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Scott S, Brameier DT, Tryggedsson I, Suneja N, Stenquist DS, Weaver MJ, von Keudell A. Elder Abuse in the Orthopaedic Patient: An Updated Review of Prevalence, Identification, and Screening Tools for Orthopaedic Surgeons. Geriatr Orthop Surg Rehabil 2024; 15:21514593241266486. [PMID: 39156482 PMCID: PMC11329899 DOI: 10.1177/21514593241266486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Elder abuse is a prevalent, though often overlooked and underreported, cause of musculoskeletal injury in the elderly population. The purpose of this review is to provide an updated overview of the prevalence of elder abuse, its association with musculoskeletal injuries, and the available resources to aid orthopaedic surgeons in early detection and intervention. Significance Improved training on this topic is needed throughout the medical education of orthopaedic surgeons to effectively recognize and address elder abuse. Our findings reveal an urgent need for increased awareness, education, and collaboration among healthcare professionals to address this significant public health concern. As the aging population continues to grow, understanding the connection between elder abuse and musculoskeletal injuries is essential for providing comprehensive care to older adults. Results This review offers practical recommendations for identifying individuals at risk of elder abuse and outlines strategies for intervention. Indicators of abuse range from obvious signs like dirty clothes, neglect, and unattended injuries from falls, to more subtle cues requiring careful observation and questioning, such as mental health symptoms and family histories of abuse. Conclusion By shedding light on this often-overlooked issue, this review advocates for a proactive approach to identifying and addressing elder abuse to safeguard the well-being and quality of life of older individuals.
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Affiliation(s)
- Sophia Scott
- Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Nishant Suneja
- Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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Bloemen EM, Tietz S, Lindberg DM, Hayes J, Lum H, Gottesman E, Elman A, Sullivan M, Pino C, McAuley J, Shaw A, Hancock D, Chang ES, Yasui R, LoFaso VM, Stern ME, Rosen T. Elder abuse geriatrics: describing an important new medical specialist. J Elder Abuse Negl 2024; 36:367-383. [PMID: 38602348 PMCID: PMC11333173 DOI: 10.1080/08946566.2024.2339242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Elder mistreatment, including elder abuse and neglect, is a difficult diagnosis to make and manage for most providers. To address this, two elder abuse consultation teams were developed for patients in the hospital and emergency department settings. As these teams have developed, the providers involved have obtained specialized training and experience that we believe contributes to a new field of elder abuse geriatrics, a corollary to the well-established field of child abuse pediatrics. Providers working in this field require specialized training and have a specialized scope of practice that includes forensic evaluation, evaluation of cognition and capacity, care coordination and advocacy for victims of abuse, and collaboration with protective services and law enforcement. Here we describe the training, scope of practice, ethical role, and best practices for elder mistreatment medical consultation. We hope this will serve as a starting point for this new and important medical specialty.
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Affiliation(s)
- Elizabeth M. Bloemen
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Tietz
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M. Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine
| | - Jason Hayes
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hillary Lum
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Robin Yasui
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, NY
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Chang ES, Bloemen E, Tietz S, Lindberg D, Elman A, Gottesman E, Baek D, Hancock D, LoFaso VM, McAuley J, Sullivan M, Pino C, Rachmuth L, Rosen T. ED/hospital program contributions to community multi-disciplinary team meetings: Different models. J Elder Abuse Negl 2024; 36:413-422. [PMID: 38449107 PMCID: PMC11333175 DOI: 10.1080/08946566.2024.2324315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Elder mistreatment (EM) is a complex problem, with response and prevention requiring contributions from professionals from many disciplines. Community-based multi-disciplinary teams (MDTs) that conduct meetings to discuss challenging cases and coordinate services are a common strategy to ensure effective collaboration. Though they play an important role in EM identification, intervention, and prevention, hospitals and hospital-based healthcare professionals have been particularly difficult to engage in MDTs. Two hospitals in different communities recently launched Emergency Department (ED)/hospital-based response teams to consult in cases of potential EM, and both participate in MDTs. We explored similarities and differences between the MDTs in these communities including in the role of the ED/hospital-based response team. The comparison demonstrates both core common features as well as large variations. These differences reflect different circumstances in the models on which they were based, on MDT development in these communities, available resources and infrastructure, and the ED/hospital program's role.
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Affiliation(s)
- E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elizabeth Bloemen
- Department of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Tietz
- Department of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
| | - Lisa Rachmuth
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
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Bloemen EM, Gottesman E, Furfari K, Glover J, Gabbay E, Cox S, Lindberg D, Tietz S, Rosen T, Baek D, Elman A, Huberman B. Examining ethical issues that arise in providing ED/hospital care for patients experiencing elder mistreatment and approaches to address them. J Elder Abuse Negl 2024; 36:395-412. [PMID: 38867518 PMCID: PMC11333161 DOI: 10.1080/08946566.2024.2365341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Clinicians in the emergency department and hospital who treat patients experiencing elder mistreatment (EM) can expect to encounter challenging ethical dilemmas. Collaboration with ethics and EM consultation services offers teams an important opportunity to improve patient-centered outcomes and address value-based concerns when treating these patients. This article describes the role of a hospital clinical ethics consultation service and best practices for collaboration between ethics and EM consultation services. Illuminated via four case studies, the article presents several core ethical frameworks, including allowing patients the dignity of risk, considerations around a harm reduced discharge, involving abusers in surrogate decision making, and providers' experience of moral distress when dealing with patients experiencing EM. Increasing collaboration with ethics and elder mistreatment services can help teams more effectively respond to EM.
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Affiliation(s)
- Elizabeth M. Bloemen
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Kristin Furfari
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jackie Glover
- Department of Pediatrics and the Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ezra Gabbay
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sarah Cox
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine
| | - Sarah Tietz
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Barrie Huberman
- Division of Medical Ethics, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
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Bloemen EM, Elman A, Tietz S, Shaw A, Lindberg DM, Gottesman E, Hayes J, Baek D, Sullivan M, Yasui R, Pino C, McAuley J, Hancock D, Chang ES, LoFaso VM, Stern ME, Rosen T. Emergency department and hospital-based programs responding to elder mistreatment: developing consensus about an idea whose time has come. J Elder Abuse Negl 2024; 36:339-349. [PMID: 39051637 PMCID: PMC11333158 DOI: 10.1080/08946566.2024.2384400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Elder mistreatment is common, serious, and under-recognized, with Emergency Department and hospital clinical encounters offering a potential but currently unrealized opportunity to identify and help older adults experiencing mistreatment. Interdisciplinary emergency department and hospital-based response teams represent a promising care model to address this. This manuscript describes two such teams and introduces a special issue dedicated to this work.
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Affiliation(s)
- Elizabeth M. Bloemen
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sarah Tietz
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Daniel M. Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jason Hayes
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Robin Yasui
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, USA
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Elman A, Cox S, Gottesman E, Herman S, Kirshner A, Tietz S, Shaw A, Hancock D, Chang ES, Baek D, Bloemen E, Clark S, Rosen T. The critical role of the specialized social worker as part of ED/hospital-based elder mistreatment response teams. J Elder Abuse Negl 2024; 36:384-394. [PMID: 37691425 PMCID: PMC10924767 DOI: 10.1080/08946566.2023.2255742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The emergency department and hospital provide a unique and important opportunity to identify elder mistreatment and offer intervention. To help manage these complex cases, multi-disciplinary response teams have been launched. In developing these teams, it quickly became clear that social workers play a critical role in responding to elder mistreatment. Their unique skillset allows them to establish close connections with community resources, collaborate with various hospital stakeholders, support patients/families/caregivers through challenging situations, navigate the legal and protective systems, and balance patient safety and quality of life in disposition decision-making. The role of the social worker on these multi-faceted teams includes conducting a comprehensive biopsychosocial assessment, helping to develop a safe discharge plan, and making appropriate referrals, among other responsibilities. Any institution considering developing a multi-disciplinary program should recognize the critical importance of social work.
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Affiliation(s)
- Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Sarah Cox
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Seth Herman
- Department of Social Work, NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Avery Kirshner
- Department of Social Work, NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Sarah Tietz
- Department of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Elizabeth Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
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Turner R, Glue P, Barak Y. Effects of changing criteria on improving interRAI assessment for elder abuse: analysis of a national dataset from Aotearoa New Zealand. BMJ Open 2024; 14:e081791. [PMID: 38960466 PMCID: PMC11227781 DOI: 10.1136/bmjopen-2023-081791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/11/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Globally, one in six older adults in the community will be a victim of abuse (elder abuse; EA). Despite these horrific statistics, EA remains largely undetected and under-reported. Available screening methods and tools fail to accurately identify the phenomenon's true prevalence. We aimed to test assessment capture rates by altering the criteria for suspicion of EA in the interRAI-HC (International Resident Assessment Instrument-Home Care) in a large national dataset. DESIGN We employed secondary analyses of existing data to test a methodology to improve the detection of older adults at risk of EA using the interRAI-HC, which currently underestimates the extent of abuse. SETTING The interRAI is a suite of clinical assessment instruments. In Aotearoa New Zealand, interRAI is mandatory in aged residential care and home and community services for older people living in the community. They are designed to show the assessor opportunities for improvement and any risks to the person's health. OUTCOME MEASURE Capture rates of individuals at risk of EA when the interRAI Abuse-Clinical Assessment Protocol (A-CAP) is changed to include the unable to determine abuse (UDA) group shown in a pilot study to increase capture rates of individuals at risk of EA. RESULTS Analysis of 9 years of interRAI-HC data (July 2013-June 2022) was undertaken, encompassing 186 713 individual assessments consisting of 108 992 women (58.4%) and 77 469 men (41.5%). The mean age was 82.1 years (range: 65-109); the majority 161 378 were European New Zealanders (86.4%) and the most common minority ethnicity was Māori (6.1%). Those at high risk of abuse (A-CAP) tended to be male (2402; 51.0%), were 79.2 years old on average (range 65-105), with 49.6% (2335) living alone, 39.4% (1858) suffering from depression and a majority were assessed as not having independent decision making (2942; 62.5%). In comparison, the UDA group showed similar characteristics to the A-CAP group on some measures. They were slightly younger than the general sample, with a mean age 80.1 years (range 65-107), they had higher rates of depression (2123; 33.5%) compared with the general sample (25 936; 14.8%) and a majority were assessed as not having independent decision-making (3855; 60.9%). The UDA group is distinct from the general sample and the UDA group broadly has similar but less extreme characteristics to the A-CAP group. Through altering the criteria for suspicion of EA, capture rates of at-risk individuals could be more than doubled from 2.5% to 5.9%. CONCLUSIONS We propose that via adapting the interRAI-HC criteria to include the UDA category, the identification of older adults at risk of EA could be substantially improved, facilitating enhanced protection of this vulnerable population.
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Affiliation(s)
- Robin Turner
- Biostatistics Centre, University of Otago, Dunedin, Otago, New Zealand
| | - Paul Glue
- Psychological Medicine, School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yoram Barak
- Psychological Medicine, School of Medicine, University of Otago, Dunedin, Otago, New Zealand
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Kong J, Moorman SM, Qin Y. Lifetime Abuse Victimization and Prospective Health Outcomes in Older Adults. J Appl Gerontol 2024; 43:990-996. [PMID: 38350889 PMCID: PMC11166519 DOI: 10.1177/07334648231225377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Objectives: The current study examined the associations between lifetime abuse victimization and prospective health outcomes in late adulthood. Methods: Data from 4907 older adults (mean age = 80) from the Wisconsin Longitudinal Study were analyzed. Multivariate analyses examined the associations of lifetime abuse victimization with depression, physical health status, and memory. Results: Greater exposure to lifetime abuse was associated with a significantly higher risk of depression (OR = 1.13, CI: [1.08, 1.19], p < .001) and a greater number of limitations in physical functioning (b = .08, SE = .02, p < .001), but not with memory performance (b = .01, SE = .14, p > .05). Discussion: Our results support the interrelations of interpersonal violence across the life course and the lasting health effects of exposure to lifetime abuse. Findings highlight the need for a life course-based, trauma-informed approach in prevention and intervention programs for older adults.
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Affiliation(s)
- Jooyoung Kong
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | - Sara M. Moorman
- Department of Sociology, Boston College, Chestnut Hill, MA, USA
| | - Yue Qin
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
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Durmaz A, Yılmaz M. Family physicians' knowledge levels about elder abuse and neglect in a province of Türkiye and hesitations in reporting. Fam Pract 2024; 41:255-261. [PMID: 36723876 DOI: 10.1093/fampra/cmad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to investigate the knowledge, attitudes and reservations of family physicians (FPs) in reporting elderly abuse and neglect (EAN). METHODS Our cross-sectional study was conducted with 161 FPs in Kütahya, a city in Türkiye. A questionnaire including demographic characteristics, the frequency with which Elder Abuse Suspicion Index (EASI) questions were asked and knowledge level of EAN was applied to the FPs. RESULTS Only about a quarter (24.2%) of the FPs felt competent regarding EAN. The rate of participants who had encountered EAN victims before was 46%. Of these, 40% reported psychological violence, 24.3% reported physical and psychological violence and 21.6% reported only physical violence. FPs also reported that inconsistency in anamnesis (87.0%), inconsistency between anamnesis and physical examination findings (85.1%) and frequent visits to the emergency department (59.6%) raised suspicion about EAN. It was also observed that 68.9% of the FPs knew that healthcare professionals had a legal obligation to report elder abuse. Only 23.0% of the FPs who encountered cases of violence and abuse stated that they had made a legal report. Among the FPs who did not report, 40.4% stated that they did not report because they had some reservations or did not know how to do so (35.1%). CONCLUSION Due to a lack of knowledge and some concerns, the rate of reporting EAN to judicial authorities was also low. FPs were not aware of the importance of EAN in terms of elderly health.
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Affiliation(s)
- Adem Durmaz
- Department of Family Medicine, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Türkiye
| | - Muammer Yılmaz
- Department of Public Health, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Türkiye
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10
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Riedel HB, Espejo T, Dreher-Hummel T, Bingisser R, Nickel CH. Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study. Swiss Med Wkly 2024; 154:3775. [PMID: 38875501 DOI: 10.57187/s.3775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
AIM OF THE STUDY The mistreatment of older adults is a global and complex problem with varying prevalence. As there are no data on the prevalence of elder mistreatment in European emergency department populations, we aimed to translate and culturally adapt the Emergency Department Senior Abuse Identification (ED Senior AID) tool for German use, assess the positive screen rate for elder mistreatment with the German version, and compare characteristics of patients who screened positive and negative. METHODS To assess the prevalence of elder mistreatment, we created a German version of the ED Senior AID tool. This tool identifies intentional or negligent actions by a caregiver or trusted person that cause harm or risk to an older adult. Then, the German ED Senior AID tool was applied to all consecutively presenting patients aged ≥65 years at our academic emergency department in the Northwest of Switzerland from 25 April to 30 May 2022. Usability was defined as the percentage of patients with completed assessments using the German ED Senior AID tool. RESULTS We included 1010 patients aged ≥65 years, of whom 29 (2.9%) screened positive with the ED Senior AID tool. The patients who screened positive were older, more severely cognitively impaired, hospitalised more frequently, and presented with higher frailty scores than those who screened negative. Mortality up to 100 days after presentation was comparable in all patients (p = 0.861), regardless of their screening result. The tool showed good usability, with 73% of assessments completed. CONCLUSION This is the first prospective investigation on the prevalence of elder mistreatment in a European emergency department setting. Overall, 2.9% of patients screened positive using a validated screening tool translated into German. TRIAL REGISTRATION This study was registered with the National Institute of Health on ClinicalTrials.gov with the registration number NCT05400707.
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Affiliation(s)
- Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Dreher-Hummel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
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11
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Brijnath B, Feldman P, Dow B, Muoio R. Australian Frontline Service Response to Elder Abuse During COVID-19: Learnings, Successes, and Preparedness for Disaster. J Appl Gerontol 2024; 43:723-733. [PMID: 37994902 DOI: 10.1177/07334648231214941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
This study examines how service providers in Victoria, Australia, undertook early intervention and response to elder abuse during the COVID-19 pandemic in 2020-2021. This study comprised two phases: (a) interviews with 29 staff members from 23 frontline service organizations about their experience responding to the needs of vulnerable older people during COVID-19; followed by (b) a co-design workshop with 15 service providers to discuss and endorse recommendations to improve sector preparedness for early intervention and responses to elder abuse during disasters. Participants reported that the severity and frequency of elder abuse increased during the pandemic, and that remoteness of services undermined comprehensive risk assessments, especially for older people who were not proficient in English and/or current digital platforms. Service providers endorsed a range of recommendations to improve sector preparedness for responses to elder abuse during disasters, primarily to upskill providers and improve the service system and direct support for individuals.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute, Melbourne, Australia
- University of Western Australia, Perth, Australia
- The University of Melbourne, Melbourne, Australia
| | - Peter Feldman
- National Ageing Research Institute, Melbourne, Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, Australia
- Deakin University, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
| | - Rachel Muoio
- National Ageing Research Institute, Melbourne, Australia
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12
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Cavuoto MG, Markusevska S, Stevens C, Reyes P, Renshaw G, Peters MDJ, Dow B, Feldman P, Gilbert A, Manias E, Mortimer D, Enticott J, Cooper C, Antoniades J, Appleton B, Nakrem S, O'Brien M, Ostaszkiewicz J, Eckert M, Durston C, Brijnath B. The impact of elder abuse training on subacute health providers and older adults: study protocol for a randomized control trial. Trials 2024; 25:338. [PMID: 38778386 PMCID: PMC11110438 DOI: 10.1186/s13063-024-08160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse. METHODS This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses. DISCUSSION This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral. TRIAL REGISTRATION ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.
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Affiliation(s)
- Marina G Cavuoto
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Simona Markusevska
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
| | | | - Patricia Reyes
- . Vincent's Health Sydney, Darlinghurst, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
- Uniting War Memorial Hospital, Waverley, NSW, Australia
| | - Gianna Renshaw
- Sir Charles Gairdner Osborne Park Health Care Group, Stirling and Nedlands, WA, Australia
| | - Micah D J Peters
- Rosemary Bryant AO Research Centre, Clinical Health Science, University of South Australia, Adelaide, South Australia, Australia
- Australian Nursing and Midwifery Federation (Federal Office), Melbourne, VIC, Australia
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Health Evidence Synthesis, Recommendations, and Impact (HERSI), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Briony Dow
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
- The University of Melbourne, Parkville, VIC, Australia
- Deakin University, Waurn Ponds, Victoria, Australia
| | - Peter Feldman
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
| | - Andrew Gilbert
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
- La Trobe University, Bundoora, VIC, Australia
| | - Elizabeth Manias
- Deakin University, Waurn Ponds, Victoria, Australia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Josefine Antoniades
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- School of Media, Creative Arts and Social Inquiry, Curtin University, Bentley, WA, Australia
| | | | - Sigrid Nakrem
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Joan Ostaszkiewicz
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia
- The University of Melbourne, Parkville, VIC, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, VIC, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical Health Science, University of South Australia, Adelaide, South Australia, Australia
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - Bianca Brijnath
- Social Gerontology, National Ageing Research Institute, PO Box 2127, Parkville, VIC, 3050, Australia.
- The University of Melbourne, Parkville, VIC, Australia.
- The School of Social Sciences, The University of Western Australia, Perth, WA, Australia.
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13
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Swearinger H, Lapham JL, Martinson ML, Berridge C. Older Adults' Unmet Needs at the End of Life: A Cross-Country Comparison of the United States and England. J Aging Health 2024:8982643241245249. [PMID: 38613317 DOI: 10.1177/08982643241245249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Objectives: This study aimed to compare the end-of-life (EOL) experiences in concentration with place of death, for older adults in the U.S. and England. Methods: Weighted comparative analysis was conducted using harmonized Health and Retirement Study and English Longitudinal Study of Ageing datasets covering the period of 2006-2012. Results: At the EOL, more older adults in the U.S. (64.14%) than in England (54.09%) had unmet needs (I/ADLs). Home was the main place of death in the U.S. (47.34%), while it was the hospital in England (58.01%). Gender, marital status, income, place of death, previous hospitalization, memory-related diseases, self-rated health, and chronic diseases were linked to unmet needs in both countries. Discussion: These findings challenge the existing assumptions about EOL experiences and place of death outcomes, emphasizing the significance of developing integrated care models to bolster support for essential daily activities of older adults at the EOL.
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Affiliation(s)
- Hazal Swearinger
- Department of Social Work, Cankiri Karatekin University, Çankırı, Turkey
| | | | | | - Clara Berridge
- Department of Social Work, University of Washington, Seattle, WA, USA
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van Houten ME, Vloet LCM, Rikkert MGMO, van de Kerkhof-van Bon B, de Rooij A, Verhoeven M, Bil WME, Lucke JA, Schoon Y, Berben SAA. ERASE: a feasible early warning tool for elder abuse, developed for use in the Dutch emergency department. BMC Emerg Med 2024; 24:52. [PMID: 38570746 PMCID: PMC10988976 DOI: 10.1186/s12873-024-00971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Elder abuse is a worldwide problem with serious consequences for individuals and society. To effectively deal with elder abuse, a timely identification of signals as well as a systematic approach towards (suspected) elder abuse is necessary. This study aimed to develop and test the acceptability and appropriateness of ERASE (EldeR AbuSE) in the emergency department (ED) setting. ERASE is an early warning tool for elder abuse self-administered by the healthcare professional in patients ≥ 70 years. METHODS A systematic literature review was previously conducted to identify potential available instruments on elder abuse for use in the ED. Furthermore, a field consultation in Dutch hospitals was performed to identify practice tools and potential questions on the recognition of elder abuse that were available in clinical practice. Based on this input, in three subsequent rounds the ERASE tool was developed. The ERASE tool was tested in a pilot feasibility study in healthcare professionals (n = 28) working in the ED in three Dutch hospitals. A semi-structured online questionnaire was used to determine acceptability and appropriateness of the ERASE tool. RESULTS The systematic literature review revealed seven screening instruments developed for use in the hospital and/or ED setting. In total n = 32 (44%) hospitals responded to the field search. No suitable and validated instruments for the detection of elder abuse in the ED were identified. The ERASE tool was developed, with a gut feeling awareness question, that encompassed all forms of elder abuse as starting question. Subsequently six signalling questions were developed to collect information on observed signs and symptoms of elder abuse and neglect. The pilot study showed that the ERASE tool raised the recognition of healthcare professionals for elder abuse. The tool was evaluated acceptable and appropriate for use in the ED setting. CONCLUSIONS ERASE as early warning tool is guided by an initial gut feeling awareness question and six signalling questions. The ERASE tool raised the recognition of healthcare professionals for elder abuse, and was feasible to use in the ED setting. The next step will be to investigate the reliability and validity of the ERASE early warning tool.
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Affiliation(s)
- Miriam E van Houten
- Department of Geriatric Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Research Department of Emergency and Critical Care, School of Health Studies, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
- Trompetter & Partners Social Medical Expertise, Utrechtseweg 75, 3702 AA, Zeist, The Netherlands.
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, School of Health Studies, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, P.O. Box 9101, 114, 6500 HB, Nijmegen, the Netherlands
| | - Marcel G M Olde Rikkert
- Radboudumc Alzheimer Centre, Donders Insititute of Medical Neuroscience, Department of Geriatrics, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | | | | | | | | | - Yvonne Schoon
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 114, 6500 HB, Nijmegen, The Netherlands
| | - Sivera A A Berben
- Research Department of Emergency and Critical Care, School of Health Studies, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, P.O. Box 9101, 114, 6500 HB, Nijmegen, the Netherlands.
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15
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Ricoy-Cano AJ, Zambrano-Rodríguez CV, de la Fuente-Robles YM, Vásquez-Peña GE. Violence, Abuse and Neglect in Older Women in Rural and Remote Areas: A Scoping Review and Prevalence Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024:15248380241234342. [PMID: 38433383 DOI: 10.1177/15248380241234342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
This systematic review addressed the issue of the abuse and neglect of older women (age 60 and over) in rural and remote areas, examining these phenomena's prevalence, risk and protective factors, consequences, and associated perceptions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Arksey and O'Malley methodological framework, peer-reviewed articles published until September 2023 were identified in six electronic databases. Out of the manuscripts initially identified (n = 219), 28 articles met the selection criteria. The study's quality was assessed using the Mixed Methods Appraisal Tool. The included studies provided a comprehensive overview of this phenomenon, encompassing data from 6,579 older rural women. Prevalence rates of abuse and neglect exhibited wide variability, with an average of 27.3%. Among the risk factors, financial dependence and incapacity stood out, while higher income and education levels were protective factors, among others. Emotional/psychological abuse emerged as the most common form, with significant impacts on older women's physical and mental health. Cultural norms and gender expectations also influenced perceptions of abuse and victims' coping mechanisms. In a context in which access to specialized resources and services is hampered by significant limitations, community awareness and education prove vital to address this issue, which positions social work as key to addressing these challenges. The prevalence of abuse against older rural women is significant. Emotional abuse stands out as a major issue, underscoring the need for comprehensive interventions accounting for cultural and gender factors.
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16
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Yalçın Gürsoy M, Uçan Yamaç S. Elder abuse, depression, anxiety, and stress in community-dwelling older adults. Psychogeriatrics 2024; 24:336-344. [PMID: 38237963 DOI: 10.1111/psyg.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 03/04/2024]
Abstract
BACKGROUND Elder abuse as an important public health issue is associated in the literature with various physical and psychological symptoms. The aim of the study is to determine the relationship between elder abuse and depression, anxiety, and stress in the elderly living in the community. METHOD The cross-sectional study was completed with 729 older people. Data were collected through a face-to-face interview and a survey form. The Geriatric Mistreatment Scale (GMS) was used to evaluate elder abuse and the Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress. Multivariate regression analysis was performed to determine the relationship between elder abuse and depression, anxiety, and stress. RESULTS Of the participants, 20.9% were exposed to at least one type of abuse, 9.2% experienced physical abuse, 18.2% experienced psychological abuse, 4.4% experienced neglect, and 7.0% had financial abuse. The general prevalence of moderate to very severe depression, anxiety, and stress among the elderly was respectively 17.1%, 16%, and 10%. As a result of multivariate analysis it was determined that neglect (t = 6245; ß = 4952) and economic abuse (t = 3865; ß = 3350) had statistically significant effects on depression; psychological abuse (t = 2924; ß = 0,992), economic abuse (t = 3127; ß = 3517) and neglect (t = 5913; ß = 4810) had statistically significant effects on anxiety, while psychological (t = 5023; ß = 1756) and economic abuse (t = 5719; ß = 5238) had statistically significant effects on stress (P < 0.05). CONCLUSION As a result of the study, it was seen that the prevalence of abuse and depression, anxiety, and stress was high in the elderly. There was also a strong relationship between types of elder abuse and depression, anxiety, and stress. It is recommended that health professionals working with older people to screen them for types of abuse and mental symptoms with the help of appropriate screening tools.
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Affiliation(s)
- Melike Yalçın Gürsoy
- Health Sciences Faculty, Nursing Department, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Sabriye Uçan Yamaç
- Bucak Health School, Department of Midwifery, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
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17
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Smith JR. Older mothers and their difficult adult children: a life course exploration. J Elder Abuse Negl 2024; 36:174-197. [PMID: 38459784 DOI: 10.1080/08946566.2024.2325558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Adult child to parent violence is a growing international social problem that needs to be better understood to develop clinical interventions. An exploratory study on the antecedents of early life adversity on adult child to parent violence/elder mistreatment was carried out using secondary analysis. Directed content analysis was used based on life course theory with a data set of older mothers all > 57 years old (J. R. Smith 2021, 2022). Measurement of instances of child abuse, domestic violence, and birth trauma among abused older mothers was conducted. All the older women had reported being negatively affected by their adult children's problems and 56% reported being physically attacked. A case example is presented to illustrate how repeated incidents of abuse or neglect in early life might explain an older woman's inability to take actions for her own safety.
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Affiliation(s)
- Judith R Smith
- Graduate School of Social Service, Fordham University, New York, NY, USA
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18
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Weissberger G, Bergman YS. Subjective Age and Financial Exploitation Vulnerability: The Mediating Role of Financial Self-Efficacy. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:230-241. [PMID: 37560899 DOI: 10.1080/01634372.2023.2246159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023]
Abstract
An older subjective age, or feeling older than one's chronological age, has been associated with increased financial exploitation vulnerability (FEV) among older adults. However, the mechanisms behind this relationship have not been examined. This study examined whether financial self-efficacy mediates the relationship between subjective age and FEV. Participants were 156 Israeli older adults (M age= 66.97, SD = 6.46) who responded to questionnaires of subjective age, FEV, and financial self-efficacy. Correlations indicated that an older subjective age was associated with reduced financial self-efficacy (r= -.36, p < .001) and increased FEV (r = .51, p < .001). Testing the mediation model revealed an indirect effect of subjective age on FEV via financial self-efficacy (b = 1.57; bootstrapped 95% Cis [.80, 2.39]). Findings suggest that an older subjective age may reduce financial self-efficacy, thereby increasing FEV. Findings are discussed with regard to Stereotype Embodiment Theory and clinical implications are suggested.
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Affiliation(s)
- Gali Weissberger
- Department of Social and Health Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Yoav S Bergman
- Faculty of Social Work, Ashkelon Academic College, Ashkelon, Israel
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19
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Makaroun LK, Halaszynski JJ, Smith KA, Drake R, Amelio-Hering V, Atchison K, Dichter ME, Rosland AM, Thorpe CT, Rosen T. Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System. J Gen Intern Med 2024:10.1007/s11606-023-08560-2. [PMID: 38191973 DOI: 10.1007/s11606-023-08560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening. OBJECTIVE Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA. DESIGN Survey of all 139 VHA medical centers from January to August 2021. PARTICIPANTS Surveys were completed by the Social Work Chief, or delegate, at each site. MAIN MEASURES The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey. KEY RESULTS Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents' understanding of the definition of screening. CONCLUSIONS High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.
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Affiliation(s)
- Lena K Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | | | - Ruth Drake
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
| | | | - Karley Atchison
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University Philadelphia, Philadelphia, PA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, NY, USA
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Fettig N, Mitchell H, Gassoumis Z, Nizam Z, Whittier Eliason S, Cory S. Adult Maltreatment Risk Factors: Adding Community-Level Factors to an Individual-Level Field. TRAUMA, VIOLENCE & ABUSE 2024; 25:5-21. [PMID: 36636944 DOI: 10.1177/15248380221137659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Adult maltreatment is a pervasive problem in the United States and has serious individual and societal consequences. Adult protective services (APS) agencies are the social services programs responsible for serving older adults and adults with disabilities who may be experiencing adult maltreatment. The adult maltreatment literature differentiates elder maltreatment from the maltreatment of adults with disabilities, yet APS agencies serve both groups. Understanding the etiology of adult maltreatment as well as the associated risk and protective factors is crucial for APS workers, clinical practitioners, researchers, and policymakers. To advance the evidence in this area, we undertook a scoping review to examine recent evidence on risk and protective factors associated with adult maltreatment. Searches of nine electronic databases were conducted in 2020 to identify studies published in peer-reviewed journals since 2010. A total of 29 studies were included in the final review. The findings identified several categories of risk factors associated with the individual: demographic traits, socioeconomic characteristics, physical and mental health, interpersonal issues, and historical events. Several studies identified caregiver and alleged perpetrator risk factors. However, the current body of research lacks community and contextual risk and protective factors. Therefore, we present several potential data sources that may be leveraged to examine the links between social-contextual characteristics and adult maltreatment. These data may be combined with APS data to advance the field's understanding of risk and protective factors through advanced analytic techniques.
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Affiliation(s)
| | | | | | - Zainab Nizam
- WRMA, Inc., a TriMetrix Company, Arlington, VA, USA
| | | | - Scott Cory
- Administration for Community Living, Washington, DC, USA
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Zhang H, Bao Y, Baek D, Clark S, Elman A, Hancock D, Chang ES, Jeng P, Gassoumis Z, Fettig N, Zhang Y, Wen K, Lachs MS, Pillemer K, Rosen T. Healthcare costs for legally adjudicated elder mistreatment victims in comparison to non-mistreated older adults. J Am Geriatr Soc 2024; 72:236-245. [PMID: 38112382 PMCID: PMC10872321 DOI: 10.1111/jgs.18712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Elder mistreatment (EM) is associated with adverse health outcomes and healthcare utilization patterns that differ from other older adults. However, the association of EM with healthcare costs has not been examined. Our goal was to compare healthcare costs between legally adjudicated EM victims and controls. METHODS We used Medicare insurance claims to examine healthcare costs of EM victims in the 2 years surrounding initial mistreatment identification in comparison to matched controls. We adjusted costs using the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk score. RESULTS We examined healthcare costs in 114 individuals who experienced EM and 410 matched controls. Total Medicare Parts A and B healthcare costs were similar between cases and controls in the 12 months prior to initial EM detection ($11,673 vs. $11,402, p = 0.92), but cases had significantly higher total healthcare costs during the 12 months after initial mistreatment identification ($15,927 vs. $10,805, p = 0.04). Adjusting for CMS-HCC scores, cases had, in the 12 months after initial EM identification, $5084 of additional total healthcare costs (95% confidence interval [$92, $10,077], p = 0.046) and $5817 of additional acute/subacute/post-acute costs (95% confidence interval [$1271, $10,362], p = 0.012) compared with controls. The significantly higher total costs and acute/sub-acute/post-acute costs among EM victims in the post-year were concentrated in the 120 days after EM detection. CONCLUSIONS Older adults experiencing EM had substantially higher total costs during the 12 months after mistreatment identification, driven by an increase in acute/sub-acute/post-acute costs and focused on the period immediately after initial EM detection.
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Affiliation(s)
- Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
- Department of Health Policy and Organization, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Vanderbilt University, Nashville, TN, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
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22
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Berg K, Kjellberg I. Managing reports of trouble: designated officials' responses to reports of mistreatments initiated by service users and relatives. J Elder Abuse Negl 2024; 36:1-24. [PMID: 38126731 DOI: 10.1080/08946566.2023.2297221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Mandatory reporting of elder abuse aims to detect and prevent mistreatment and improve services. Service users and their relatives can raise concerns, but only staff can file mandatory reports. This article examines how the concerns of service users and relatives were managed by designated officials in reports of mistreatments in care for older adults in Sweden. We lean on sociological theories of "interpersonal trouble" and organizational "disputes domains." The thematic analysis is based on 28 incident reports initiated by service users or their relatives. The analysis shows that the reports were managed in one of three ways: asymmetrically, by 1) dismissing or 2) supporting the complainant's position, or symmetrically, by 3) treating complainants' accounts as credible but minimizing their seriousness. There were differences between reports initiated by service users and relatives. Dismissing concerns about abuse, mainly those made by relatives, risks support for service users failing.
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Affiliation(s)
- Karin Berg
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Inger Kjellberg
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
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Zhang Kudon H, Herbst JH, Richardson LC, Smith SG, Demissie Z, Siordia C. Prevalence estimates and factors associated with violence among older adults: National Intimate Partner and Sexual Violence (NISVS) Survey, 2016/2017. J Elder Abuse Negl 2024; 36:67-83. [PMID: 38129823 DOI: 10.1080/08946566.2023.2297227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Abuse of older adults is a public health problem. The National Intimate Partner and Sexual Violence Survey (NISVS) is a nationally-representative, telephone survey for non-institutionalized adults in the United States. To determine the prevalence and factors of intimate partner psychological aggression and physical violence and sexual violence by any perpetrator against older adults, we analyzed NISVS 2016/2017 data (n = 10,171, aged ≥ 60 years). Past 12-month prevalence of psychological aggression, physical violence, and sexual violence was 2.1%, 0.8%, and 1.7%, respectively. Odds of psychological aggression were significantly higher among those with hearing or vision impairment, and lower among those aged ≥70 years. Odds of physical violence were significantly higher for males and for those with hearing or vision impairment. Odds of sexual violence were significantly higher for unpartnered individuals and those with cognitive impairment; and lower for those aged ≥ 70 years. Epidemiologic studies of violence against older adults can inform population-specific prevention strategies.
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Affiliation(s)
- Hui Zhang Kudon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey H Herbst
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - LaTonia C Richardson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon G Smith
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zewditu Demissie
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Office of Health Equity and Health Disparities, Centers for Disease Control and Prevention, U.S. Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Carlos Siordia
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Rollandi I, Banerjee S, Qiu Y, Fiallo O, Abramson T, Berman J, Solomonov N, Sirey JA. Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19. Psychother Res 2023:1-13. [PMID: 38109490 PMCID: PMC11182890 DOI: 10.1080/10503307.2023.2292743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery. METHOD PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT. RESULTS PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms. CONCLUSIONS PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.
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Affiliation(s)
- Isabel Rollandi
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Samprit Banerjee
- Weill Cornell Department of Population Health, Weill Cornell Medicine, New York, NY, USA
| | - Yuqing Qiu
- Weill Cornell Department of Population Health, Weill Cornell Medicine, New York, NY, USA
| | - Olivia Fiallo
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Tobi Abramson
- New York City Department for the Aging, New York, NY, USA
| | | | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Jo Anne Sirey
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
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Santos-Rodrigues RCD, Araújo-Monteiro GKND, Dantas AMN, Beserra PJF, Morais RMD, Souto RQ. Elder abuse: a conceptual analysis. Rev Bras Enferm 2023; 76:e20230150. [PMID: 38055495 DOI: 10.1590/0034-7167-2023-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to analyze the concept of elder abuse and identify its respective antecedents, attributes and consequents. METHODS this is a conceptual analysis according to Walker and Avant's proposition. The search for the concept was mediated by an integrative review in the LILACS, PubMed, CINAHL, Web of Science and BDENF databases. RESULTS as antecedents, female, family member, low social support and low income or socioeconomic conditions stand out. Attributes were threats and/or intimidation, intentional use of physical force, using resources without authorization, unwanted sexual activity, offering low insufficient amount of nutrients for older adults and not meeting older adults' affective/emotional needs. Consequents were psychological disorders, dependence on aggressors, environment of insecurity and damage/loss of human rights or human dignity. FINAL CONSIDERATIONS the phenomenon under discussion is broad and multifaceted, suggesting expansion of studies related to the theme in order to explore it in detail.
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Ross J. Elder Abuse-the Need for Increased Awareness, Assessment, and Reporting in Health Care. J Perianesth Nurs 2023; 38:945-946. [PMID: 38042582 DOI: 10.1016/j.jopan.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Jacqueline Ross
- Department of Patient Safety and Risk Management, The Doctors Company, Chagrin Falls, OH.
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Patterson T, Hobbs L, Brown E, Barak Y. Sexual Assault in Older-Age Adults: Criminal Justice Response in New Zealand. J Aging Soc Policy 2023:1-16. [PMID: 38007620 DOI: 10.1080/08959420.2023.2284575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/19/2023] [Indexed: 11/27/2023]
Abstract
There is growing recognition that older persons, both male and female, may experience sexual assault. One clearly identified gap in the body of scientific literature is examination of the criminal justice response for older adults who have been sexually assaulted. This retrospective age-group comparative data analysis examines publicly available population and police statistics for 2018 to describe rates (per 100,000) of reported sexual assault across adult age categories (young adult, n = 748; adult, n = 1,478; middle age, n = 290; older adult, n = 58) and compare (using Chi-square bivariate analysis) the criminal justice response to sexual assault for these adult age categories in New Zealand (NZ). Sexual assault was perpetrated against victims across all age and sex groups examined. The rate of reported sexual assault against older adults was significantly lower after the age of 65 years (7.90 per 100,000) compared to younger adults aged 20-64 years (87.57 per 100,000). Across age categories no difference was found in the proportion of cases proceeded to court action. This study raises awareness of the topic of sexual assault perpetrated against older persons and shows that a substantial number of older adults experience sexual assault in cases that do not result in court action. It points to the need for policy-makers to consider the reporting of sexual assaults against older persons to justice services.
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Affiliation(s)
- Tess Patterson
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
- Optentia Research Focus Area, North-West University, Potchefstroom, South Africa
| | - Linda Hobbs
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Elliott Brown
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Yoram Barak
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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Gottesman E, Elman A, Rosen T. Elder Mistreatment: Emergency Department Recognition and Management. Clin Geriatr Med 2023; 39:553-573. [PMID: 37798065 DOI: 10.1016/j.cger.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.
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Affiliation(s)
- Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA.
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Li Y, Qiu D, Wu Q, Ni A, Tang Z, Xiao S. Family caregivers' abusive behaviour and its association with internalized stigma of people living with schizophrenia in China. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:61. [PMID: 37726337 PMCID: PMC10509261 DOI: 10.1038/s41537-023-00393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
Family caregiving of people living with schizophrenia (PLS) can be burdensome, and some family caregivers may perpetrate abusive behavior that could be harmful to PLS. This study aims to examine the association of family caregivers' abusive behavior with internalized stigma of PLS and draw attention to this problem. PLS were recruited from four cities across China and completed measures of abusive behavior and internalized stigma. Linear regression analyses were used to determine the association between family caregivers' abusive behavior and internalized stigma of PLS. A total of 693 PLS were include in this study. 22.7% of the participants had experienced one or more of the abusive behaviors perpetrated by family caregivers. The most common type of abusive behavior towards PLS was verbal abuse and 4.2% of the participants reported physical abuse. 44.6 % of participants reported a high level of internalized stigma. PLS who experienced any abusive behavior by family caregivers had significantly higher levels of internalized stigma. Family caregivers' abusive behavior is positively associated with alienation and social withdrawal but not with stereotype endorsement and discrimination of PLS. To end all forms of stigma and discrimination against PLS, more attention needs to be paid to the families of PLS.
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Affiliation(s)
- Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Anyan Ni
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Beverly EA, Love C, Love M, Lammert L, Bowditch J. Cinematic Virtual Reality for Educating Health Care Providers About Type 2 Diabetes, Disability, and Elder Abuse and Neglect: A Pilot Study. J Diabetes Sci Technol 2023; 17:1160-1171. [PMID: 37114917 PMCID: PMC10563529 DOI: 10.1177/19322968231171586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Diabetes care for older adults is complex and must consider geriatric syndromes, disability, and elder abuse and neglect. Health care providers would benefit from professional training programs that emphasize these risks. One new educational approach is cinematic virtual reality (cine-VR). We conducted a pilot study to evaluate a cine-VR training program based on an older patient with type 2 diabetes and multiple geriatric syndromes who is at risk for elder abuse and neglect. METHODS We employed a single-arm, pre-post-test study to assess changes in attitudes to disability and self-efficacy in identifying and managing elder abuse and neglect. RESULTS Thirty health care providers completed the pilot study (83.3% women, 86.7% white, 56.7% physicians, 43.4% practiced in outpatient clinics). We observed change in attitudes toward discrimination (Z = -2.628, P = .009, Cohen's d = .62). In addition, we observed changes in six of the eight self-efficacy items, including how participants would ask questions about abuse (Z = -3.221, P = .001, Cohen's d = .59) and helping an older patient make a report to the police or social services (Z = -2.087, P = .037, Cohen's d = .52). In addition, we observed positive changes in understanding the documentation needed to complete whether a patient reports abuse (Z = -3.598, P < .001) as well as the legal knowledge for how to report elder abuse and neglect (Z = -2.556, P = .011). CONCLUSION Findings from this pilot study suggest that cine-VR training may increase health care providers' awareness of discrimination and improve self-efficacy toward identifying and managing elder abuse and neglect. Research with a proper control condition is needed to confirm its effectiveness.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Primary Care, Heritage
College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Diabetes Institute, Ohio University,
Athens, OH, USA
| | - Carrie Love
- Department of Primary Care, Heritage
College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Matthew Love
- J. Warren McClure School of Emerging
Communication Technologies, Ohio University, Athens, OH, USA
- Game Research and Immersive Design
(GRID) Lab, Ohio University, Athens, OH, USA
| | - Lori Lammert
- Department of Primary Care, Heritage
College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Diabetes Institute, Ohio University,
Athens, OH, USA
| | - John Bowditch
- J. Warren McClure School of Emerging
Communication Technologies, Ohio University, Athens, OH, USA
- Game Research and Immersive Design
(GRID) Lab, Ohio University, Athens, OH, USA
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Elman A, Gottesman E, Makaroun LK, Chang ES, Baek D, Clark S, Rosen T. Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:1551-1564. [PMID: 37083117 PMCID: PMC10125886 DOI: 10.1177/07334648231166276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 04/22/2023] Open
Abstract
The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six focus groups and seven interviews during March-April 2021 using a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and caseworkers in New York City, a community hard hit by the initial COVID surge. Data from transcripts were analyzed to identify themes. Participants identified challenges faced by APS (e.g., clients less willing to engage with APS, inability to perform necessary job tasks remotely, and low staffing levels) as well as strategies APS used in response (e.g., increasing collaboration with other community-based programs and service providers, enabling remote court hearings through technology and in-person facilitation, and ensuring staff had access to personal protective equipment). These findings may inform APS planning for future large-scale societal disruptions.
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Affiliation(s)
- Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | | | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
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Makaroun LK, Rosland AM, Mor MK, Zhang H, Lovelace E, Rosen T, Dichter ME, Thorpe CT. Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study. J Am Geriatr Soc 2023; 71:1724-1734. [PMID: 36695515 PMCID: PMC10258119 DOI: 10.1111/jgs.18245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system. METHODS We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model. RESULTS The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation. CONCLUSIONS A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.
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Affiliation(s)
- Lena K. Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria K. Mor
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hongwei Zhang
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Elijah Lovelace
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, New York, USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- School of Social Work, Temple University Philadelphia, PA
| | - Carolyn T. Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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El-Qawaqzeh K, Hosseinpour H, Gries L, Magnotti LJ, Bhogadi SK, Anand T, Ditillo M, Stewart C, Cooper Z, Joseph B. Dealing with the elder abuse epidemic: Disparities in interventions against elder abuse in trauma centers. J Am Geriatr Soc 2023; 71:1735-1748. [PMID: 36876983 DOI: 10.1111/jgs.18286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults. METHODS Analysis of the 2017-2018 ACS TQIP. All trauma patients ≥60 years with an abuse report for suspected physical abuse were included. Patients with missing information on abuse interventions were excluded. Outcomes were rates of abuse investigation initiation following an abuse report and change of caregiver at discharge among survivors with an abuse investigation initiated. Multivariable regression analyses were performed. RESULTS Of 727,975 patients, 1405 (0.2%) had an abuse report. Patients with an abuse report were younger (mean, 72 vs 75, p < 0.001), and more likely to be females (57% vs 53%, p = 0.007), Hispanic (11% vs 6%, p < 0.001), Black (15% vs 7%, p < 0.001), suffer from dementia (18% vs 11%, p < 0.001), functional disability (19% vs 15%, p < 0.001), have a positive admission drug screen (9% vs 5%, p < 0.001) and had a higher ISS (median [IQR], 9 [4-16] vs 6 [3-10], p < 0.001). Perpetrators were members of the immediate/step/extended family in 91% of cases. Among patients with an abuse report, 1060 (75%) had abuse investigations initiated. Of these, 227 (23%) resulted in a change of caregiver at discharge. On multivariate analysis for abuse investigation initiation, male gender, private insurance, and management at non-level I trauma centers were associated with lower adjusted odds (p < 0.05), while Hispanic ethnicity, positive admission drug screen, and penetrating injury were associated with higher adjusted odds (p < 0.05). On multivariate analysis for change of caregiver, male gender, and private insurance were associated with lower adjusted odds (p < 0.05), while functional disability and dementia were associated with higher adjusted odds (p < 0.05). CONCLUSIONS Significant gender, ethnic, and socioeconomic disparities exist in the management of physical abuse of older adults. Further studies are warranted to expand on and address the contributing factors underlying these disparities. LEVEL OF EVIDENCE III. STUDY TYPE Therapeutic/Care Management.
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Affiliation(s)
- Khaled El-Qawaqzeh
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lynn Gries
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Collin Stewart
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Zara Cooper
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
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Makaroun LK, Halaszynski JJ, Rosen T, Haggerty KL, Blatnik JK, Froberg R, Elman A, Geary CA, Hagy DM, Rodriguez C, McQuown CM. Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool. Acad Emerg Med 2023; 30:428-436. [PMID: 36575600 PMCID: PMC10192131 DOI: 10.1111/acem.14646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.
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Affiliation(s)
- Lena K. Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, New York, USA
| | | | | | | | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, New York, USA
| | | | - Dyan M. Hagy
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | | | - Colleen M. McQuown
- VA Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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Kennedy B, Bugeja L, Olivier J, Johnson M, Hua P, Koppel S, Ibrahim JE. Epidemiology of Homicide in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:390-406. [PMID: 34253097 DOI: 10.1177/15248380211030250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Empirical research investigating older adult homicide is sparse and rarely accumulated for greater insights. This systematic review and meta-analysis quantifies the prevalence and characteristics of homicide victimization among older adults (65 years and older) compared with younger adults (18-64 years). METHOD We searched Cumulative Index to Nursing and Allied Health Literature, Cochrane, Criminal Justice Abstracts, EMBASE, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science for studies published before December 31, 2018 (International Prospective Register of Systematic Reviews registration: CRD42017054536). Included were English-language, original, peer-reviewed studies describing the homicide of older adults. Excluded were studies not meeting age criteria, residence as an institution, or with insufficient outcome variables. The review included 39 studies; 17 were included in the meta-analysis. Data were extracted via open access or from study authors. Heterogeneity was assessed through study-level random effects estimates. RESULTS Pooled homicide rates per 100,000 population were 2.02 (95% CI [1.23, 3.33]) for older adults (n = 35,325) and 3.98 (95% CI [2.42, 6.53]) for younger adults (n = 607,224; rate ratio = .51, 95% CI [0.37, 0.70], p < .001). Proportion estimates for older adults: victim female 46.3%, location home 71.4%, offender familiar 25.2%, compared to stranger, 24.2%, motive argument 36.1%, compared to felony 30.8%, and weapon firearm 24.5%. Older adults were significantly different to younger adult victims (p = <.001) for female (OR = 2.5, 95% CI [2.02, 3.10]), home (3.87, 95% CI [3.45, 4.35]), stranger (1.81, 95% CI [1.66, 1.98]), argument (0.33, 95% CI [0.28, 0.39]), felony (2.78, 95% CI [2.58, 2.99]), and firearm (0.38, 95% CI [0.36, 0.40]). CONCLUSIONS Homicide against older adults differs from younger adults and warrants specific research and tailored prevention strategies.
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Affiliation(s)
- Briohny Kennedy
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Jake Olivier
- School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia
| | - Marilyn Johnson
- Institute of Transport Studies, Monash University, Clayton, Victoria, Australia
| | - Phuong Hua
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Sjaan Koppel
- Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Nyirenda M, Sukazi S, Buthelezi C, Hanass-Hancock J. “A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs. Front Public Health 2023; 11:1061339. [PMID: 36992889 PMCID: PMC10040649 DOI: 10.3389/fpubh.2023.1061339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/10/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundAs the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people.MethodsThis qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed.ResultsThe study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities.ConclusionAlthough there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.
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Affiliation(s)
- Makandwe Nyirenda
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- *Correspondence: Makandwe Nyirenda
| | - Sizakele Sukazi
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Cebo Buthelezi
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Jill Hanass-Hancock
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
- College of Health Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kothapalli J, Munikumar M, Kena T, Chaturvedi A, Sujir N, Kodumuri PK, Lourembam D, Tagum T. Childhood abuse and anxiety, depression - An interprofessional approach to optimize knowledge and awareness among young adult health professions students of Arunachal Pradesh, India. Acta Psychol (Amst) 2023; 233:103837. [PMID: 36716638 DOI: 10.1016/j.actpsy.2023.103837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Child abuse is a major public health concern with deep rooted squeal events on adult mental health. The childhood negligence and abusive events is connected invariably with anxiety and depressive disorders in adult life. OBJECTIVES The study focused to determine the prevalence of child abuse, and connection of child abuse with depression and anxiety in course of adulthood, and to evaluate the effect of Interprofessional approach on the knowledge and awareness on child abuse and legal polices among young adult students of health professions in Arunachal Pradesh, India. PARTICIPANTS AND SETTING Four hundred sixty-one young adult health professions students from Tomo Riba Institute of Health and Medical Sciences (TRIHMS) and related health sciences institutes in the Itanagar capital complex region of Arunachal Pradesh between age group of 18-25 years. METHODS A semi structured self-administered questionnaire was adopted to measure the prevalence of child abuse, Patient Health Questionnaire-9 (PHQ-9) questionnaire to grade the severity of depression and Generalized Anxiety Disorder-7 (GAD-7) questionnaire to grade severity of anxiety. Interprofessional intervention interactive sessions with a psychologist, psychiatrist, and advocate were held after pre-test. Before and after the intervention, the participants' awareness and knowledge on various types of child abuse& negligence and legal policies were assessed. RESULTS The overall prevalence of child abuse in any form was 73.42 %. Physical abuse was the most frequent form, accounting for 65.26 %, followed by childhood negligence (62.63 %), emotional abuse (53.15 %), and sexual abuse (23.42 %). Higher incidence of psychological distress with depression (80 %) and anxiety (55.52 %) was observed in participants with previous history of childhood abuse. There was a significant improvement in the knowledge and awareness on various forms of child abuse and negligence (p < 0.05) and legal policies (16.05 % before intervention, 85.90 % after intervention) (p < 0.05) after intervention sessions with interprofessional members. CONCLUSIONS The interprofessional interactive sessions exhibited significant improvement in the knowledge and awareness in terms of child abuse and policies in all domains. Utmost need and necessity of including implementation of interprofessional intervention interactive sessions or counselling program in academic institutions specially in developing states where there is a lack of awareness and easy access to services.
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Affiliation(s)
- Jyothinath Kothapalli
- Department of Anatomy, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India; MAHE-FAIMER International Institute for Leadership in Interprofessional Education, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Manne Munikumar
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
| | - Tame Kena
- Department of Psychiatry, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
| | - Abhishek Chaturvedi
- Division of Biochemistry, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; MAHE-FAIMER International Institute for Leadership in Interprofessional Education, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Nanditha Sujir
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; MAHE-FAIMER International Institute for Leadership in Interprofessional Education, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Praveen Kumar Kodumuri
- Department of Physiology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
| | | | - Taba Tagum
- Gauhati High court, Itanagar Permanent Bench, Naharlagun, Arunachal Pradesh, India
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Interventions to enhance safety culture for nursing professionals in long-term care: a systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Yurdakul ES, Veizi BGY, Avcı C, Yazır HT, Avaner E, Naharcı Mİ, Sarı O. Reliability and validity of the Turkish version of the elder abuse suspicion index in community-dwelling older adults. Turk J Med Sci 2023; 53:432-438. [PMID: 36945952 PMCID: PMC10388021 DOI: 10.55730/1300-0144.5600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/04/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults. METHODS This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed. RESULTS EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity. DISCUSSION The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.
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Affiliation(s)
- Eray Serdar Yurdakul
- Department of Medical History and Bioethics, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Betül Gülsüm Yavuz Veizi
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Candeniz Avcı
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hatice Tuğba Yazır
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Elif Avaner
- Department of Medical History and Bioethics, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mehmet İlkin Naharcı
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Oktay Sarı
- Department of Family Medicine, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Rosen T, Zhang H, Wen K, Clark S, Elman A, Jeng P, Baek D, Zhang Y, Gassoumis Z, Fettig N, Pillemer K, Lachs MS, Bao Y. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. JAMA Netw Open 2023; 6:e2255853. [PMID: 36787139 PMCID: PMC9929702 DOI: 10.1001/jamanetworkopen.2022.55853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/15/2023] Open
Abstract
Importance Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment. Objective To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults. Design, Setting, and Participants This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022. Main Outcomes and Measures We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses. Results This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001). Conclusions and Relevance In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | | | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Bugelli V, Campobasso CP, Feola A, Tarozzi I, Abbruzzese A, Di Paolo M. Accidental Injury or "Shaken Elderly Syndrome"? Insights from a Case Report. Healthcare (Basel) 2023; 11:healthcare11020228. [PMID: 36673596 PMCID: PMC9859477 DOI: 10.3390/healthcare11020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Subdural haemorrhage (SDH) as result of a traumatic brain injury (TBI) is a common cause of death in cases of fatal physical abuse. Since intracranial bleeding is a common finding in elderly due to age-related intracranial changes or increasing prevalence of anticoagulant medication, differential diagnosis between inflicted and non-inflicted head injury is challenging. A case of an elderly woman's death caused by TBI is reported. Autopsy showed multiple polychromatic bruises and a frontoparietal hematoma with bilateral subacute SDH. History excluded paraphysiological or pathological non-traumatic conditions that could justify SDH, while iatrogenic factors only played a contributory role. Since polychromatic bruises distributed on the face, the upper extremities and the chest were consistent with forceful grasping/gripping or repeated blows and SDH can form in absence of impact or by mild/minor blows, SDH was considered the result of repeated physical abuses. Differential diagnosis between traumatic and non-traumatic SDH is still challenging for forensic pathologists. As largely accepted in the pediatric population and occasionally described also in adults, however, violent shaking should be also considered as a possible mechanism of SDH-especially in elderly who do not have any sign of impact to the head.
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Affiliation(s)
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
- Correspondence:
| | | | - Arturo Abbruzzese
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Pisana-Santa Chiara, 56100 Pisa, Italy
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
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Knowledge, attitudes, detection, and reporting practices of elder abuse among orthopedists. Eur Geriatr Med 2022; 13:1425-1431. [PMID: 36040647 DOI: 10.1007/s41999-022-00685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/27/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of the present study is to explore orthopedists' level of knowledge regarding laws and directives related to the detection and reporting of elder abuse, their attitudes towards the detection and reporting of elder abuse, detection and reporting practices, and the associations between these variables. METHODS In this cross-sectional study, 145 orthopedists employed in various Israeli hospitals-senior orthopedists, orthopedic residents, and orthopedic interns-completed a questionnaire. RESULTS The orthopedists had a medium level of knowledge and held positive attitudes on the detection and reporting of elder abuse, but the actual number of cases they detected and reported was low. Senior orthopedists had the highest level of knowledge and also the most positive attitudes, followed by orthopedic residents, and then orthopedic interns. Common reasons for unwillingness to report cases of elder abuse differed between levels of training. A minority of the orthopedists had received training on the detection and management of elder abuse. Higher knowledge and more positive attitudes were found associated with a higher number of detected and reported cases of elder abuse. CONCLUSIONS The importance of training orthopedists on the detection and management of elder abuse cannot be overemphasized. It seems that orthopedists should receive such training early in their career. LEVEL OF EVIDENCE IV.
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Toya M, Minegishi S, Utsuno H, Ohta J, Namiki S, Unuma K, Uemura K, Sakurada K. Forensic Characteristics of Physical Elder Abuse and Current Status and Issues of Collaboration between Forensic Medicine Departments and Related Institutions in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15382. [PMID: 36430103 PMCID: PMC9692923 DOI: 10.3390/ijerph192215382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
This study sought to clarify the characteristics and trends of physical elder abuse and the status of collaboration between forensic medicine departments and related institutions in Japan. Questionnaires were sent to 82 forensic medicine departments and 2857 institutions randomly selected from hospitals, municipalities and public community general support centers. The survey period was February to June 2021, including an extension period for collection. Responses from 675 facilities were analyzed. The most common finding in cases of physical elder abuse at forensic medicine departments was subcutaneous hemorrhage on the head (85.7%), with mixed old and new injuries most commonly observed in the lower limbs (70%). There were few cases in which there was collaboration between forensic medicine departments and other institutions. Among the issues identified, there is a need to provide related institutions with information obtained in forensic medicine departments. A new collaboration system is needed to achieve this.
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Affiliation(s)
- Maiko Toya
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Saki Minegishi
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Hajime Utsuno
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Jun Ohta
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Shuuji Namiki
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koichi Sakurada
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Zhan X, Li K, Zheng Y, Yang G, Luo X. A chain multiple mediation model reveals the association between abuse and depression in Chinese adolescents. Front Public Health 2022; 10:1023749. [PMID: 36466489 PMCID: PMC9714438 DOI: 10.3389/fpubh.2022.1023749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Depression is a common mental disorder in Chinese adolescents. Identifying its risk factors will facilitate early prevention. As abuse is reported to be a great risk factor of depression, it is necessary to identify factors mediating the relation between abuse and depression. Objective This study aims to investigate the association between abuse and depression by investigating the mediating role of academic stress, social anxiety, and generalized anxiety to offer insights for depression prevention. Participants and setting We investigated adolescents in urban and rural areas in Wansheng District of Chongqing city in China. This study included a total of 14,108 students from secondary and primary schools, among whom 7,086 were men (50.2%) and 7,022 were women (49.8%). The participants aged from 11 to 17 with an average age of 13.58 (M = 13.58, SD = 1.86). Methods A questionnaire survey was conducted among the participants between October and December in 2020. The following questionnaires were adopted: DSM-5 Patient Health Questionnaire for Adolescents, DSM-5 Severity Measure for Generalized Anxiety Disorder, The International Society for Prevention of Child Abuse and Neglect Child Abuse Screening Tool, DSM-5 Severity Measure for Social Anxiety Disorder (Social Phobia), and Study Stress Scale. Results The lifetime prevalence of abuse was high in Chinese adolescents. The direct effect value from abuse to depression was 0.05, the total mediating effect value was 0.14, and the overall effect value was 0.19. According to the mediating effect analysis, the direct and indirect effects from abuse to depression were significant, and the mediating effect accounted for 73.68% of the total effect, suggesting that 73.68% of the effects of abuse to depression are mediated by academic stress, social anxiety, and generalized anxiety. Conclusions Academic stress, social anxiety and generalized anxiety play a chain multiple mediating role in the association between abuse and depression, which sheds light on the prevention of depression in the future.
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Affiliation(s)
- Xiaoqing Zhan
- Department of Medical English, School of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Kuiliang Li
- School of Psychology, Army Medical University, Chongqing, China
| | - Yingcan Zheng
- School of Psychology, Army Medical University, Chongqing, China
| | - Guoyu Yang
- School of Psychology, Army Medical University, Chongqing, China,Guoyu Yang
| | - Xi Luo
- Department of Medical English, School of Basic Medical Sciences, Army Medical University, Chongqing, China,*Correspondence: Xi Luo
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Alhalal E, Alkhair Z, Alghazal F, Halabi R, Muhaimeed F. Psychological elder abuse among older Saudi adults: A cross-sectional study. J Elder Abuse Negl 2022; 34:349-368. [PMID: 36597203 DOI: 10.1080/08946566.2023.2164880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The research examining elder abuse in diverse cultural contexts, such as in Saudi Arabia, remains limited. This study examined the extent of psychological elder abuse among older Saudi adults and investigated the characteristics of the victims that increase the risk of such abuse and its impact on older adults' self-rated health. Between December 2021 and April 2022, a sample of 444 older adults were recruited from 25 primary health care centers in Saudi Arabia and completed a structured interview. Of those surveyed, 88.3% reported at least one symptom or suspected symptom of psychological elder abuse. Age, gender, income, living arrangements, functioning, and social networking predicted vulnerability psychological elder abuse. Self-rated health was negatively impacted by psychological elder abuse, and this relationship is not moderated by social networking. These findings can provide insights about psychological elder abuse in Saudi Arabia and increase awareness of its impact.
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Affiliation(s)
- Eman Alhalal
- Community and Mental Health Nursing Department, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Zainab Alkhair
- Qatif Health Centers Administration, Qatif Health Network, Eastern Region, Saudi Arabia
| | | | - Rehab Halabi
- The Administration of School Health Affairs in Makkah Health Care Cluster, Makkah, Saudi Arabia
| | - Fatema Muhaimeed
- Hematology/ Oncology unit, King Saud Medical City, Riyadh, Saudi Arabia
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Mosqueda LA. Expanding the role of interdisciplinary teams in the emergency department: Using a consultative model to serve older adults who are abused. J Am Geriatr Soc 2022; 70:3061-3063. [PMID: 36062464 PMCID: PMC9669142 DOI: 10.1111/jgs.18018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
This Editorial comments on the article by Rosen et al. in this issue.
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Affiliation(s)
- Laura A Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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Rosen T, Elman A, Clark S, Gogia K, Stern ME, Mulcare MR, Makaroun LK, Gottesman E, Baek D, Pearman M, Sullivan M, Brissenden K, Shaw A, Bloemen EM, LoFaso VM, Breckman R, Pillemer K, Sharma R, Lachs MS. Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program. J Am Geriatr Soc 2022; 70:3260-3272. [PMID: 35860986 PMCID: PMC9669128 DOI: 10.1111/jgs.17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED-based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. METHODS We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. RESULTS During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty-two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy-five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety-four percent reported believing that there is merit in establishing a VEPT Program in other EDs. CONCLUSION VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer-term outcomes.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine / Boston Medical Center, Boston, MA, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mary R. Mulcare
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Lena K. Makaroun
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Morgan Pearman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kelly Brissenden
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elizabeth M. Bloemen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
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Vaishnav LM, Joshi SH, Joshi AU, Mehendale AM. The National Programme for Health Care of the Elderly: A Review of its Achievements and Challenges in India. Ann Geriatr Med Res 2022; 26:183-195. [PMID: 36039665 PMCID: PMC9535372 DOI: 10.4235/agmr.22.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aging care is critical. Projections for 2020 indicate that India’s older population will comprise 6.57% of the overall population. The best-known newly developed technologies must be provided to the older population. Non-governmental organizations and private institutions are increasingly providing more door-to-door guidance and help. This study evaluated the impact of the National Programme for Health Care of the Elderly (NPHCE) in India and analyzed its achievements and challenges. The program’s key strategies include providing preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation. The NPHCE is an excellent project for caring for a rapidly aging population. This study described the existing programs and schemes related to older people in India, with a focus on the NPHCE and an analysis of the program’s achievements and challenges.
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Affiliation(s)
- Lokesh Mukut Vaishnav
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Shiv Hiren Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Abhishek Upendra Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
- Corresponding Author: Shiv Hiren Joshi, MD Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), 442001, India E-mail:
| | - Ashok Madhukar Mehendale
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
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Khurana B, Loder RT. Injury Patterns and Associated Demographics of Intimate Partner Violence in Older Adults Presenting to U.S. Emergency Departments. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16107-NP16129. [PMID: 34121494 DOI: 10.1177/08862605211022060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner violence (IPV) is a global public health issue and occurs in intimate relationships regardless of age or sexual orientation. Several studies, most of them relying on small-scale samples, have explored the prevalence and risk factors of IPV in older adults. Still, none have focused on the demographics and injury patterns in older adult victims. Using the National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data, we performed a retrospective analysis from 2005 through 2015 of the demographics and injuries of older adult IPV patients (>60 years old) presenting to emergency departments (EDs) compared to younger adult IPV patients (<60 years old). IPV accounted for 2,059,441 ED visits (.61%) with 37,534 (1.8%) visits in the older adults. Older adults were more frequently male (36.1% vs 16.8%), White (65.3% vs 52.8%), sustained fewer neck/head injuries (47.6% vs 59.4%), fewer contusions/abrasions (34.6% vs 47.2%), had more trunk fractures (38.4% vs 11.9%), trunk strains/sprains (39.5% vs 15.4%) and more hospital admissions (15.7 vs 4.2%), compared to younger IPV patients. Within the older adult cohort, females were more commonly White (71.2% vs 56.0%) while males were more commonly Black (36.3% vs 19.0%). Injuries in older adult males were more commonly lacerations (40.6% vs 14.2%%) and less commonly contusions/abrasions (33.8% vs 43.5%) compared to elderly females. Older adult females had more internal organ injuries than older adult males (18.9% vs 12.9%) and nearly all involved the head. Knowledge of these injury patterns in older adults can equip the health care providers when to be more suspicious of unexplained or suspicious injuries as the victim's symptoms at the presentation might not be directly related to violence.
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Weissberger GH, Lim AC, Mosqueda L, Schoen J, Axelrod J, Nguyen AL, Wilber KH, Esquivel RS, Han SD. Elder abuse in the COVID-19 era based on calls to the National Center on Elder Abuse resource line. BMC Geriatr 2022; 22:689. [PMID: 35987616 PMCID: PMC9392067 DOI: 10.1186/s12877-022-03385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated circumstances that place older adults at higher risk for abuse, neglect, and exploitation. Identifying characteristics of elder abuse during COVID-19 is critically important. This study characterized and compared elder abuse patterns across two time periods, a one-year period during the pandemic, and a corresponding one-year period prior to the start of the pandemic. METHODS Contacts (including social media contacts, and email; all referred to as "calls" for expediency) made to the National Center on Elder Abuse (NCEA) resource line were examined for differences in types of reported elder abuse and characteristics of alleged perpetrators prior to the pandemic (Time 1; March 16, 2018 to March 15, 2019) and during the pandemic (Time 2; March 16, 2020 to March 15, 2021). Calls were examined for whether or not abuse was reported, the types of reported elder abuse, including financial, physical, sexual, emotional, and neglect, and characteristics of callers, victims, and alleged perpetrators. Chi-square tests of independence compared frequencies of elder abuse characteristics between time periods. RESULTS In Time 1, 1401 calls were received, of which 795 calls (56.7%) described abuse. In Time 2, 1009 calls were received, of which 550 calls (54.5%) described abuse. The difference between time periods in frequency of abuse to non-abuse calls was not significant ([Formula: see text]). Time periods also did not significantly differ with regard to caller, victim, and perpetrator characteristics. Greater rates of physical abuse ([Formula: see text] and emotional abuse ([Formula: see text] were reported during Time 2 after adjustment for multiple comparisons. An increased frequency of multiple forms of abuse was also found in Time 2 compared to Time 1 ([Formula: see text]. CONCLUSIONS Findings suggest differences in specific elder abuse subtypes and frequency of co-occurrence between subtypes between time periods, pointing to a potential increase in the severity of elder abuse during COVID-19.
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Affiliation(s)
- Gali H Weissberger
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel.
| | - Aaron C Lim
- Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
| | - Laura Mosqueda
- Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
- USC Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
- National Center On Elder Abuse, Department of Family Medicine and Geriatrics, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
- USC Leonard Davis School of Gerontology, Los Angeles, CA, 90089, USA
| | - Julie Schoen
- Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
- National Center On Elder Abuse, Department of Family Medicine and Geriatrics, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
| | - Jenna Axelrod
- NorthShore University HealthSystem, 909 Davis, Evanston, IL, 60201, USA
| | - Annie L Nguyen
- Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
| | - Kathleen H Wilber
- USC Leonard Davis School of Gerontology, Los Angeles, CA, 90089, USA
| | - Richard S Esquivel
- Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
- National Center On Elder Abuse, Department of Family Medicine and Geriatrics, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
| | - S Duke Han
- Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, Alhambra, CA, 91803, USA
- USC Leonard Davis School of Gerontology, Los Angeles, CA, 90089, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St, Chicago, IL, 60612, USA
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, 90089, USA
- Department of Neurology, USC Keck School of Medicine, Los Angeles, CA, 90033, USA
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