1 / 30

Investigation of Abuse: Use of Science, Technology and Law in Detection and Resolution

Explore the detection and resolution of elder abuse through collaborative efforts in science, technology, and law. Learn about the challenges, benefits, and outcomes for elders with a focus on abuse prediction models.

jwinnifred
Download Presentation

Investigation of Abuse: Use of Science, Technology and Law in Detection and Resolution

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Investigation of Abuse:Use of Science, Technology and Law in Detection and Resolution Laura Mosqueda, M.D. Director of Geriatrics Professor of Family Medicine University of California, Irvine School of Medicine

  2. Normal & Common Changes • Musculoskeletal • sarcopenia • osteopenia/osteoporosis • Cardiovascular • orthostatic hypotension • peripheral vascular disease • Function • gait/falls • ADLs

  3. Normal & Common Changes • Integument • thinner epidermis • capillary fragility • Renal • decrease in creatinine clearance • Sensory system • presbycussis • slower reaction time • macular degeneration, cataracts

  4. Injury Assessment:The Challenge in Elders • Normal changes of aging Medication effects Multiple co-morbidities Cognitive impairment

  5. Are there ways to improve what we are doing through collaborative efforts?

  6. O.C. V.A.S.T.O.C. Vulnerable Adult Specialist Team • Integrates geriatricians and psychologists into the “system” • Consultation: APS, law enforcement, district attorney • Original funding: Archstone Foundation • Current funding: Orange County

  7. O.C. VAST • Case presentations at weekly team meetings • Telephone and email consultations • Record review (written, photographs, videotapes) • Examinations (cognitive and/or physical) in appropriate location

  8. Team Home Visit • Living conditions • Physical environment • Emotional environment • Social environment • Functional capacity • Caregiver/family dynamics • Mental status exam • Limited physical exam

  9. Outgrowths of VAST • Research: bruising, capacity, dementia • Pocket Doc • Publications in medical journals • Interest in reproducing VAST • Elder Abuse training institute • Orange County Coalition for the Prevention of Elder Abuse • Orange County Elder Death Review Team • Forensic Center

  10. Orange County Elder Abuse Forensic Center • The Need: coordinated effort among many agencies that deal with criminal justice aspects of mistreatment

  11. Elder Abuse Forensic Center

  12. Elder Abuse Forensic Center A collaboration between 9 agencies: • Program in Geriatrics, UCI School of Medicine • Adult Protective Services • District Attorney’s Office • Sheriff • Public Administrator/Public Guardian • Human Options (domestic violence experts) • Community Service Programs • Long-Term Care Ombudsman • HCA Older Adult Services (county mental health agency)

  13. Elder Abuse Forensic CenterMission Statement Identify and promote the appropriate legal remedies for vulnerable adult mistreatment through collaborative evaluation, research, education, and consultation

  14. The Hard Part About Collaboration • May take more time, especially in early phase • Always takes more effort • Frustration with the other party • Cultural differences

  15. Cultural Differences • Victim Advocate has victims • Adult Protective Services have clients • Regional Center has consumers • Geriatricians/Psychologists have patients • Law Enforcement has suspects • District Attorney has defendants

  16. Benefits of Collaboration • Communication/inclusion • Team approach • Creative solutions • Time efficiency • Improved risk assessment • Support for each other • Education

  17. Bruising Study: Objective To summarize the occurrence, progression, and resolution of accidentally acquired bruises in a sample of adults aged 65 and older. Our Hope: The systematic documentation of accidentally occurring bruises in older adults will provide a foundation for comparison when considering suspicious bruising in older adults.

  18. Study Procedure • A subject was enrolled in the study if they developed a bruise during a two week period of daily observation. • The bruise was then documented everyday until resolution or up till 6 weeks. • Bruises present at the first visit were documented and not included in the study. • If a new bruise appeared, we knew that it had occurred during the prior 24 hours.

  19. Location of Bruises (108 bruises at Day 1)

  20. Summary of Results Nearly 90% of the bruises were on the extremities. There were no bruises on the neck, ears, genitalia, buttocks, or soles of the feet. Subjects were more likely to know the cause of the bruise if the bruise was on the trunk. Contrary to the common perception that yellow coloration indicates an older bruise, 16 bruises were predominately yellow within the first 24 hours of onset. Those people on medications known to impact coagulation pathways and those with compromised function were more likely to have multiple bruises.

  21. Abuse of Elders With Dementia: Toward a Model of Prediction UC Irvine Program in Geriatrics UC Irvine Institute for Brain Aging and Dementia (IBAD) Alzheimer’s Association of Orange County (AAOC) County of Orange, Adult Protective Services (APS)

  22. Research Design • Pilot, cross-sectional study • Goal is development and testing of a model for assessing risk factors associated with mistreatment of elders with dementia • Two cohorts being recruited: • UCI ARCC/ADRC-based • AAOC community-based • Home visit methodology • Future goal – longitudinal study

  23. Flowchart of The System

  24. It is time for people who work in the fields of Science, Technology, and Law to wake up and take this seriously.

  25. Common Questions • How long did it take for that pressure sore to develop? • She has dementia: can we trust anything she tells us? • His daughter told us “I was doing the best I could”; why should we prosecute her? • Has this crossed the line from poor care to criminal neglect? • Isn’t this inevitable when you’re old?

More Related