1. Protecting Our Elders Kelly Steagall PAS 645 Spring 2007

2. Elderly Population is on the Rise Baby Boom occurred 1946-1964 Of the 70 million people born during the baby boom generation, 65 million are alive today. It is estimated that by the year 2030, the number of Americans over the age of 65 will be 71.5 million (This is about 1 In 5) With this increase in elderly population comes an increased likelihood of elder abuse

3. Elder Abuse  Under-diagnosed  Estimated 2.1 million elderly adults are abused each year  Victims have decreased quality of life, increased feelings of helplessness and increased stress and psychological disorders (results in increased ER visits, hospitalization, and higher mortality rates)

4. Forms of Elder Abuse  Physical  Emotional  Sexual  Neglect & Self Neglect  Abandonment  Financial Exploitation

5. Physical Abuse Any act that intends to cause physical injury  Shaking  Improper Restraining  Hitting  Over-/Under- medicating  Depriving the individual of food

6. Signs and Symptoms of Physical Abuse  Unexplainable/Questionable Injuries  Sudden behavioral changes  Patchy hair loss  Broken eye glasses  Check medications for any signs of over/under use  Be wary if the caregiver refuses to allow the pt. to be examined alone!

8. Emotional Abuse Infliction of mental anguish or fear  Belittlement  Threatening acts of violence  Treating the elder adult as if they were a child

9. Signs and Symptoms of Emotional Abuse  Changes in emotional state or attitude Withdrawn Evasive or fearful Ambivalent attitude toward caregiver * Many times emotional abuse is difficult to identify unless the abuse has been witnessed

10. Sexual Abuse  Can range from forcing elderly adults to view pornographic material to rape  Often overlooked in the elderly population

11. Signs and Symptoms of Sexual Abuse  Unexplained vaginal or anal bleeding  Torn or bloody undergarments  Bruising of the breasts, inner thighs, and/or genital area  Unusual/Unexplainable difficulty in walking or sitting  Presence of an STI, oral venereal lesions, or bruising of the uvula and/or palate  Insomnia

12. Signs and Symptoms of Sexual Abuse cont…  Behavioral changes Withdrawn Depressed Angry Frightened Heightened interest in sex or elicit sexual or aggressive behavior

13. Neglect  Neglect occurs when a caregiver refuses or is unsuccessful in their attempts to provide adequate care  The victims are often Denied: Food Water Shelter

14. Signs and Symptoms of Neglect  Poor personal hygiene  Multiple Deep Decubiti  Weight loss  Malnutrition and/or dehydration

15. Self Neglect  Self inflicted and often unintentional  Elderly may refuse to eat, drink or take medication  May become abusive to the caregiver and/or become destructive

16. Signs and Symptoms of Self Neglect  Poor personal hygiene  Malnutrition and/or dehydration  Untreated health conditions  Unsanitary living conditions  Soiled or ragged clothing  Refuses to take medication  Lacks basic necessities at residence  Admits to or shows signs of depression

17. Financial Exploitation  Ranges from simply misusing funds to committing embezzlement  Forgery or even forcing the elder adult to unknowingly transfer their property over to the caregiver

18. Signs and Symptoms of Financial Exploitation  Sudden changes in bank accounts  Abrupt changes to the elder’s will  Funds or personal property disappearing without explanation  Unpaid bills  Financial Exploitation is uncommonly reported by health care providers simply because they are usually unaware of the patient’s financial affairs

19. Who is at risk?  Elder adults who are: Frail Unable to accomplish basic daily activities Dependent on a caregiver  Nearly all victims live with their abuser  Women>Men  Occurs most frequently in individuals with: Short term memory loss Psychiatric disorders Alcohol abuse

20. Reporting Elder Abuse  All states have APS laws but they differ from state to state  All APS laws provide protection from liability for those who report in good faith and with no malicious intent  You DO NOT need to obtain the pt.’s permission to report suspected abuse  Nearly all states (44) have mandatory reporting of suspected cases

21. Conclusion Our Physician Assistant Professional Oath states: “I will hold as my primary responsibility the health, safety, welfare and dignity of all human beings.” Failure to properly report suspected cases of elder abuse completely disregards our professional oath

23. References www-medlib.med.utah.edu/kw/derm/mml www.seniorjournal.com www.elderabusecenter.org www.centeronelderabuse.org www.oceansidepolice.com/Images/Elder_abuse_pl (SAAAPA) Student Academy of the American Academy of Physician Assistants. 2007 Feb. [cited 2007 Feb 13] Available from: http://saaapa.aapa.org/students/grad/oath.htm Pearsall C. Forensic Biomarkers of Elder Abuse: What Clinicians Need to Know. J Foren Nurs. 2005: 1(4):182-186 Dong X. Medical Implications of Elder Abuse and Neglect. Clin Geriatr Med. 2005; 21(2):293-313. PreMedline Identifier: 15804552

24. References cont… American Psychological Association (APA) Elder Abuse and Neglect: In Search of Solutions 2006 January [cited 2006 Sept 26] Available from: http://www.apa.org/pi/aging/elderabuse.html http://www.apa.org/pi/aging/elderabuse.html Herbers J., Wei GS. Reporting Elder Abuse: A Medical, Legal, and Ethical Overview. J Am Med Women’s Assoc. 2004; 59(4):248-54. PreMedline Identifier:16845753 The AGS Foundation for Health in Aging. Elder Mistreatment. 2005 Feb 28. [Cited 2006 Sept 26] Available from: http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=9 http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=9 Geller A., Zenick H. Aging and the Environment: A Research Framework. Environ Health Perspect. 2005 Sept.; 113(9): 1257-1262 Mayo Clinic. Elder Abuse: When You Suspect A Loved One’s Mistreatment. 2005 Jan 13. [updated 2006 Jul 24; cited 2006 Oct 2] Available from: http://www.mayoclinic.com/health/elder-abuse/HA00041 Mangione C., Rodriguez M., Wallace S., Woolf N. Mandatory Reporting of Elder Abuse: Between a Rock and a Hard Place. Annals of Family Medicine: 2006 Sept-Oct: 4 (5): 403-409