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

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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

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Goals Today

• Review our understanding of EM
• Summarize current research
• Discuss future research goals
• Renew our sensitivity to the clinical realm

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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

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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

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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

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Elder Mistreatment

• Affects approx 4 of those gt 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

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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.
  
  

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Elder Mistreatment

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

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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

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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.

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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)

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Prevalence Pillemer and Finkelhor 1988

• Random sample survey in metro Boston
• 32/1000
• Therefore est of 700,000-1.,2 million in USA

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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

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1980-90

• Studies were exploratory descriptive
• No intervention studies funded by NIH to date for
  EM
• Potential for national prevalence study under
  review

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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

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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

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Barriers To Research

• Case finding over-reporting (under-reporting)
• Confidentiality issues
• Difficulty confirming cases
• Human resources needed for effectiveness
• Determining intentionally

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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

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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

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Thank you