Geriatric Guide: Assessment by Elder Abuse Investigators

1
Geriatric Guide Assessment by Elder Abuse
Investigators
Elaine A. Chen, M.S. Gerontology California State
University, Long Beach
2

• What is elder abuse?

3
Definition Elder

• An elder, in California, is any person 65 years
  of age or older.

4
Definition Dependent Adult

• Any person between the ages of 18 and 64 who has
  physical or mental limitations that restrict his
  or her ability to carry out normal activities or
  to protect his or her rights.

18 64
5
Examples of abuse and neglect

• Which types are most commonly reported?

6
Caregiving
7
(No Transcript)
8
(No Transcript)
9
Sunday, November 2, 2008 Trial set to start in
suspected 11 million Ponzi scheme Prosecutors
say a San Juan Capistrano man bilked investors of
millions. The defense contends he acted in good
faith. BY VIK JOLLY, THE ORANGE COUNTY REGISTER
"IT HURTS" Jo Peacock of Orange now lives on
social security. Her plans to move are on hold.
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
Types of Reportable Abuse

• Physical (WIC15610.63)
• Financial (WIC15610.30)
• Abduction (WIC15610.06)
• Abandonment (WIC15610.17)
• Isolation (WIC15610.43)
• Mental Suffering (WIC15610.53)
• Neglect / Self-Neglect (WIC15610.57)

15
Orange County
16
EA in California

• In 2006, California Adult Protective Services
  (APS) agencies received over 104,000 reports of
  abuse and neglect, a 34 increase since 2000
  (County Welfare Directors Association, 2007).

For every report of abuse, five go unreported.
17
CONSEQUENCES OF ELDER ABUSE

• Victims of elder abuse are known to experience
  depression, anxiety and other mental health
  issues (Dyer, Pavlik, Murphy Hyman, 2000
  Lachs, Williams, OBrien, Hurst, Horwitz,
  1997).

? 3x premature death (Lachs, Williams,
OBrien, Pillemer, Charlson, 1998)
18

• What can law enforcement investigators do?

19
Predators
20
Predators
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
Coordinated Community Response
Advocates
Police
Religious Leaders

Health Professionals
Adult Protective Agencies
Friends
Judges Legal Professionals
Policy Makers
Educators
28

• Elder Abuse Training Institute
• Educating professionals to prevent, detect and
  intervene in abuse of vulnerable adults

The Institute is made possible by a generous
grant from the UniHealth Foundation.
29
(No Transcript)
30
Introducing Pocket Doc!
An easy-to-access guide to common geriatric
disorders and medications like having a doctor
in your pocket.
31
Topics Include

• Screening for Common Geriatric Problems
• Signs and Symptoms of Common Medical Conditions
• Activities of Daily Living / Instrumental
  Activities of Daily Living (ADLs/IADLs)
• Memory Loss and Dementia
• Medications

32
Topics Include

• Pressure Sores (a.k.a. Bedsores or Decubitus
  Ulcers)
• Bruises
• Interviewing Techniques
• Assessing Dehydration
• Assessing Malnutrition
• Assessing Pain

33
Geriatric Pocket Doc
4300 Geriatric Pocket Docs sold since Fall 2007.
34
Roundtable Discussion on Elder Justice Medical
Forensic Issues Related to Elder Abuse and
Neglect (Stiegel, 2006)

• Suggested providing officers with easy-to-carry
  reference information on
• Key medical indicators of elder abuse and
  neglect, in list form
• Activities of daily living
• Cognitive capacity assessment (to gauge
  decision-making capacity)
• Medications associated with high risk of abuse
• Pressure sores (i.e., decubitus ulcers),
  categorizing the four stages
• Tips for interviewing older adults (Stiegel, p.
  71)

35
Objectives

• Identify members of the target group (law
  enforcement investigators and detectives) to
  participate in a written survey and discussion
  group
• Develop a set of questions to elicit the desired
  information
• Administer the questions and obtain responses
• Analyze the responses and report on them
• Offer recommendations designed to help developers
  of the Geriatric Pocket Doc

36
Recruitment
37
(No Transcript)
38

• Would you carry GPD with you on the job?
• Usefulness of sections
• Physical markers
• ADLs/IADLs
• Memory loss and dementia
• Medications
• Interviewing older adults
• Organization
• Design

39
Discussion Questions

• What would be your highest recommendation to
  improve the Geriatric Pocket Doc?
• What topics should be added?
• Who would most benefit from having the
  Geriatric Pocket Doc in your line of work?

40
Response Group

• 20 Investigators/Detectives
• 1 Investigations Sergeant
• Experience
• 0 to 10 years
• 8 worked elder abuse lt 1 year
• 0 to 50 cases

41
Responses

• Would you carry the Geriatric Pocket Doc (GPD)
  with you on the job?

42
How would you improve

• Add photos/pictures of injuries
• Wound care for pressure sores
• Make it easier to find the info
• Tabs
• Color coding

43
If you didnt have the GPD, where would you get
the same information? (N 19)
44
Comments on Format

• Make it available on disc or downloadable
• Checklists
• Laminated foldouts

45
(No Transcript)
46

• Respondents found it useful.
• Add tabs or color-coding
• Add more to help investigate circumstances when a
  person has pressure sores
• Add more about simple capacity assessment methods
  that investigators could use
• Consider new formats

47
(No Transcript)
48

• Special thanks to
• Jeanne E. Bader, Ph.D.
• Maria Claver, Ph.D.
• Laura Mosqueda, M.D., UC Irvine Geriatrics
• Det. Cherie Hill, Anaheim Police Dept., Family
  Crimes Detail
• Lori Delagrammatikas, M.S.W., San Diego State
  University
• Orange County Sheriffs Department, Advanced
  Officer Training Division
• My family

49
(No Transcript)