development, technical assistance, and consultation. Coalitions also monitor state
and national legislation and lobby to support the creation of laws that increase
victim safety and support and hold perpetrators accountable.
A contact directory of state domestic violence coalitions is available on the U.S.
Department of Justice, Office of Violence Against Women Web site at
www.usdoj.gov/ovw/state.htm. To locate your state sexual assault coalition, see
www.usdoj.gov/ovw/saresources.htm
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12
National Center on Elder Abuse, funded by the U.S. Administration on Aging, is a
gateway to a wealth of information on subjects ranging from elder abuse and neglect
to financial exploitation, nursing home abuse, and domestic violence in later life.
Examples of publications are Domestic Violence: Older Women Can Be Victims Too and
Multidisciplinary Elder Abuse Prevention Teams: A New Generation. For more
information, call (202) 898-2578, e-mail ncea@nasua.org, or visit the NCEA Web site at
www.elderabusecenter.org
ƒ
National Clearinghouse on Abuse in Later Life, a project of the Wisconsin Coalition
Against Domestic Violence, has numerous publications and resources concerning
older battered women and sexual assault including. Examples include Golden Voices:
Support Groups for Older Abused Women and A National Domestic Abuse in Later Life
Resource Directory. For more information, call (608) 255-0539, e-mail
wcadv@wcadv.org, or visit the Clearinghouse’s Web site at www.ncall.org
ƒ
American Bar Association Commission on Law and Aging has produced a Resource
Packet on Domestic Violence and Sexual Abuse in Later Life with funding from the Office
on Violence Against Women at the U.S. Department of Justice. For more information,
call (202) 662- 8690 or e-mail abanet@abanet.org, or visit
www.abanet.org/aging/resourcepack.pdf
ƒ
Clearinghouse on Abuse and Neglect of the Elderly is the nation’s largest
computerized collection of scholarly references and other resources relating to elder
abuse, neglect, and exploitation. To search for literature, visit the CANE Web site at
http://db.rdms.udel.edu:8080/CANE/index.jsp. To narrow the search, key in ‘domestic
violence’ or ‘older battered women.’ For more information, call (302) 831-3525 or e-mail
CANE-Ud@udel.edu
ƒ
National Resource Center on Domestic Violence, a project of the Pennsylvania
Coalition Against Domestic Violence, provides technical assistance, training and
information on domestic violence and related issues. For more information, call 1800-537-2238, or visit the Center’s Web site at www.vawnet.org/index.php
ƒ
National Coalition Against Domestic Violence is a national organization of
grassroots shelter and service programs for battered women. It serves as a national
information and referral center on domestic violence. For information, technical
support, or referral, call (303) 839-1852, e-mail mainoffice@ncadv.org, or visit the
Coalition’s Web site at www.ncadv.org/
ƒ
Asian & Pacific Islander Institute on Domestic Violence serves as a forum for, and
clearinghouse on information, research, resources, and critical issues about violence
against women in Asian and Pacific Islander communities. For more information,
call (415) 954-9988, e-mail apidvinstitute@apiahf.org, or visit the Institute’s Web site at
www.apiahf.org/apidvinstitute/default.htm
ƒ
Sacred Circle, National Resource Center to End Violence Against Native Women
provides training, consultation, and technical assistance to Indian Nations, tribal
organizations, law enforcement agencies, prosecutors, and courts to address the
13
safety needs of Native women who are battered, raped and stalked. It is a project of
Cangleska, Inc., which operates a shelter on the Pine Ridge reservation in
southwestern South Dakota. For more information, call (605) 341-2050, e-mail
scircle@sacred-circle.com, or visit the Sacred Circle Web site at www.sacred-circle.com/
ƒ
Alianza – National Latino Alliance for the Elimination of Domestic Violence is
part of a national effort to address the domestic violence needs and concerns of
under-served populations in Latino communities. For more information, call (800)
342-9908 or 1 -800-342-9908, e-mail inquiry@dvalianza.org, or visit the Alianza Web
site at www.dvalianza.org
ƒ
Institute on Domestic Violence in the African American Community is focused on
setting an agenda to reduce/eliminate domestic violence in the African American
community. For more information, call (612) 624-5357, e-mail nidvaac@che.umn.edu,
or visit the DV Institute Web site at www.dvinstitute.org
ƒ
Institute on Aging, San Francisco Elder Abuse Prevention Program has worked
with local and national organizations to create several publications on late life
domestic violence. Titles include: Domestic Violence and the Elderly: A Cross-Training
Curriculum in Elder Abuse and Domestic Violence; Serving the Older Battered Woman: A
Conference Planning Guide; and Older Battered Women: Integrating Aging and Domestic
Violence Services. For more information, call (715) 750-4188, e-mail,
elderabuseprevention@ioaging.org, or visit the IOA Web site at
www.ioaging.org/programs/eap/eap.html
ƒ
American College of Obstetricians and Gynecologists, Division of Women’s
Health Issues has produced a variety of materials about domestic violence and older
battered women. For more information, call (202) 863-2487, or visit the ACOG Web
site at www.acog.org/departments/dept_web.cfm?recno=17
ƒ
Area Agency on Aging, Region One, Phoenix has produced an educational video,
The Dance, available in English and Spanish (Nuestro Baile), depicting the life of an
older battered woman. For more information or to order a copy of the video, call
(602) 264-2255 or 1-888-783-7500. Or visit the agency’s Web site at
www.aaaphx.org/main/domesticViolence.asp
ƒ
American Medical Association has developed diagnostic and treatment guidelines
for physicians on topics of domestic violence and elder abuse. For more information,
call (312) 464-5066, or visit the AMA Web site at www.amaassn.org/ama/pub/category/3242.html
ƒ
Family Violence Prevention Fund has a number of helpful publications on domestic
violence. For more information, visit the FVPF Web site at http://endabuse.org/
14
Sources
Albright, Ada, Bonnie Brandl, Julie Rozwadowski, and Mary K. Wall. Building a Coalition to Address Domestic
Abuse in Later Life. National Clearinghouse on Abuse in Later Life and AARP Foundation National
Legal Training Project, 2004 www.ncall.us/docs/BuildingCoalitionParticipantRev.pdf
Brandl, Bonnie, Carmel Dyer, Candice Heisler, Joanne Otto, Lori Stiegel, and Randy Thomas. Elder Abuse: A
Multidisciplinary Approach. New York: Springer, in press.
Clingan-Fisher, Deanna. “Elder Abuse and the Legal Services Connection,” National Center on Elder Abuse
Newsletter 7 (May 2005) www.elderabusecenter.org/enews/nceaenews050531.cfm
National Aging Information and Referral Support Center. “The Art of Active Listening,”Aging I&R Tip Sheet
No. 1. Washington, DC: National Association of State Units on Aging, 2005
______. “The Art of Active Listening,”Aging I&R Tip Sheet No. 5. Washington, DC: National Association of
State Units on Aging, 2005
Schechter, Susan. Guidelines for Mental Health Practitioners in Domestic Violence Cases. Washington, DC:
National Coalition Against Domestic Violence, 1987.
The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, adult
protective services, law enforcement and legal professionals, medical and mental health providers, public
policy leaders, educators, researchers, and concerned citizens. It is the mission of NCEA to promote
understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.
NCEA Partners
ƒ
National Association of State Units on Aging Lead Partner
ƒ
American Bar Association Commission on Law and Aging
ƒ
Clearinghouse on Abuse and Neglect of the Elderly at the University of Delaware
ƒ
National Adult Protective Services Association
ƒ
National Committee for the Prevention of Elder Abuse
National Center on Elder Abuse
National Association of State Units on Aging
1201 15th Street, NW, Suite 350
Washington, DC 20005
202.898.2586 / Fax 202.898.2538
ncea@nasua.org
www.elderabusecenter.org
Major funding support for the National Center on Elder Abuse comes from the U.S. Administration on
Aging, Department of Health and Human Services, Grant no.90-AM-2792. The ideas and opinions
expressed in this document are solely of the authors, and do not necessarily reflect the official position or
policies of the federal government.
This Issue Brief was prepared by Sara Aravanis, Director of Elder Rights, National Association of Units on
Aging and Director, National Center on Elder Abuse. Expert consultation on domestic violence was
provided by the National Clearinghouse on Abuse in Later Life. Edited by Susan Coombs Ficke, National
Association of State Units on Aging.
NCEA Issue Brief
March 2006
15
Caregiving Resources
Online Support
Caregiver Forum: http://caregiveraction.org/forum
Family Caregiver Tool Box: http://caregiveraction.org/family-caregiver-toolbox
Facebook: The Fearless Caregiver:
https://www.facebook.com/groups/99391001688/?multi_permalinks=10153360697846689¬i
f_t=group_highlights
Alzheimer’s Disease
Alzheimers.Gov: http://www.alzheimers.gov/
Coping with Alzheimers: http://caregiveraction.org/resources/alzheimer-videos
Today’s Caregiver: http://www.caregiver.com/index.htm
Family Caregiver Alliance
Caregiver Issues and Strategies: https://www.caregiver.org/caregiving-issues-and-strategies
Fact and Tip Sheets: https://www.caregiver.org/fact-sheets
Caregiver Education: https://www.caregiver.org/caregiving-webinars
Videos for Caregivers: https://www.youtube.com/user/CAREGIVERdotORG/videos
AgingCare.com (some content can be a bit off-putting.)
Caregiver Support: https://www.agingcare.com/Caregiver-Support
Caregiver Support Discussions: https://www.agingcare.com/Caregiver-Support/Discussions-1
Q&A: https://www.agingcare.com/Caregiver-Support/Questions-1
Eldercare Locator: Caregiving
http://www.eldercare.gov/eldercare.net/public/resources/topic/Caregiver.aspx
ARCH National Respite Network
http://archrespite.org/lifespan-programs
AARP Caregiving
http://www.aarp.org/home-family/caregiving/
Caregiver Action Network: http://caregiveraction.org/
Centers for Disease Control and Prevention
Caregiving Resources: http://www.cdc.gov/aging/caregiving/resources.htm
Caregiver Series YouTube Videos

National Alliance for Caregiving: http://www.caregiving.org/
FAMILY VIOLENCE IN LATER LIFE
& SEXUAL A
L
A
BUS
C
SI
Y
E
PH
PHYSICAL ABUSE:
SEXUAL ABUSE:
Slaps, hits punches.
Throws things. Burns.
Makes demeaning
Chokes. Breaks bones.
remarks about intimate
body parts. Is rough with
intimate body parts during
caregiving. Takes advantage of
physical or mental illness to
engage in sex. Forces you to
perform sex acts that make you
feel uncomfortable or that are
against your wishes.
Forces you to watch
pornographic movies.
THREATS/
INTIMIDATION:
Threatens to leave,
divorce, commit suicide, or
institutionalize. Abuses or
kills pets or prized livestock.
Destroys property.
Displays or threatens
with weapons.
ABUSING
DEPENDENCIES/
NEGLECTING:
FINANCIAL
EXPLOITATION:
Steals money, titles, or possessions.
Takes over accounts, bills, and
spending without permission.
Abuses power of attorney.
Takes walker, wheelchair, glasses,
dentures. Takes advantage of confusion.
Denies or creates long waits for food, heat,
care, or medication. Does not report medical
problems. Understands but fails to follow medical,
therapy, or safety recommendations. Makes you
miss medical appointments.
Power
&
Control
RIDICULING VALUES/
SPIRITUALITY:
USING PRIVILEGE:
Treats you like a servant.
Makes all major decisions.
Denies access to church or clergy.
Makes fun of personal values. Ignores
or ridicules religious and/or cultural
traditions.
EMOTIONAL
ABUSE:
ISOLATION:
Controls what you do, who
you see, and where you
go. Limits time with friends
and family. Denies access to
phone or mail.
PH
Adapted by the Wisconsin Coalition Against Domestic
Violence (608.255.0539) based upon the model
developed by the Domestic Violence Intervention
Project, Duluth, MN.
YSIC
USING FAMILY
MEMBERS:
Magnifies
disagreements.
Misleads members
about extent and
nature of illnesses/
conditions. Excludes
or denies access to
family. Forces family
to keep secrets.
Humiliates, demeans,
ridicules. Yells, insults, calls
names. Degrades, blames.
Witholds affection. Engages
in crazy-making behavior.
Uses silence or profanity.
AL & S E X U AL
Produced and distributed by:
S
U
B
A
E
Grand Valley State University
ScholarWorks@GVSU
Masters Theses
Graduate Research and Creative Practice
1996
The Detection and Reporting of Elder Abuse and
Neglect: A Training Video for Prehospital
Personnel
Jason P. Seamon
Grand Valley State University
Follow this and additional works at: http://scholarworks.gvsu.edu/theses
Part of the Education Commons, Medical Education Commons, and the Sociology Commons
Recommended Citation
Seamon, Jason P., “The Detection and Reporting of Elder Abuse and Neglect: A Training Video for Prehospital Personnel” (1996).
Masters Theses. Paper 272.
This Thesis is brought to you for free and open access by the Graduate Research and Creative Practice at ScholarWorks@GVSU. It has been accepted
for inclusion in Masters Theses by an authorized administrator of ScholarWorks@GVSU. For more information, please contact
scholarworks@gvsu.edu.
THE DETECTION AND REPORTING OF ELDER ABUSE & NEGLECT:
A TRAINING VIDEO FOR PREHOSPITAL PERSONNEL
By
Jason P. Seamen
A Thesis
Submitted to
Grand Valley State Universiiy
In partial fulfillment of the requirements
for the degree of
MASTER OF HEALTH SCIENCE
Faculiy Supervising Project:
Theresa Bacon-Baguley, Ph.D.
Supporting Physician:
Jeffreys. Jones. M.D.
“ABSTRACT”
THE DETECTION AND REPORTING OF ELDER ABUSE & NEGLECT;
A TRAINING VIDEO FOR PREHOSPITAL PERSONNEL
by
Jason P. Seamen
The Em ergency Medicine Residency Program a t B utterw orth
Hospital in G rand Rapids, Michigan developed an instructional video for
prehospital personnel in hopes of broadening their awareness about elder
ab u se an d neglect. A sample of 60 EMS personnel were asked to
complete a pretest in order to assess cu rren t knowledge of the subject
m atter, view the educational video, and then complete the posttest. This
session was used to evaluate the video as a potential training device.
While the study population reported seeing 256 suspected cases of abuse
or neglect in their careers, only 11 (4%) were reported. Furtherm ore,
60% of the respondents thought th at the prevalence of elder abuse and
neglect was rather rare. This response dropped to 38% after seeing the
video. The 60 EMS respondents had an average pretest score of 5.35,
and an average posttest score of 10.03, resulting in an overall score
improvement of +4.68 points.
ACKNOWLEDGEMENTS
This research study was made possible by the helpful guidance
and support of my consulting physician, Jeffrey S. Jones, M.D. I would
also like to th a n k Doug Sm ith and Jon Krohmer, M.D. of Kent County
EMS for th eir time and effort in helping to schedule the EMS portion of
th is study. I am grateful to the entire staff at the Cook Institute for
R esearch & E ducation a t B utterw orth Hospital, for their continued
encouragem ent and support. In particular, 1 th an k J a n Nowicki for her
creativity a n d clerical efforts. Finally, 1 would like to m ake special
acknow ledgem ent of my graduate academic advisor, Theresa BaconBaguley, R.N., Ph.D. who has not only guided me through this program,
but has also become a true friend.
DEDICATION
I dedicate th is work to my parents, David M. and Cheryl L.
Seam en.
Their unconditional love an d never-ending su p p o rt has
inspired me to challenge my abilities and believe in myself. They are
more than ju s t parents, they are my best Mends. Thank you for always
being there.
ii
Table of Contents
Page
List of T ab le s…………………………………………………………………………. iv
List of A ppendices…………………………………………………………………..v
CHAPTER
1 INTRODUCTION………………………………………………………..1
2 MATERIALS & METHODS……………………………………….. 8
3 RESULTS……………………………………
12
4 DISCUSSION…………………………………………………………… 15
5 CONCLUSION…………………………………………………………… 18
ili
List of Tables
Table
Page
1
Indications of Possible A b u se………………………………………… 2
2
Indications of Possible Neglect……………………………………….3
3
Relationships Between Perpetrators & Their V ictim s
4
Organization of the Training V ideo……………………………….. 10
5
Demographics of the Study P opulation…………………………. 12
6
Study Population’s Experience With Elder
6
Abuse & N eglect………………………………………………….13
7
Prevalence of Elder Abuse & N eglect……………………………..13
8
Average Score R e su lts……………………………………………………14
9
Reasons for Not Reporting Cases of Elder
Abuse & Neglect………………………………………………….16
10
Additional Comments by EMS R espondents…………………. 17
iv
List of Appendices
Appendix
Page
A Pretest: Elder Abuse and Neglect………………………………. …… 20
B Primary Posttest: Elder Abuse and N eglect……………………..22
CHAPTER ONE
INTRODUCTION
Elder abuse is defined as the m istreatm ent of an older adult (65
years of age or older), usually by a relative or other caregiver. Its various
forms include battery, neglect, abandonment, and exploitation. It may be
intentional, which involves a conscious and deliberate attem pt to inflict
harm or injury, or it may be unintentional where an action inadvertently
results in harm to the elderly. It has been estimated th at over 2 million
persons in the United States experience elder abuse each year, m ost of
them repeatedly and in multiple fo rm s, i 2
In the past, research on domestic violence has focused primarily on
child and spouse abuse. Despite the num erous surveys th a t docum ent
the increasing exposure of medical professionals to elderly victims, the
abuse and neglect of older persons h as received little attention in the
medical literature. A possible explanation for this trend is th a t elder
abuse m ay be more difficult to identify th an child or spousal abuse
because of professional an d public unaw areness, lack of detection
guidelines or protocols, relative Isolation of the victims, and reluctance to
report an occurrence. In addition, many cases involve only subtle signs
such as poor hygiene or dehydration, and are likely to pass undetected.
Because of these factors, it is estimated th at only one in 14 cases of elder
abuse comes to the attention of a u t h o r i t i e s . 2 . 3
The American Medical Association has described elder abuse and
neglect as “actions or the omission of actions th a t result in harm or
threatened harm to the heedth or welfare of the e l d e r l y .
More th an 30
different forms of elder abuse have been described in various studies, all
of which can be condensed into five prim aiy categories: physical abuse,
neglect, psychological abuse, violation of personal rights, and financial
abuse. ^
Physical abuse can be defined as the Infliction of physical pain,
injury or coercion on an individual. The identified physical acts of elder
abuse include beating, withholding care (personal or medical), lack of
supervision, sexual abuse, physical battering, intentional o v er/u n d er
medication, forced confinement, bruising, cutting, burning, or physically
restraining an older I n d i v i d u a l . 6.7,8 Indications of possible physical
abuse, as described by Jones et al® are seen In Table 1.
Table 1
In d ication s o f P ossib le A buse *
-Delay In seeking medical care for Illness or Injury
-Conflicting or Implausible accounts regarding how injuries
occurred
-History of similar episodes or of other suspicious injuries In the
past
-Multiple Injuries in various stages of healing
-Unusual soft tissue Injuries (bite m arks or scalp hemorrhage)
-Eye injuries or broken teeth
-Bum s (cigarette. Immersion, or friction burns firom restraints)
*As described by Jones et al^
Neglect of an older person can be defined as th e failure of the
caregivers to provide goods or services th a t are necessary for maintaining
the activities of dally living.^ The three forms of neglect most prevalent
in elder abuse are active, passive, and self-inflicted neglect (also known
simply as self-neglect). Active neglect, as defined by Wolf et al^, is the
refusal or failure to fulfill a caretaklng obligation Including a conscious
and intentional attem pt to Inflict physical and emotional distress on the
elder. Such ac ts Include abandonm ent, the denial of food or medical
care, or withholding needed appliances such as glasses, hearing aids, or
walkers. Passive neglect, on the other hand. Is the refusal or failure to
fulfill caretaklng obligations excluding a conscious and in tentional
attem p t to inflict physical or emotional distress on th e elder. This
includes passive abandonm ent, nonprovision of food or medical services
because of inadequate knowledge, laziness, infirmity, or disputing the
value of prescribed services.® Self-inflicted neglect {self-neglect) is the
failure of persons to provide the essentials for themselves. Given th at
older adults are ethically entitled to refuse medical treatm ent despite the
fact th a t such refusal may end in death, they are equally entitled to make
less life-threatening choices regarding personal eating habits, dress,
cleanliness, an d other elem ents of life style.® Indications of possible
neglect as described by Jones et al® are presented in Table 2.
Table 2
In d ic a tio n s o f P o ssib le N eglect *
-Filthy living conditions
-Soiled linens or clothing
-Lack of necessities (heat, food, or water)
-Lack of necessary equipment (walkers, canes, dentures, glasses,
or hearing aids)
-Placed in restraints while no one is in the house
-Inappropriate clothing for the season
-Bed sores
-M alnutrition or dehydration
-Evidence of improper adm inistration of medications
*As described by Jones et al®
Psychological abuse is defined as the infliction of m ental anguish
upon a n older person. It comes in th e form of verbal a s sa u lts and
th re a ts provoking fear and isolation.^ It also includes being called
nam es, treating the elder as a child, frightening, or isolating the elder.®
Violation of personal rights occurs when caregivers or providers
ignore th e older person’s inalienable or legal rights and capabilities to
m ake decisions for themselves.® S uch acts can include denying an
individual privacy, opening their mail, not allowing them to m ake or
receive phone calls, forcing them out of their own home and into another
dwelling, or prohibiting simple contact with the outside world through
newspapers or telecasts.
Financial abuse is defined as the illegal or improper exploitation or
use of funds or other resources.® Such abuse may be suspected if an
older person has been coerced into giving power of attorney to a relative,
if he or she is unaw are of their financial statu s (including net worth and
bills th a t are being paid), or if the elder is receiving care below th eir
financial means.
As described by Jones et al,® the majority of victims suffer more
than one type of m istreatm ent since the occurrence of one form of abuse
or neglect seem s to provoke other forms. In 1990, there were 211,000
cases of elder ab u se and neglect reported nationwide to the Adult
Protective Services (APS). Of these, 5000 (2.4%) were from Michigan with
th e m ajority of cases representing neglect or self-inflicted neglect,
followed by physical and financial abuse. On the surface, it may seem as
though Michigan represents only a small portion of the elder abuse in
our country, b u t recall th at only one in 14 cases are even reported.®
An im portant consideration of any form of abuse or neglect is the
etiology behind the act itself. J u s t as with child and spouse abuse, a
num ber of theories have come to the surface in the hopes of explaining
why elder ab u se and neglect exist in our society. Five of the m ost
prom inent theories for elder abuse have been described by Lachs et al.i®
The social teaming theory contends th a t violence is learned, w hich
im plies th a t children learn to be violent by experiencing violence
themselves. This theory suggests th at abused children grow up to not
only abuse their own children, but to abuse their parents as well. The
stressed caregiver theory contends th a t elder abuse occurs w hen the
stress threshold of the caregiver has been exceeded. This can be a resu lt
of external sources or stem from the actu al caregiving itself. The
isolation theory suggests th a t the shrinking social network of the elder
becomes a major risk factor for the abuse and neglect. It is im portant to
understand th a t this theory does not blame the older persons themselves
for the abusive acts. Rather, it focuses on the fact th a t as people age,
their chances of dying increase. Therefore, older individuals may have a
smaller social network which in tu rn becomes a risk factor for the abuse.
The dependency theory concentrates on the functional frailty and the
medical illness th a t the older person exerts on the caregiver. In this
instance, the constant pressure of being depended upon can lead to the
caregiver’s abusive actions. Finally, there is the psychopathology o f the
abuser theory which em phasizes the non-normal characteristics of the
ab u se r’s personality. A caregiver who is a su b stan ce a b u se r or is
mentally handicapped, may not have the capacity to make appropriate
decisions about the older person and their well being. O ther potential
causes for elder abuse and neglect may include a lack of knowledge by
caregivers, ageism, greed, social isolation of the elderly victim, an d lack
of community support.
It is evident th a t theories regarding the etiology of elder abuse and
neglect are vast and continually developing. While old theories fall to the
wayside and new ones take their place, there is a common them e tying
them together. The theories focus on the caregiver, and not th e older
person, as the source of the problem. In aU cases, the theories portray
the elderly person as the victim. It is im portant to realize th a t any
person can potentially become an abuser or a victim. During February
22-25, 1990. the National Aging Resource C enter on E lder Abuse
(NARCEA) m et to examine the current state of knowledge in the field of
elder abuse. One portion of their study was to identify the perpetrators
of elder abuse in regard to some of the aforementioned theories. The
NARCEA found various relationships existing between the perpetrators
and elderly victims, all of which are described in Table 3 . ^ 2
These resu lts are both shocking and frightening. Considering
these findings, and the fact th a t nearly 70% of the population over 60
years of age reside with family members (while 25% live on their own and
only 5% reside in an institution), it is not difficult to see th a t elder abuse
and neglect are family affairs. 13
It is evident th a t elder abuse and neglect is a significant problem
an d is advancing through society an d the medical profession a t a
frightening pace. Among th e various h ealth care professionals,
param edics and emergency medical technicians (EMTs) have the greatest
opportunity to identify and report elder abuse. They are the only health
care providers who routinely enter the patient’s home, and they are often
the first medically trained personnel to evaluate an 111 and Injured elderly
person.
U nfortunately there rem ains to be a limited am o u n t of
Inform ation In the medical literature devoted to the detection and
repo rtin g of elder ab u se an d neglect by em ergency p reh o sp ital
personnel. 14
Table 3
R ela tio n sh ip s B etw een P erpetrators & T heir E lderly V ic tim s *
Identified Perpetrators
Adult Children
O ther Relatives
Spouse
Service Provider
Friends/Neighbors
Grandchildren
Sibling
Unknown
All Others
Percentage of Cases
30.0%
17.8%
14.8%
12.8%
10.0%
1.9%
1.7%
1.5%
9.4%
*As described by the NARCEA
Jones et ali4 recently conducted a survey of emergency prehospital
personnel (EMTs, Specialists/Intermediates, and Paramedics) In the state
of Michigan to determine the scope of this problem, the various levels of
awcireness, an d the willingness to report cases of elder abuse. The
respondents had an average of 8.7 years of prehospital emergency-care
experience an d evaluated 11 p atients >65 years of age each week.
Seventy-eight percent had seen a suspected case of elder ab u se or
neglect during the p ast 12 m onths (mean of 2.3 cases/year). Despite
these num bers, surveyed personnel reported only 27% of su spected
cases to the appropriate authorities last year (mean of 0.62 cases/year).
Some of the reasons given for not reporting Included: uncertain as to
which authorities take reports, unclear about the definition of abuse and
neglect, u n aw are of th e m andatory reporting laws, an d lack of
anonymity. Ninety-five percent of the respondents stated th a t training
related to elder abuse was not available through their Emergency Medical
Services (EMS) agency. In this same survey, one paramedic suggested the
following;
“Have a slide or any visual presentation showing signs and
symptoms of abuse. Share actual case scenarios, including family
backgrounds and typical events th a t lead to the abuse of the
elderly. Help us to recognize the problems. Tell us w hat to
docum ent in our reports, what docum ents for reporting should be
used, and where to subm it information. Provide assurance of how
our reporting will benefit our patients and not harm them. ‘i^
Based on th is information, the specific aim of this research project is to
test the training program developed by Jones et al^ which focuses on the
identification an d reporting of elder abuse and neglect. The intended
audience will be th e prehospital perso n n el (EMTs, S p ecialists or
Intermediates, and Paramedics) working in the state of Michigan.
CHAPTER TWO
MATERIALS & METHODS
The training video entitled, “Elder Abuse”, was created by the
Emergency Medicine Residency Program at Butterworth Hospital, Grand
Rapids, Michigan. Butterworth Hospital is a 530 bed acute care tertiary
facility w hich serves as th e prim ary training site for a nu m b er of
residencies including Emergency Medicine, In tern al Medicine, and
Surgery.
It is a major teaching affiliate of Michigan S tate University
College of H um an Medicine.
In addition to providing prim ary care,
Butterw orth serves as a tertiary referral center for an eleven county area
of West Michigan in Cardiology, Oncology, and Trauma. The Emergency
D epartm ent has 34 beds and averages 72,000 patient visits annually.^
References for this training program were obtained from a variety
of sources, including the review of the medical literature, ^^-47 Adult
Protective Services (APS), the National Center on Elder Abuse (NCEA),
Citizens for Better Care Elder Abuse Prevention Project, Michigan Area
Agency on Aging, Michigan State Medical Society, Ohio State Medical
Association, AMA’s Diagnostic and Treatment Guidelines on Elder Abuse
an d Neglect, American Association of Retired Persons (AARP), and the
Michigan D epartm ent of Social Services. ^ The organization of this video,
as described by Jones et al, 5 can be seen in Table 4.
The design of this study was to adm inister two tests to emergency
prehospital personnel both prior to and following the viewing of the
“Elder Abuse” video in order to assess their present knowledge regarding
8
the subject m atter and to evaluate the information content of the training
video. A sam ple of 60 EMS personnel in Kent County were asked to
complete a 22-question pretest on elder abuse and neglect, view the 20
m inute training video, followed by the posttest. All respondents were
asked to include their name, the date, their EMS unit, and the last four
digits of their social security num bers on each of the exams in order to
accurately m atch the pre and posttests and for follow-up purposes. The
pretest questions were derived from a prior survey of EMS personnel in
M ic h ig a n .
The first page of the pretest (questions 1-11) focused on
demographic item s and characteristics of practice, such as professional
statu s, years in practice, and patient load. The second page, and the
rem aining 11 statem ents, concentrated on identifying the abuse, the
understanding of m andatory reporting requirements, and the willingness
to report. The respondents were asked to evaluate these statem ents on a
three-point Likert scale ranging from “not true”, “unsure”, an d “true”.
The pretest used in this study may be found in Appendix A.
In order to rem ain consistent and establish study reliability, the
posttest was very sim ilar to the initial pretest. On the first page of the
posttest (10 items), the demographic questions on the pretest regarding
professional sta tu s, years in practice, an d patient load were replaced
with five statem ents asking the EMS personnel to evaluate the subject
m atter and presentation of the video Itself. The remaining 11 statem ents
on the second page of the posttest were Identical to the 11 statem ents
answered on the second page of the p retest which concentrated on
identifying th e ab u se, u n d e rsta n d in g th e m an d ato ry rep o rtin g
requirements, and the willingness to report. The posttest may be found
in Appendix B.
Upon completion of th e testing session, the EMS
personnel were given a pamphlet^s which was supplied by the Kent
C ounty D ep artm en t of Social S ervices/A dult Protective Services,
describing the appropriate steps for reporting elder abuse and neglect.
This information can be seen in Appendix C.
Table 4
O rganization o f th e T raining Video*
-Introduction
-Goals and objectives of the training video
-Background information