Elder Mistreatment Research Today and Tomorrow March 9, 2005 Consortium of New York Geriatric Education Centers Elder

1. Elder Mistreatment ResearchToday and TomorrowMarch 9, 2005Consortium of New York Geriatric Education CentersElder Mistreatment Training Project Terry Fulmer, PhD, RN, FAAN The Erline Perkins McGriff Professor & Head, Division of Nursing New York University

2. Goals Today Review our understanding of EM Summarize current research Discuss future research goals Renew our sensitivity to the clinical realm

3. Elder Mistreatment (EM) First recognized in 1975 as �granny battering�.. Many doctors, nurses and social workers are reluctant to address this issue and/or are not knowledgeable of legislation involving EM. Adult protective services workers are overwhelmed with complex cases and modest resources Elder mistreatment was first recognized in the 1970�s when the term �granny battering� first appeared in the literature. Over the past decade it has been recognized as a serious social and public health problem, and is an issue that will continue to grow in importance as the geriatric populace ages. The need for protective services and elder mistreatment are independent risk factors for death after adjusting for other factors associated with increased mortality in older people. It is estimated that between 700,000 and 1.2 million older persons are victims of elder mistreatment annually in the United States. This accounts for approximately 4% of those over the age of sixty-five. clinicians are in a key position to identify, assess and report elder mistreatment. However, many clinicians are reluctant to address this issue and/or are not knowledgeable of legislation involving elder mistreatment. A recent Michigan study found that physician reports averaged only 2% of all reports of suspected elder mistreatment. Today many unresolved issues and unanswered questions remain. Because of differing definitions, poor detection and under-reporting, the true extent is unknown. These same factors make data collection difficult and the accuracy of such data questionable. Many barriers to detection exist and need to be addressed. Elder mistreatment was first recognized in the 1970�s when the term �granny battering� first appeared in the literature. Over the past decade it has been recognized as a serious social and public health problem, and is an issue that will continue to grow in importance as the geriatric populace ages. The need for protective services and elder mistreatment are independent risk factors for death after adjusting for other factors associated with increased mortality in older people. It is estimated that between 700,000 and 1.2 million older persons are victims of elder mistreatment annually in the United States. This accounts for approximately 4% of those over the age of sixty-five. clinicians are in a key position to identify, assess and report elder mistreatment. However, many clinicians are reluctant to address this issue and/or are not knowledgeable of legislation involving elder mistreatment. A recent Michigan study found that physician reports averaged only 2% of all reports of suspected elder mistreatment. Today many unresolved issues and unanswered questions remain. Because of differing definitions, poor detection and under-reporting, the true extent is unknown. These same factors make data collection difficult and the accuracy of such data questionable. Many barriers to detection exist and need to be addressed.

4. Case Mrs. R.: 88 year old woman, living with her 2 adult sons, both who had a psychiatric diagnosis Sons did well as caregivers usually, unless her CHF got out of control and she had episodes of incontinence Battered her - �leave my boys alone� Mrs. R discharged back to them with a daily home care attendant

5. Elder Mistreatment Umbrella term that encompasses abuse, neglect, exploitation, abandonment Poorly understood Little research to date Increasing lawsuits Unclear how many dollars spent each year because of elder abuse, neglect, exploitation or abandonment! May be millions

6. Elder Mistreatment Affects approx 4% of those > 65 yrs Only 1 in 6 cases reported vs. 1 in 4 for children Mandatory reporting laws in 46 states Rare litigation against non-reporters California leading in litigation against individuals and institutions

7. Definitions Definitions associated with EM vary significantly among researchers and the laws of different states. In 1985 the American Medical Association proposed a standard definition: � �Abuse� shall mean an act or omission which results in harm or threatened harm to the health or welfare of an elderly person.� Definitions associated with EM vary among researchers and the laws of different states. Even the age at which an individual is considered geriatric is debated (typically 60 or 65). Clear and meaningful definitions are needed in order to facilitate accurate detection of EM and to implement appropriate interventions. In 1985 the AMA addressed this need in a position paper on EM, where they proposed a standard definition: � �Abuse� shall mean an act or omission which results in harm or threatened harm to the health or welfare of an elderly person. Abuse includes intentional infliction of physical or mental injury; sexual abuse; or withholding of necessary food, clothing, and medical care to meet the physical and mental needs of an elderly person by one having the care, custody or responsibility of an elderly person. Definitions associated with EM vary among researchers and the laws of different states. Even the age at which an individual is considered geriatric is debated (typically 60 or 65). Clear and meaningful definitions are needed in order to facilitate accurate detection of EM and to implement appropriate interventions. In 1985 the AMA addressed this need in a position paper on EM, where they proposed a standard definition: � �Abuse� shall mean an act or omission which results in harm or threatened harm to the health or welfare of an elderly person. Abuse includes intentional infliction of physical or mental injury; sexual abuse; or withholding of necessary food, clothing, and medical care to meet the physical and mental needs of an elderly person by one having the care, custody or responsibility of an elderly person.

8. Elder Mistreatment Part of a larger framework of family violence Child abuse studies in 60�s Battered women research in 70�s Elder abuse research in 80�s Need for comprehensive thinking across the lifespan

9. Hard to document causes and effects Many questions remain! National Academies of Science Published in 2003: Elder Mistreatment NRC National Policy Summit held in December 2001

10. Summary of recent research Handout summarizing studies ARNR Fulmer, T. (2002) "Elder Mistreatment" in Annual Review of Nursing Research: Focus on Geriatric Nursing Volume 20, Fitzpatrick, J. Archbold, P., Stewart, B. & Lyons, KS (eds). New York: Springer Publishing. pp. 369-395.

11. Studies Using �elder mistreatment, elder neglect, elder abuse or domestic abuse of the elderly� through 2002 PubMed: 878 CINHAL: 593 Psych Info: 443 36 data based studies in USA (cultural variations in terms)

12. Prevalence: Pillemer and Finkelhor 1988 Random sample survey in metro Boston 32/1000 Therefore est of 700,000-1.,2 million in USA

13. Incidence (Westat and NCEA(1998) Incidence study using sentinel approach Sample: 20 counties in 15 States: nationally representative 551,000 new cases in 1996 Females abused at higher rates Oldest elders (over 80) EM 2-3x their proportion in population

14. 1980-90 Studies were exploratory descriptive No intervention studies funded by NIH to date for EM Potential for national prevalence study � under review

15. Case Mr. S.treated and released from Emergency Room with scalp laceration- a large cut that required stitches Discharged without asking exact cause of cut Son had hit him with a brick

16. Complexity Cases often hard to diagnose because their may be other health problems Ageism Memory problems in older person Fear of reporting- worry that there will be retribution Fear of nursing home placement

17. Barriers To Research Case finding: over-reporting (under-reporting) Confidentiality issues Difficulty �confirming� cases Human resources needed for effectiveness Determining intentionally

18. Summary Complex practice issues nurses generally taking a lead in practice guidelines well-being of older adults depends on excellent assessment and intervention Need to draw researchers into the field

19. What Older People Can Do (AARP) Name a health care proxy in advance Do not share any financial information with those not well know Travel with others- avoid isolating situations Have a primary care provider who knows you Tell others if you are being abused or neglected Get help

20. Thank you