Lauren K Lietzau, BS Linda N Meurer, MD, MPH Bernadette Witzack, MPS Linda Cieslik, PhD Ramona Williams, MSW Syed Ahmed, MD, DrPH Development and Evaluation of a Self-neglect Module

This project was funded by a National Institute on Aging Research Training Grant and is supported by the Healthier Wisconsin Partnership Program, a component of the Advancing a Healthier Wisconsin endowment. FINANCIAL DISCLOSURE

Describe the burden, risk factors, and clinical features of self-neglect in elderly patients Describe the approach taken by a community- academic partnership to improve recognition and response to elder abuse and neglect through the education of professionals Discuss features of a multi-media self-neglect curriculum, evaluation results, and ways to incorporate into family medicine education 3 LEARNING OBJECTIVES

Prevalence of elder abuse = 2% to 10% Will increase as the population ages Self-neglect is the most common form of elder abuse reported to Adult Protective Services (APS) 50% of all reports in Wisconsin (2006-7) 40% in Milwaukee (2006-7) 4 BACKGROUND

Self-neglect risk factors include: Depression Dementia Living alone Advanced age Annual income < $5,000 Male gender Abrams R, et al. Predictors of Self-Neglect in Community-Dwelling Elders. Am J Psychiatry BACKGROUND

Clinical features of self-neglect may include: Poor personal hygiene Bed sores and skin rashes Dehydration, malnourishment, and/or hypernatremia without illness-related cause Unexplained weight loss Untreated medical or mental conditions 6 BACKGROUND

Environmental features of self-neglect may include: Absence of necessities – food, water, heat Lack of utilities, space, or ventilation Unsafe or unsanitary living conditions Insect or animal infestations 7 BACKGROUND

8 LULA’S STORY

Describe characteristics of self-neglect victims in Milwaukee County Create, pilot, and evaluate an online self-neglect training module for physicians 9 AIMS

Cross-sectional descriptive analysis of data obtained from self-neglect cases reported to the Milwaukee County Dept. on Aging (MCDA) Wisconsin Incident Tracking System (WITS) 2006 and 2007 Victim characteristics, referral source, outcomes 10 METHODS

Creation of self-neglect online training module using Angel Learning, version 7.2 Overview material from 22 sources Interactive materials: video, links to elder abuse resources, scholarly articles Formative evaluation instruments: 6-item self- assessed competency pre/post-test using a 4-point Likert scale, 7-item multiple-choice knowledge pre/post- test, module evaluation survey using a 4-point Likert scale 11 METHODS

Module pilot: Convenience sample recruited by invitation and word-of-mouth Dept. of Family and Community Medicine faculty/residents Injury Research Center summer research students 12 METHODS

Elders referred for self-neglect in Milwaukee County: Were over age 70 (78%) Lived alone (54%) Were frail (65%) with dementia (15%) or some mental illness (10%) Were referred by medical professionals (26%) Seldom accepted APS services (7%) 13 RESULTS

Online self-neglect module pilot Participation: N=11 (3 faculty, 3 residents, 5 students) Self-assessed competency (1-4, 4=strongly agree) Knowledge of risk factors: 2.73  3.54 (p<0.0001) Ability to recognize signs: 2.82  3.54 (p=0.0004) Likelihood to report to APS: 3.73  3.82 (p=0.34) Knowledge: 66.2%  92.2% (p=0.001) 14 RESULTS

Online self-neglect module pilot Evaluation (1-4, 4=strongly agree/very valuable) Learning objectives met: 3.84 Valuable content: 3.64 Easy to navigate: RESULTS

WITS data provide a baseline profile of reported self-neglect cases The self-neglect module was well-received Easy to navigate Valuable content The module resulted in increases in: Self-assessed competency to recognize risk factors and signs/symptoms Knowledge of risk factors, presentation, and implications 16 DISCUSSION

WITS data is limited to reported cases only The self-neglect module evaluation is limited by small sample size and the inability to measure actual behavior or clinical outcomes 17 LIMITATIONS

Module evaluations were used for editing Module pilot was used to guide the development of final SANE online learning modules on elder abuse and neglect CME programs for physicians Educational materials for community-based professionals Module is included in final SANE online curricula 18 CONCLUSION

Dr. Linda Meurer Bernadette Witzack Dr. David Lillich Karl Takabayashi Dept. of Family and Community Medicine Injury Research Center Milwaukee County Dept. on Aging 19 ACKNOWLEDGEMENTS

20 QUESTIONS?