Human Rights & Elderly Rights Workshop Payal Patel, Mercer University PharmD Candidate 2012 Dorris Ottens, University of Georgia PharmD Candidate 2012

Human Rights Fundamental rights to which a person is inherently entitled because she or he is a human being Cornerstone of public policy Continuous philosophical debate over what is meant by “right” Started during the Protestant Reformation and continued to the Bill of Rights and United States Constitution

Universal Declaration of Human Rights Adopted in 1948 by the United Nations General Assembly, secondary to WWII Holocaust atrocities This document outlines 30 Articles which promote specific freedoms.

Highlights of Declaration of Human Rights All humans are born free and equal Everyone is entitled to all rights set forth, without distinction of race, colour, sex, language, religion, political opinion, national origin, property, birth, or other status. Right to life, liberty, and security No slavery or servitude Right to recognition as a person

Highlights continued… All people are equal before the law No arbitrary detention or exile Freedom of movement, residence, and leave Right to social security and resources of economic, social, and cultural resources of each State Right to work, with equal pay for equal work Right to education and culture

Highlights continued… Right to standard of living adequate for his health and well-being: food, clothing, housing, and medical care and necessary social services Right to security in the event of unemployment, sickness, disability, widowhood, old age or other circumstances beyond his control

Patient Case 60 yo wf CC: worsening dementia and secondary Parkinsonism HPI: MVA with head injury 10 yr prior with loss of consciousness. Diagnosed with normal pressure hydrocephalus Shunt x 4 years, stable Rapid decline: aphasia, increased falling and confusion

Elderly Prevalence 12.5% of the US population is 65 years of age or older This group will increase by 5.5% by the year 2020 45 million people over the age of 60 and 3 million over the age of 85 As the number of elderly Americans increase, the number of abuse cases will increase With the increase in the number of elderly people, there is an increased need to address elderly rights and abuse

Prevalence In US, over 2 million older adults are mistreated every year 3 to 10% elderly are neglected or abused For every 1 case of elderly abuse, about 5 cases go unreported Approximately 1.5 million seniors live in nursing homes 30% of the nursing homes have been cited for abuse that can potentially harm the patients

Introduction Most victims are older, frail and vulnerable and depend on others for basic needs Most seniors do not get the help they need Elderly people are often subject to discrimination/abuse because they are viewed as being easily taken advantage of

Introduction Many governments have support systems for elderly people Social security Medicare Senior citizen discounts Adult protective services agencies Receives and investigates reports of abuse/neglect Provide services to the victims

Rights of an elderly person The rights of an elderly person can be broken down in 3 main categories Protection: securing the physical, psychological and emotional safety in regards to their vulnerability to mistreatment and abuse Participation: To create a greater and more active role for the elderly Image: To define a more positive and less degrading idea of the elderly and their capabilities

Elderly Abuse Definition: Intentional or neglectful acts by a caregiver or any person that can cause harm to an elderly individual Self-neglect can also be considered mistreatment Elderly abuse can occur anywhere – in the house, nursing homes, or any other location Abusers can be spouses, family members, personal acquaintances or opportunistic strangers

Risk factors of abuse Older age Lack of access to resources Low income Elderly women are more vulnerable and more likely to be a victim Dementia Social Isolation Low level of education Functional impairment Substance abuse by elder or caregiver

Types of Elderly Abuse Physical abuse: using force to physically injure a vulnerable elder Emotional abuse: verbal threats, rejection, isolation that can cause a mental distress to an elderly Sexual abuse: forced or threatened sexual contact on an elderly person Exploitation: Gaining control over an elderly person’s money or property by misusing authority or fraud

Types of Elderly Abuse Neglect: Failure of a caregiver to provide the needed safety, physical or emotional needs of an elderly person Abandonment: Abandoning an elderly person by the caregiver Self-neglect: not being able to understand the consequences of your own action or inaction leading to harm

What is self-neglect? Sometimes elders neglect their own care, which can cause illness or injury. Such behaviors include: Hoarding Failure to take medications or refusal to seek medical treatment Poor hygiene Not wearing suitable clothing for the weather Dehydration

Warning Signs Physical abuse: marks, bruises, burns (ex: cigarette burns), blisters Neglect: malnutrition, lack of medical care, filth Emotional abuse: depression, unusual behavioral changes, withdrawal from usual activities Sexual abuse: marks/bruises around breasts or genital area, STDs Exploitation: unusual bank activities, property loss, altered wills

Problems in a nursing home Low staff-to-patient ratios Rotating nurses and nursing assistants Staff not well trained Facility characteristics Personality problems of the caregiver

Clues for elder abuse in nursing homes Bruises or skin tears Multiple fractures due to falls Unintended weight loss Poor hygiene dehydration

Preventing abuse in nursing homes Screening potential employees for history of abuse, neglect or mistreatment Training all employees Staffing appropriately Observing residents for signs of abuse Investing all types of incidents and reporting results to the proper authorities

What can the elderly do to prevent abuse? Take care of one’s own health Seek professional help for drug, alcohol and depression concerns Spouses can attend support groups Plan for the future with a power of attorney or a living will Stay active in the community Stay connected with friends and family Report any form of mistreatment or abuse

What can the elderly do to protect their rights? Living Will Directions for a terminally ill patient Instructions specifying what actions should be taken if the patient is not able to make decisions due to their illness or incapacity Durable Power of Attorney for Health Care (Health Care Proxy) Allows the patient to choose a person who can make decisions related to the patient’s healthcare

Patient Case Continued… Husband was given ample prescription samples from the physician’s office Patient kept deteriorating cognitively and physically Home health nurses were sent to give care, and reported plenty of medications were at the home, although husband asked for more Patient missed/cancelled several appointments

Case Continued… At next office visit, a middle-aged woman came as caregiver with the couple Patient’s symptoms continued to accelerate Husband picked up samples, and reported he was dating the “caregiver” PCP concerned about this conflict of interest Patient’s husband eventually refused home healthcare services

Case continued… Neighbors noticed the “caregiver” was not there during the day, but sometimes at the home for two to three days Also reportedly saw the husband and caregiver having sex Neighbors called the police, who then invoked Adult Protection Husband jailed for spousal abuse x 4 years

What can healthcare professionals do? Healthcare professionals are often the first to notice abuse and neglect and are in a key position to help Identify signs and symptoms of abuse Evaluate the validity of the explanations provided for the injuries Evaluate the cognitive status and health factors Treat injuries and health problems Perform screenings for possible abuse

What can you do? Do not let abuse go undetected If you suspect abuse, contact your local adult protective services agency If you suspect abuse in a nursing home or long term care facility, contact your state specific agency

Resources for the Elderly The National Center on Elder Abuse (NCEA): Information on elderly rights, resources for families, caregivers, adult protective services, helpful phone numbers to report abuse Georgia Department of Human Services –Division of Aging Services Information on disability, elderly programs, senior employment program, adult protective services

References http://www.un.org/en/documents/udhr/ ; the Universal Declaration of Human Rights found on the United Nations website. Accessed Feb 2012. http://www.ncea.aoa.gov/ncearoot/Main_Site/index.aspx National Center on Elder Abuse website. Accessed Feb 2012. http://aging.dhr.georgia.gov/portal/site/DHS-DAS/ Georgia Division of Aging Services website. Accessed Feb 2012. http://www.gpoaccess.gov/wmprints/green/2004.html House Ways and Means Committee Prints, Green Book. Accessed Feb 2012.