Piloting elder abuse screening tools in Ireland Dr. Amanda Phelan Co-Director NCPOP, INPEA national Representative.

Power-point overload!!!

Elder abuse ‘ a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights". (Working Group on Elder Abuse 2002) Typologies: Physical abuse, psychological abuse, sexual abuse, discriminatory abuse & financial/material abuse.

Why is screening important? Irish prevalence study Naughton et al (2010) 2.2%=10,201 HSE Statistics During 2011 the HSE received 2302 referrals. (429 Self Neglect)

The iceberg theory! What we are seeing. 1,873 What we are NOT seeing. At least 8,328

Elder abuse Older people can be living with abuse and not be able to a) recognise it, b) speak of it or b) seek appropriate help.

Screening Elder abuse screening assists case finding. Screening provides a standardised approach to directed questions. Screening can stimulate a discussion where an older person may not readily perceive the/she is being abused A screening tool facilitates the healthcare professional to focus.

Screening The early identification of risk of a disease or disorder so that early treatment may be initiated resulting in a decrease in the disease related mortality and morbidity rates (United States Preventative Services Task Force 1996; Petersen 1997). Screening in elder abuse?

Alternative Roadmap to Discovery?

Elder abuse screening tools Validated? Method? Who to screen? Self-completed or third party?

Irish Pilot The NCPOP identified the Elder Abuse Suspicion Index (EASI) (Yaffe et al 2008) & the Older Adult Financial Exploitation Measure (OAFEM) (Conrad et al 2010) as a risk assessment tools with particular merit for the Irish setting. (Phelan & Treacy 2011)

Both Studies: Inclusion and exclusion criteria Older person meets the inclusion criteria if he or she is: – Is a client. – Is aged 65 years or older. – Has English as their first language or can converse in English. – Is not a resident in a residential care facility or hospital. – Demonstrates cognitive capacity. Older person should be excluded if he or she: – Does not meet the above criteria – Has a known diagnosis of cognitive impairment

EASI Study Aim To examine the reliability of the EASI in the Irish setting Phase 1: Cognitive Interviews & Surveys Phase 2: 1,600 participants screened with anticipated 160 SCW/SW referrals (Revised) – Referrals tracked to SCW/SW assessment and analysis focus will be the establishment of positive predictive value (PPV) of EASI.

EASI study sites 1 Hospital – (Geriatrician team) 2 Local Health Areas – (Public Health Nurses & Community Registered General Nurses) 6 General Practitioners. Day centres Geographical spread

Process Information on the study Meets inclusion criteria Written consent Score 0-7 on the 6 Cognitive Impairment Assessment (or 24 or more on the MMSE). Completion of the EASI Qs. Referral offered. Tracked to referred SCWPOP.

Study Process STEP 1: Person meets inclusion criteria STEP 2: Person is provided with information EXIT – not interested STEP 3: Participant recruitment and consent EXIT- does not consent STEP 4: Conduct a cognitive assessment EXIT- does not meet criteria STEP 5: Administration of EASI STEP 6: Suspicion of abuse No suspicion of abuse EXIT Person agrees to investigation Person declines investigation

Older Adult Financial Exploitation Measure (OAFEM) The aim of this study is to examine the appropriateness of the OAFEM in the Irish setting.

Study Process Phase 1 Survey of SCWs regarding the OAFEM content. Cognitive interviewing with older people Reviewed the results of phase one and considered the impact of results on the OAFEM Phase 2 Piloting OAFEM in practice with SCWPOPs/SWs.

Process for OAFEM Information on the study Meets inclusion criteria Consent Obtains 0-7 on the 6 Cognitive Impairment Assessment (or 24 or more on the MMSE). Completion of the OAFEM Review of appropriateness of the OAFEM with SCWPOP/SWs.

Study Process STEP 1: Person meets inclusion criteria STEP 2: Person is provided with information EXIT – not interested STEP 3: Participant recruitment and consent EXIT- does not consent STEP 4: Conduct a cognitive assessment EXIT- does not meet criteria STEP 5: Administration of OAFEM STEP 6: Suspicion of abuse No suspicion of abuse EXIT Person agrees to investigation Person declines investigation

Withdrawal If the older person wishes to withdraw at any point:  If OAFEM/EASI tool is still in the data collector’s possession, process is discontinued and recorded as a withdrawal  If the tool has been placed in the NCPOP box the older person can contact NCPOP. Contact details are provided in the participant information sheet. Withdrawal can take place up to 8 weeks following assessment.

Which do we want? The Forgotten Mother By Ruby Latimer Edwards A gray old woman sits all alone Unloved, uncherished and unknown. Sitting beside her broken door. Dreaming of days past long ago, When children played about her knee Filling the air To Watch You, Admire You, Adore You By Danny Blackburn I was a blessed today in a special way I was able to be with you all day..