There's an innovative new way of fighting elder abuse -- and it's all about collaboration. Geriatrician Lisa Gibbs, medical director of UC Irvine's Senior Health Center, and Elaine Chen, program manager for the Center of Excellence on Elder Abuse and Neglect and the National Center on Elder Abuse, have combined forces to teach caregivers and family members of older and vulnerable adults what elder abuse is, how to spot it, and what steps to take if they suspect an elderly loved one has fallen victim.
How did the Center of Excellence on Elder Abuse and Neglect come to be?
Lisa Gibbs and Elaine Chen: Prior to the advent of the Center of Excellence, Adult Protective Service (APS) workers and geriatricians (physicians specializing in the care of older adults) were each addressing elder abuse in their own fields. However, it soon became clear that teamwork and collaboration were needed to address the complex issues of elder abuse. In 2003, the Elder Abuse Forensic Center was formed in Orange County, California, and included physicians, psychologists, social workers, victim advocates, and members from law enforcement and the local district attorney's office. This became a very successful model of collaboration and there are now five Elder Abuse Forensic Centers in the United States. As professionals at the University of California, Irvine, developed education and research programs in addition to direct client services, the Forensic Center became a part of a much larger endeavor, the Center of Excellence on Elder Abuse and Neglect.
Established in 2005, the Center of Excellence on Elder Abuse and Neglect acts as the hub for six domains of activity related to elder mistreatment. At the local level in Orange County, California, the Center provides direct services to older adults and works as a leader and member of several interdisciplinary teams, including the nation's first Elder Abuse Forensic Center. Statewide and nationally, the Center provides technical assistance to others who are at earlier stages of evolution in their elder mistreatment services. We also provide multidisciplinary training and research and weigh in on relevant policy issues.
Most recently, we've been expanding our outreach and public awareness work as the National Center on Elder Abuse (NCEA) and with the national grassroots elder justice movement Ageless Alliance. Please visit centeronelderabuse.org for information about some of our Center's milestones.
What kinds of abuse are we talking about?
LG & EC: To quote the National Center on Elder Abuse, we are talking about "any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult." This includes both elders and adults with a disability that increases their vulnerability to mistreatment.
There are six primary types of reportable abuse, including neglect, emotional, physical, sexual, financial abuse, and self-neglect. Many states add other specific types. For example, in California, isolation, abandonment, and abduction are also specified in the law.
In four types of abuse, a perpetrator takes action against an elder or adult with a disability. These include emotional abuse, physical abuse, sexual abuse, and financial abuse. However, sometimes "abuse" is actually the omission of action that would ensure the good care, health, and welfare of a person -- often referred to as neglect. Other terms that might be used as synonyms for "abuse" are "mistreatment" and "maltreatment."
In some cases, an older or disabled person cannot or chooses not to care adequately for themselves. Research shows that self-neglect is connected to the depression, dementia, and/or drug/alcohol use.
What are some of the warning signs of abuse that a family member might watch out for?
LG & EC: Although elder abuse may affect anyone, certain medical and cognitive problems cause vulnerability and increase the risk of elder abuse. If a caregiver is needed to assist with daily activities, it is prudent to watch for changes in a family member's personality, behavior, and habits. For instance, a change in cognitive ability may at first affect financial decision-making capacity, making one vulnerable to financial abuse. In the later stages of dementia, persons who require assistance with basic daily activities are at increased risk for neglect. If the one receiving care is verbally or physically aggressive, the risk of elder abuse is even higher. In fact, our colleagues found that nearly half of community-dwelling elders with dementia were experiencing some form of abuse, especially those patients who were verbally or physically aggressive.(1) If that sounds like someone you know, be especially alert. Also, be observant for a caregiver who appears overwhelmed, resentful, or overly burdened.
Financial abuse also commonly occurs in persons without specific medical or cognitive problems, and victims may not ask for help due to embarrassment or shame. Be aware of solicitors, both by phone and in person, and of changes in spending habits or new concerns about finances.
There are many more warning signs. Visit our website for "Red Flags of Elder Abuse and Neglect" in several languages. We have also created a guide, the Geriatric Pocket Doc, that family caregivers have found useful in addressing commonly asked questions about normal aging, as well as warning signs of elder abuse and neglect.
It's shocking to learn that 90 percent of elder abuse occurs at the hands of family members. Why is that figure so high?
LG & EC: Although more research is needed, most cases of elder abuse are perpetrated by known and trusted others, particularly family members (including adult children, spouses, and others). Abusers can be men or women of any age, race, or socioeconomic status. Some of the popular theories for why this happens cite situations with increased vulnerability due to isolation and decreased functional abilities. If one's circle of family, friends, and acquaintances shrinks, there may be fewer watchful eyes to identify and help with at-risk situations. As one's care needs increase, more people may have access to finances and intimate access to one's person. Caregivers are not always suitably equipped to handle the new duties. Consumers and families can help prevent abuse by planning ahead for incapacity, clarifying financial and legal issues, and communicating about family members' roles. Healthcare providers, including social workers, can play a role in helping older adults and families to understand and plan for changing care needs and helping to explore care options. Another way to help protect against elder abuse is to reduce isolation of the older adult and his or her caregivers.
The percentage of abusers that are family members can vary by how elder abuse is defined and how the questions are asked. For example, in a telephone survey of self-reporting elders, Acierno and colleagues found that nearly 60 percent of perpetrators of physical abuse were partners or spouses.(2) A national incidence study including community sentinels and agencies yielded the 90 percent figure, based on observers' and investigators' findings.(3) An elder might feel hesitant to report abuse or might not identify that it's happening to them, so it's all the more important for those who care about the elder to be informed about signs of abuse and neglect and how to respond.
It's also surprising that, by some estimates, 10 percent of all older adults have experienced mistreatment by a caregiver or another close contact. How can one report suspected abuse?
LG & EC: Most often, reports are made to Adult Protective Services, a long-term care ombudsman, and law enforcement. Anywhere in the U.S., call the Eldercare Locator for a referral by dialing (800) 677-1116 for help connecting with the right state or local agency, or visit eldercare.gov. You can also visit the National Center on Elder Abuse State Directory to find agencies in your area. For help reporting financial fraud, www.stopfraud.gov is a good resource. If you think it might be a domestic violence situation, visit www.thehotline.org or call (800) 799-7233.
What else, if anything, can a family member do, especially about suspected abuse in a care facility, where you say up to 36 percent of residents have experienced abuse or neglect?
LG & EC: To learn more about the quality of the nursing home you are interested in, visit Nursing Home Compare, a tool designed to provide detailed information about Medicare- and Medicaid-certified nursing homes in the country. This will help you understand more about the overall environment of the nursing home, as assessed by the licensing agency.
You should also contact the local long-term care ombudsman, serving the town/city of the nursing home where your loved one is residing. Long-term care ombudsmen are professionals who advocate on behalf of residents of long-term care facilities and help to resolve complaints about issues of care. They are dedicated to enhancing the lives of long-term care residents through advocacy, education, and resolving resident complaints. The ombudsman will help you understand the situation, and if a formal complaint is warranted, they can advise you and your family member on how and with whom you would file the complaint. Family and friends who advocate for loved ones in nursing homes are an invaluable asset to their care.
Everyone can do something to help address or prevent elder abuse. Elder abuse destroys victims' lives. Research reveals that victims of elder abuse have an increased risk of illness and death.(4) Many lose their life savings and health, in addition to the loss of dignity and the ability to age gracefully. To learn about ways you can help raise awareness or volunteer to promote dignity and respect for elders, join the grassroots social justice movement www.agelessalliance.org. You can also stay informed by liking the Facebook page for the UCI Center of Excellence and subscribing to their quarterly newsletter.
Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, Fitzgerald W. Screening for abuse and neglect of people with dementia. Journal of the American Geriatrics Society. 2010; 58(3):493-500. http://dx.doi.org/10.1111/j.1532-5415.2010.02737.
Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health. 2010; 100(2):292-297.
NEAIS 1998 National Center on Elder Abuse, Westat, Inc. The national elder abuse incidence study: Final report. Washington D.C., 1998.
Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. Journal of the American Medical Association. 1998; 280(5):428-432. http://dx.doi.org/10.1001/jama.280.5.428.