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4 - The geriatric patient

Published online by Cambridge University Press:  17 August 2009

Fiona E. Gallahue
Affiliation:
Weill Medical College of Cornell University
Laura D. Melville
Affiliation:
Weill Medical College of Cornell University
Jonathan Glauser M.D., M.B.A.
Affiliation:
Assistant Professor, Case Western Reserve University
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Summary

Goals and objectives

  1. To recognize the patterns of geriatric abuse that exist

  2. To learn how to screen and identify geriatric abuse

  3. To learn to treat and refer victims of geriatric abuse

Introduction and overview

Elder abuse and neglect has been recognized as a growing problem in the United States. All 50 states have reporting requirements for elder abuse and neglect, although there is no federal policy requiring reporting of elder abuse. Literature suggests that the abusers appear most frequently to be family members and caretakers of the elderly. The responsibility for identifying elder mistreatment often falls on emergency care providers.

There are 45 million people over the age of 60 in the United States, and 3 million over the age of 85. Those over 85 represent the fastest growing segment of the elderly population; it is estimated that the number of persons over the age of 85 will be seven times higher in 2050 than it was in 1980.

Modern reports of elder abuse in the medical literature date from 1975 when the British Medical Journal published a report of “granny battering.” In the United States, reports of abuse and neglect in nursing homes in the 1970s led to a systematic study of elder mistreatment by the United States Senate Special Committee on Aging. Since that time, under the auspices of the Department of Health and Human Services, there has been the creation of the National Institute on Elder Abuse.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

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References

Hardin, E, Khan-Hudson, A.Elder abuse – “society's dilemma.” J Nat Med Assoc. 2004; 97( 1 ): 91–4.Google Scholar
The Program Resources Department, the American Association of Retired Persons, and the Administration on Aging. A Profile of Older Americans 1993. Washington, DC: U.S. Department of Health and Human Services.
Burston, G R. Granny battering. BMJ. 1975; 3: 592–3.CrossRefGoogle ScholarPubMed
U.S. House Select Committee on Aging and U.S. House Science and Technology Subcommittee on Domestic, International, Scientific Planning Analysis and Cooperation Domestic Violence 1978, Washington DC: U.S. Government Printing Office.
Protecting America's Seniors: A History of Elder Abuse and Neglect from the United States Senate, Special Committee on Aging 2002.
Shields, L B, Hunsaker, D M, Hunsaker, J C. Abuse and neglect: a ten-year review of mortality and morbidity in our elders in a large metropolitan area. J Forensic Sci. 2004; 49( 1 ): 122–7.Google Scholar
Lachs, M, Berkman, L, Fulmer, T, Horwitz, R.A prospective community-based pilot study of risk factors for the investigation of elder mistreatment. J Am Geriatr Soc. 1994; 42: 169–73.CrossRefGoogle ScholarPubMed
Cohen, M, Halevi-Levin, S, Gagin, R, Friedman, G.Development of a screening tool for identifying elderly people at risk of abuse by their caregivers. J Aging Health. 2006; 18: 660–85.CrossRefGoogle ScholarPubMed
Tartara, T, Kuzmeskus, L. Elder abuse in domestic settings. Elder Abuse Information Series, No. 1, Washington, DC, National Committee on Elder Abuse (NCEA), 1996–1997.Google Scholar
Kleinschmidt, K C. Elder abuse: A review. Ann Emerg Med. 1997; 30( 4 ): 463–72.CrossRefGoogle Scholar
Pillemer, K, Finkelhor, D. The prevalence of elder abuse: a random sample survey. Gerontologist. 1988; 28: 51–7.CrossRefGoogle ScholarPubMed
Levine, J M. Elder neglect and abuse. A primer for primary care physicians. Geriatrics. 2003; 58( 10 ): 37–44.Google Scholar
Schiamberg, L B, Gans, D.Elder abuse by adult children: an applied ecological framework for understanding contextual risk factors and the integrational character of quality of life. Int Jour Aging and Hum Develop. 2000; 50( 4 ): 329–59.CrossRefGoogle Scholar
Fulmer, T, Pavesa, G, Abraham, I, et al. Elder neglect assessment in the emergency department. J Emerg Nurs. 2000; 26( 5 ): 436–43.CrossRefGoogle Scholar
Cammer Paris, B E. Violence against elderly people. Mt Sinai J Med. 1996; 63: 97–100.Google ScholarPubMed
Homer, A C, Gilleard, C.Abuse of elderly people by their caregivers. Br Med J. 1992; 301: 1359–62.CrossRefGoogle Scholar
American Medical Association: AMA Diagnostic and Treatment Guidelines on Elder Abuse and Neglect, Chicago, American Medical Association 1992.
Policy Statement: American College of Emergency Physicians: Management of elder abuse and neglect. Ann Emerg Med. 1998; 31: 149–50.
American Medical Association White Paper on Elderly Health Report of the Council on Scientific Affairs. Arch Intern Med. 1990; 150: 2459–72.CrossRef
Baker, A. Slow euthanasia – or “she will be better off in a hospital.” BMJ. 1976; 2: 571–2.CrossRefGoogle ScholarPubMed
Mouton, C P, Rodabough, R J, Rovi, S L D. Prevalence and 3 year incidence of abuse among postmenopausal women. Am J Public Health. 2004; 94: 605–12.CrossRefGoogle ScholarPubMed
U.S. House of Representatives HR 1674. The Elder Abuse Prevention, Identification, and Treatment Act. 1985.
Council on Scientific Affairs. Elder abuse and neglect. JAMA. 1987; 257: 966–71.CrossRef
Wieland, D.Abuse of older persons: an overview. Holistic Nurs Pract. 2000; 14( 4 ): 40–50.CrossRefGoogle Scholar
Quinn, M J. Undue influence and elder abuse: recognition and intervention strategies. Geriatric Nurs. 2002; 23( 1 ): 11–16.CrossRefGoogle Scholar
Greenberg, E M. Violence and the older adult: the role of the acute care nurse practitioner. Crit Care Nurs Quarterly. 1996; 19( 2 ): 76–84.CrossRefGoogle Scholar
Gorbien, M J, Eisenstein, A R. Elder abuse and neglect: An overview. Clin in Geriatr Med. 2005; 21: 279–92.CrossRefGoogle ScholarPubMed
Tatara, T.Understanding the nature and scope of domestic elder abuse with the use of state aggregate data: summaries of the key findings of a national survey of state APS and aging agencies. J Elder Abuse Negl. 1993; 5: 35–57.CrossRefGoogle Scholar
Lachs, M S, Williams, C, Brien, S.Older adults: an 11-year longitudinal study of adult protective service use. Arch Intern Med. 1996; 156: 449–53.CrossRefGoogle ScholarPubMed
Lachs, M S, Williams, C S, Brien, S.The mortality of elder mistreatment. JAMA. 1998; 280: 428–32.CrossRefGoogle ScholarPubMed
Marshall, C E, Benton, D, Brazier, J M. Elder abuse: using clinical tools to identify clues of mistreatment. Geriatrics. 2000; 55( 2 ): 42–53.Google Scholar
Swagerty, D L, Takahashi, P Y, Evans, J M. Elder mistreatment. Am Fam Phys. 1999; 59( 10 ): 2804–8.Google Scholar
Wierucka D, , Goodridge D, . Vulnerable in a safe place: institutional elder abuse. Can J Nurs Admin. 1996; 9( 3 ): 82–104.Google Scholar
Comijs H, . Elder abuse in the community: Prevalence and consequences. J Am Geriatr Soc. 1998; 46: 885–8.CrossRefGoogle ScholarPubMed
Jones, J S. Elder abuse and neglect: responding to a national problem. Ann Emerg Med. 1994; 23: 845–8.CrossRefGoogle Scholar
Fulmer, T.Elder mistreatment. Ann Rev Nurs Research. 2002; 20: 369–95.Google ScholarPubMed
Pillimer, K, Suitor, J J. Violence and violent feelings: what causes them among family caregivers?J Gerontol. 1992; 47: S165–S172.CrossRefGoogle Scholar
Ramsey-Klawsnik, H.Elder-abuse offenders: a typology. Generations. 2000; 2: 17–22.Google Scholar
Collins, K A. Elder mistreatment: A review. Arch Pathol Lab Med. 2006; 130: 1290–6.Google Scholar
Kosberg J. Hidden problem of elder abuse: Clues and strategies for health care workers. In Safford, F & Krel, G. I. (Eds.) Gerontology for Health Professionals, a Practice Guide, Washington D.C.NASW Press: 130–47.
Lachs, M, Pillemer, K. Abuse and neglect of elderly persons. N Engl J Med. 1995; 332: 437–43.CrossRefGoogle ScholarPubMed
Kruger, R M, Moon, C H. Can you spot the signs of elder mistreatment?Postgrad Med. 1999; 106: 169–83.CrossRefGoogle ScholarPubMed
Ahmad, M, Lachs, M S. Elder abuse and neglect: What physicians can and should do. Cleve Cl J Med. 2002; 69: 801–8.CrossRefGoogle Scholar
Lowenstein, S R, Crescenzi, C A, Kern, D C, et al. Care of the elderly in the emergency department. Ann Emerg Med. 1986; 15: 528–35.CrossRefGoogle ScholarPubMed
Clarke, M E, Pierson, W. Management of elder abuse in the emergency department. Emerg Med Clin N Am. 1999; 17( 3 ): 631–44.CrossRefGoogle Scholar
Jones, J, Dougherty, J, Schelble, D, Cunningham, W. Emergency department protocol for the diagnosis and evaluation of geriatric abuse. Ann Emerg Med. 1988; 17: 1006–15.CrossRefGoogle ScholarPubMed
Lynch, S H. Elder abuse: what to look for, how to intervene. AJN. 1997; 97( 1 ): 27–33.CrossRefGoogle Scholar
Levine, J M. Elder neglect and abuse: a primer for primary care physicians. Geriatrics. 2003; 58: 37–44.Google ScholarPubMed
Conlin, M. Silent suffering: A case study of elder abuse and neglect. J Am Geriatr Soc. 1995; 43: 1303–08.Google ScholarPubMed
Fulmer, T, Ashley, J. Clinical indicators of elder neglect. Appl Nurs Res. 1989; 2: 161–7.CrossRefGoogle Scholar
Kruger, R M, Moon, C H. Can you spot the elder mistreatment?Postgrad Med. 1999; 106( 2 ): 169–78.CrossRefGoogle Scholar
Capezuti, E, Brush, B L, Lawson, W T. Reporting elder mistreatment. J Geront Nurs. 1997; 23( 7 ): 24–32.CrossRefGoogle Scholar
Stiegel, L A. Recommended Guidelines for State Courts Handling Cases Involving Elder Abuse. American Bar Association. 1995.Google Scholar
Dong, X Q. Medical implications of elder abuse and neglect. Clin Ger Med. 2005; 21( 2 ): 293–313.CrossRefGoogle Scholar
Faulkner, L R. Mandating the reporting of suspected cases of elder abuse: an inappropriate, ineffective and ageist response to the abuse of older adults. Fam Law Q. 1982; 16: 69– 91.Google Scholar
Cammer Paris, B E. Violence against elderly people. Mt Sinai J Med. 1996; 63: 97–100.Google ScholarPubMed
Moone, A, Williams, O. Perceptions of elder abuse and help-seeking patterns among African-American, Caucasian-American, and Korean-American elderly women. The Gerontologist. 1993; 33: 386–95.CrossRefGoogle Scholar
Wei, G S, Herbers, J E. Reporting elder abuse: A medical, legal, and ethical overview. JAMWA. 2004; 59: 248–54.Google ScholarPubMed
Rodriguez, M A, Wallace, S P, Woolf, N H, Mangione, C M. Mandatory reporting of elder abuse: Between a rock and a hard place. Ann Fam Med. 2006; 4: 403–09.CrossRefGoogle Scholar
Cohn, F, Salmon, M E, Stobo, J D, eds. Confronting Chronic Neglect: The Education and Training on Family Violence. Washington, DC: National Academy Press, 2002.Google Scholar
Welfel, E F, Danzinger, P R, Santoro, S.Mandated reporting of abuse/maltreatment of older adults: A primer for counselors. J Couns Dev. 2000; 78: 284–92.CrossRefGoogle Scholar
Hazzard, W. Elder abuse: definitions and implications for medical education. Acad Med. 1995; 70: 979–81.CrossRefGoogle ScholarPubMed
Clark-Daniels, C L, et al. Abuse and neglect of the elderly: Are emergency department personnel aware of mandatory reporting laws?Ann Emerg Med. 1990; 19: 970–7.CrossRefGoogle ScholarPubMed
Conlin, M. Silent suffering: A case study of elder abuse and neglect. J Am Geriatr Soc. 1998; 46: 885–8.Google Scholar
Tatara T. Suggested State Guidelines for Gathering and Reporting Domestic Elder Abuse Statistics for Compiling National Data, 1990. Washington, DC: National Aging Resource Center on Elder Abuse.
Rosenblatt, D E, Cho, K H, Durance, P W. Reporting mistreatment of elder adults: the role of physicians. J Am Geriatr Soc. 1996; 44: 65–70.CrossRefGoogle ScholarPubMed
Pillemer, K, Moore, D W. Abuse of patients in nursing homes: findings from a survey of staff. Gerontologist. 1989; 29: 314–20.CrossRefGoogle ScholarPubMed
Ortmann, C, Fechner, G, Bajanowski, T. Fatal neglect of the elderly. Int J Legal Med. 2001; 114: 191–3.CrossRefGoogle ScholarPubMed
Administration on Aging. Department of Health and Human Services. AGING. 1996; 367: 1–136.
Subcommittee on Health and Long-Term Care of the Select Committee on Aging, House of Representatives: Elder Abuse: A Decade of Shame and Inaction. Washington, DC. U.S. Government Printing Office, 1992.
National Center on Elder Abuse. Elder Abuse Law Background Information. At www. elderabusecenter.org/default.cfm/?p=backgrounder.cfm.
Dyer, C B, Heisler, C J, Hill, C A, Kim, L C. Community approaches to elder abuse. Clin Geriatr Med. 2005; 21( 2 ): 429–47.CrossRefGoogle Scholar
Keith, P M, Wacker, R R. It's hard to guard the aged: role strain of male and female guardians. J Gerontol Social Work. 1993; 21: 41–58.CrossRefGoogle Scholar
A response to the abuse of vulnerable adults: the 2000 survey of state adult protective services. Available at: www.elderabusecenter.org/pdf/research/apsreport030703.pdf.
Blenkner, M. A research and demonstration of protective services. Soc Casework. 1971; 52: 483–97.CrossRefGoogle Scholar
Lachs, M S, Williams, C S, Brien, S. Adult Protective Service use and nursing home placement. Gerontologist. 2002; 42: 734–9.CrossRefGoogle ScholarPubMed
Wolf, R S, Pillemer, K.Helping Elderly Victims: The Reality of Elder Abuse. New York: Columbia University Press, 1989.
Matlaw, J R, Spence, D M. The hospital elder assessment team: a protocol for suspected cases of elder abuse and neglect. JEAN. 1994; 6: 23–7.Google Scholar
Nerenberg L. Multidisciplinary elder abuse prevention teams: a new generation. Available at: www.elderabusecenter.org/default.cfm.
Aravanis, S C, Adelman, R D, Breckman, R. Diagnostic and treatment guidelines on elder abuse and neglect. Arch Fam Med. 1993; 2: 371–88.CrossRefGoogle ScholarPubMed
Jones, J S, Veenstra, T R, Seamon, J P. Elder mistreatment: national survey of emergency physicians. Ann Emerg Med. 1997; 30: 473–9.CrossRefGoogle ScholarPubMed

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