Multidisciplinary Research and Response

1. Multidisciplinary Research and Response Kerry Burnight, PhD Associate Professor, Geriatric Medicine University of California, Irvine

7. Physical abuse Sexual abuse Emotional abuse Neglect Abandonment Abduction Financial exploitation Self-neglect CATEGORIES OF ELDER ABUSE

8. RISK FACTORS FOR ELDER ABUSE • Isolation of caregiver-elder dyad • History of abuse in either • Abuser dependent on elder • Mental illness in either • Substance abuse in either • Elder’s vulnerability and frailty • Caregiver’s perceived distress

9. In a nutshell Elder abuse is: • Present in all demographics • increasing prevalence • often unrecognized by clinicians • most effectively addressed through multidiciplinary collaboration.

10. Multidisciplinary Response • MDTs • FAST • Medical Response Teams • County Coalition • Elder Abuse Forensic Center • Elder Death Review Team • Center of Excellence in Elder Abuse and Neglect • Collaboration Building

11. MDT WIC 15753.5-"Multidisciplinary personnel team" means any team of two or more persons who are trained in the prevention, identification, and treatment of abuse of elderly or dependent persons and who are qualified to provide a broad range of services related to abuse of elderly or dependent persons. The team may include, but is not limited to: (a) Psychiatrists, psychologists, or other trained counseling personnel. (b) Police officers or other law enforcement agents. (c) Medical personnel with sufficient training to provide health services. (d) Social workers with experience or training in prevention of abuse of elderly or dependent persons.

12. WIC 15754 A • Notwithstanding any provision of law governing the disclosure of information and records, persons who are trained and qualified to serve on multidisciplinary personnel teams may disclose to one another information and records which are relevant to the prevention, identification, or treatment of abuse of elderly or dependent persons

13. Mission: Identify and promote legal remedies for elder abuse through collaborative evaluation, consultation, education and research. • Participating agencies: • UCI Program in Geriatrics • Adult Protective Services • Law enforcement agencies • District Attorney • Victim Assistance Program - Long-Term Care Ombudsman • Older Adult Mental Health Services • Human Options DV Services

14. Multidisciplinary Research • Evaluation • Forensic Markers • Mistreatment of People with Dementia • Detecting Abuse and Neglect • Emotional Memory • Theoretical Modeling

15. Evaluation • Medical Response Team • Elder Abuse Forensic Center

16. Forensic Markers: Bruising • Completed study: Bruising in the Geriatric Population • Ongoing study: Bruising as a Forensic Marker of Physical Elder Abuse Accidental vs. Inflicted Bruising *Mosqueda, L., K. Burnight, et al. (2005). J Am Geriatr Soc53(8): 1339-43.

17. Accidental Bruising Study • Objective: To determine common bruising patterns in people over the age of 65 years, including location, timing and sequence of color changes, relationship to functional status, and medications • Funded by National Institutes of Justice Forensic Markers

18. Location of Bruises Finding: Nearly 90% of the observed bruises were on the extremities without a single bruise on the neck, ears, or genitals. (108 bruises at Day 1) Forensic Markers

19. Other Findings • Only 20% of the subjects knew the mechanism of injury. • Those on medications (daily Prednisone, daily ASA, Warfarin, Plavix) • more likely to have multiple bruises • not a significant correlation with duration of bruises. Forensic Markers

20. Bruising Associated with Physical Abuse Theresearch objectives: • Describe bruises associated with elder physical abuse. • Compare bruises in older adults who have not been abused with bruises inflicted on abused elders. Forensic Markers

21. Methodology • Research nurse recruits APS clients reported for physical abuse • Skin examination & Interview • LEAD* panel assesses presence of physical abuse • Preliminary findings: N=59, 50 with confirmed physical abuse *Longitudinal, Experts All Data Forensic Markers

22. Forensic Markers: Pressure Ulcers • Multisite study of bedsores occurring in nursing homes under optimal conditions • Comparable to accidental bruising study: baseline for later study of bedsores associated with neglect • Data: Research Nurses examine pts. with stage 3&4 wounds; facility and pt. records. • LEAD panel assesses Quality of Care Funded by National Institutes of Justice

23. Mistreatment of People with Dementia • Recently completed study: Abuse and Neglect of People with Dementia by Caregivers Funded by California Dept of Health Services • New study: People with Dementia as Witnesses to Emotional Events Funded by National Institutes of Justice

24. Abuse and Neglect of People with Dementia by Caregivers:Characteristics of the Individuals and their Relationship(potential “predictors”)

25. Findings: Caregiver characteristics associated with psychological abuse • Fewer years of education* • Living with the patient* • Longer duration of caregiving* • Caregiver perceived burden due to perceived behaviors of the patient* • Poor emotional status** • Symptoms of depression* • Anxiety** *p<0.05 **p<0.01

26. Findings: Care Recipient characteristics associated with psychological abuse • Lower income* • Physical assault behaviors*** • Psychological aggression behaviors**** *p<0.05 ***p<0.005 ****p<0.001

27. Detecting Elder Mistreatment • Develop a survey with Experts, using the gold standard for detecting DV and Child Abuse as the model • Validate it in US elders (Caucasians & Mexican-Americans) Funded by NIA and Archstone Foundation

28. Sample survey items: In the past year, someone I know …. (physical abuse) • pinched or scratched me on purpose. • used a knife or gun on me. (psychological abuse) • insulted or swore at me in anger. • threatened to abandon me or put me in a nursing home. (financial abuse) • charged me for unnecessary work or work that was not completed on my home. • cashed my social security or pension check and kept the money without my permission.

29. Laying the Foundation to Build a Theoretical Model of Elder Abuse Why does Elder Abuse and Neglect Occur? • Ageism? • Entitlement? • Opportuism? • Caregiver stress? • Resentment? • Power Differential? • Lack of Empathy? • Mutual Conflict? • Learned Violence? • Psychopathology?

30. Nothing so Practical as a Theoretical Model • Caregiver Stress Model • Biomedical Model • Dydadic Discord Model • Power and Control Model • Ecological Model • Learned Violence

31. Our Collaborators • The Elder Abuse Forensic Center • Orange County Adult Protective Services • Orange County Alzheimer’s Association • The Alzheimer’s Family Services Center • Orange County Senior Centers • UCI Institute for Brain Aging and Dementia • UCI Health Care Policy Research • UCI Physicians and Clinics • U Washington School of Nursing • U Wisconsin School of Medicine and Public Health

32. RESOURCES: NATIONAL • AARP: www.aarp.org • UCI Center of Excellence in Elder Abuse and Neglect: www.centeronelderabuse.org • Administration on Aging: www.aoa.gov • National Center on Elder Abuse: www.ncea.aoa.gov; • American Bar Association Commission on Law and Aging: www.abanet.org/aging • American Society on Aging: www/asaging.org; Generationsjournal.org • Family Caregiver Alliance: www.caregiver.org • Clearinghouse on Abuse and Neglect of the Elderly: http://db.rdms.udel.edu:8080/CANE/

33. RESOURCES: NATIONAL • Eldercare Locator: www.eldercare.org • National Clearinghouse on Abuse in Later Life: www.ncall.us • National Committee for the Prevention of Elder Abuse: www.preventelderabuse.org • National Council on the Aging: www.ncoa.org • Nursing Home Database: www.medicare.gov/Nursing/Overview

34. RESOURCES: ORANGE COUNTY • UCI Center of Excellence on Elder Abuse and Neglect www.centeronelderabuse.org • Adult Protective Services 800 451 5155 • Sheriff: 714 834 3636 • Long-Term Care Ombudsman 800 300 6222 • Office on Aging 800 510 2020 • Forensic Center Coordinator 714 825 3087 Download form SOC 341 www.aging.ca.gov