Elder Abuse Summit Boise, Idaho 2006

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Elder Abuse SummitBoise, Idaho 2006

• Lisa M. Gibbs, MD
• Orange County Forensic Center
• University of California, Irvine

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Interviewing Guidelines

• Interview victim and abuser separately!
• May miss the call for help
• Environment
• Avoid windows emitting glare
• Comfort face interviewee
• Note fatigue/sedation/pain
• Best time of day
• Medicines causing sedation
• If abuse is suspected, avoid leading questions.

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• Vision
• Glasses
• Hearing
• Aids? Do they work?
• Lowering your voice may help
• Speaking
• Dentures?

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Visual impairment

• Abuse
• Neglect/self neglect unsafe cluttered
  environment, isolation, decreased ability for
  IADLs
• Fraud signing contracts one cannot read
• Emotional forced dependence on caretaker for
  basic needs
• Physical unable to fight back, avoid being hit,
  falling if hit
• Examiners often under-appreciate the deficits
  since the client appears fine

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Diabetic Retinopathy Two types background and
proliferative Occurs in environment of elevated
glucose Tight diabetic control can reduce
retinopathy Treatment include laser surgery
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Glaucoma High intraocular pressure affects optic
nerve Routine eye care needed for early
identification Treatment is medical and surgical
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Macular Degeneration Leading cause of severe
vision loss in persons over 60 Central part of
retina is damaged Often not symptomatic until it
affects both eyes
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Memory Impairment

• Tip-offs
• Vague answers
• Incorrect answers
• Avoiding questions
• Looking to others for answers
• Repetitive answers

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• Beware of the charming elder.
• Who is the President?
• All those politicians are crooks!

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Dementia

• Dont speak about someone as if they are not
  present.
• Dont assume incompetence
• One instruction at a time
• Rephrase to establish understanding
• Speak the elders language

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Medical/Psychology Interview

• Open ended question of alleged abuse
• Medical history/Functional status
• Medications
• Appropriate exam
• Questions about life that can be verified
• MMSE/Clock Draw
• Capacity For what?

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Dementia Conflict for the Defense?

• Dementia establish vulnerability
• Dementia establish reliability as a witness

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Capacity

• Evaluation based on what?
• Capacity for what?

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Mini Mental Status Exam

• What it does test
• Memory
• Language
• Attention
• Visual-spatial skills
• Score affected by
• Education
• Vision
• Hearing

• What it does NOT test
• Personality
• Judgment
• Abstract reasoning
• Executive function

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Pentagons
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Write a sentence

• I wish I could drown you in the bathtub and cut
  your head off.
• Fought in the big war.
• I want Mary, my daughter, to take care of me.

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Executive Function

• Planning
• Sequencing (using an inhaler)
• Organizing
• Problem solving abilities
• Goal directed planning
• Self-monitoring (disinhibition)

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Clock Drawing
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Law enforcement Tips

• Ask about medical condition - vulnerability
• Find a person wandering, ask about medical
  condition, look for bracelets, necklaces
• Response to DV call if gt65 think elder abuse
• Note oxygen tanks, nebulizers, wheelchairs
• Ask about medications (consent)
• Check condition of home and subject
• List of medications/emergency calls
• Take pictures
• Interview neighbors

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• Notebook information
• Ask about finances
• Do they receive assistance?
• Who do they consider a caretaker?
• Take time with older victims.

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• Follow through
• Emergency contact numbers
• Call a detective early, if even suspect abuse -
  victims die
• If suspect abuse and imminent death, hold the
  body for the coroner.

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The Case of the New Car

• Mr. W, a 75 y/o with Parkinsons disease,
  dementia and related psychosis
• Caregiver with new 25K car. Dtr and victim
  allege elder abuse.
• MD/Psycho interview determine mild dementia,
  but capable of relaying story
• DA uses MD testimony first, then victim
• MD affirms dementia, but reliable witness
  impact of emotional memory