Verbal abuse of older adults: A disturbing influence on quality of life

Newly published research from Journal of Elder Abuse & Neglect (Routledge) has determined that verbal mistreatment is a highly prevalent concern among older adults in primary care clinics because of its relation to negative mental health outcomes including poor social functioning and major depression. Verbal Mistreatment of the Elderly, conducted by a research team from Northeastern University, is now available online with Free Access.

14 aug 2014--"Our work demonstrates that words can hurt and older adults who suffer from verbal mistreatment have serious sequela," said Terry Fulmer, a member of the research team. "All of us have a responsibility to better understand verbal mistreatment and develop interventions to help stop these unwanted behaviors. Further, we need to develop strategies that help older adults cope with verbal mistreatment."

A diverse sample of 142 older adults aged 65 and older were surveyed regarding verbal mistreatment, quality of life, and depressive symptoms. 38 percent of the sample reported having experienced at least one instance of verbal mistreatment from their primary caregiver. No significant differences were found among factors like age, gender, ethnicity, or marital status. Verbal mistreatment was not strongly associated with physical health, but showed significant detrimental effects on social functioning and mental health. In addition, respondents subjected to verbal mistreatment were three times more likely to report role limitations due to emotional problems.

The research team does offer future directions to alleviate this issue. "Future research should be directed at determining the best methods of intervening for patients who have reported verbal mistreatment. Sensitive and valid screening methods should also be developed to identify the patients who may be at risk for verbal mistreatment and identify patients that are currently experiencing some form of verbal mistreatment," as explained in the conclusion. "Screening methods are important in light of research that has suggested elder mistreatment is grossly under-reported."

More information: www.tandfonline.com/doi/full/1… 08946566.2013.801817

Provided by Taylor & Francis

Increased rates of hospitalization linked to elder abuse, researchers find

Older adults who are subject to elder abuse, neglect and exploitation face a greater risk of being hospitalized than other seniors, according to the results of a study published in the April 8 issue of JAMA Internal Medicine.

9 april 2013--"Elder abuse is independently associated with increased mortality risk, especially for cardiovascular related mortality. However, the relationship between elder abuse and health services utilization still remains unclear," said Dr. XinQi Dong, a researcher and geriatrician at Rush University Medical Center and the study's lead author. "Despite recent advances in our knowledge of elder abuse, we do not know the rate of health care services utilization among those who are victimized."

"Hospitalization is a significant contributor to the rapidly increasing cost in our health care system," said Dong. "Older adult victims may be put often in situations that could threaten their health and safety, which further increase their likelihood to be more frequently admitted into the hospital. However, we are not aware of any population-based study that has examined the prospective association between elder abuse and the rate of hospitalization in a community-dwelling population."

"Our study findings expand on the results of prior studies on elder abuse, but it is the only population-based study to systematically examine the association of elder abuse and rate of hospital services utilization," said Dong.

Of the 6,674 community-dwelling older adults who participated in the Chicago Health and Aging Project, researchers identified 106 participants who were identified by social services agencies for elder abuse between 1993-2010.

Chicago Health and Aging Project (CHAP) is a community-based longitudinal study of risk factors for Alzheimer's disease among older adults aged 65 and over, which began in 1993. Participants include residents of three adjacent neighborhoods on the South side of Chicago and are followed every three years.

The outcome of interest was the annual rate of hospitalization obtained from the Center for Medicare and Medicaid Services.

The study results indicate an unadjusted mean annual rate of hospitalization for those without elder abuse was 0.62 and for with reported elder abuse was 1.97 hospital admissions per year.

After adjusting for socio-demographic, socioeconomic variables, medical co-morbidities, cognitive and physical function, as well as psychological and social well being, reported elder abuse had independent higher rates of hospitalization of a rate ratio of 2.00.

Researchers found that the psychological abuse rate ratio (2.22), financial exploitation (1.75), caregiver neglect (2.43), and two more types of elder abuse (2.59) were independently associated with increased rates of hospitalization.

The mean age of those with reported elder abuse was 72.9 years. Those with reported elder abuse were more likely to be women (72 percent), black older adults (89 percent) and have lower levels of education and income.

"Elder abuse is a serious, common and under-recognized public health and human rights issue," said Dong.

According to Dong, the field of elder abuse is estimated to have lagged more than 20 years behind that of child abuse or intimate partner violence.

It is estimated that one out of 10 older adults experience some forms of elder abuse, neglect and exploitation in the United States each year.

"Given the soaring cost of health care in this country, the results my help health care providers focus on clinical screening, prevention and intervention of elder abuse cases in order to devise targeted strategies to reduce unnecessary utilization of health services." said Dong.

"With the rapidly growing aged population in this country, problems of elder abuse will likely become even more pervasive, affecting our family, friends and loved ones," Dong said. "We hope our study will help advocate for additional research and resources, as well as national policy initiatives, to improve the health and well-being of this vulnerable population."

Provided by Rush University Medical Center

Invisible Scars

Charles Mouton, MD, MS, knew something was amiss with his 88-year-old patient when he examined her. The woman had suffered a stroke a few years earlier, and her blood pressure, which previously had been in an acceptable range, now was out of control.

“I asked her some questions, and pretty soon it came out she wasn’t taking her blood pressure medication,” recalls Mouton, who now chairs the family and community medicine department at Howard University College of Medicine. “She also had mild dementia, and the son tried to imply that she wasn’t agreeing to take it. They got into a bit of an argument, so I asked to talk to her alone.”

Upon further questioning, Mouton discovered that the son was taking half the woman’s monthly social security check as “payment” for the care he was providing. That didn’t leave enough to cover her medication. But when Mouton tried to report the case to the state’s adult protective services, his patient protested. “It turned out the son had been arrested twice before for drug possession, and she was afraid if he was convicted a third time he’d be sent away for life and she would be put into a nursing home,” he says.

Jeffrey Kagan, MD, an internal medicine specialist practicing in Newington, Connecticut, recalls a similar case involving an elderly patient for whom a conservator had been appointed because he was not taking medications and was neglecting his personal care. “Two women, a home aide, and another who said she was a neighbor were with him, and they wanted me to write a letter to the probate court saying he no longer needed a conservator to pay his bills because he wasn’t demented.”

The patient seemed confused about why he had been brought to see Kagan, so Kagan administered several brief cognition tests, on which the patient performed poorly. “At that point, the women said they would get another opinion and stomped out of the room,” he recalls. “I really got the feeling that these two women were planning on taking his finances.”

In many ways, Mouton’s and Kagan’s patients were fortunate. The two doctors recognized signs of financial abuse, took the time to probe more deeply, and followed up on their suspicions. Too often, experts say, primary care doctors don’t know when their elderly patients are being taken advantage of financially or are reluctant to take action when they suspect it may be occurring.

“In my 12 years of prosecuting crimes against the elderly, it has not been my experience that a physician is the one reporting the crime,” says Paul Greenwood, deputy district attorney and head of the elder abuse unit in the San Diego County District Attorney’s Office. “They may be trained to spot signs of physical abuse, but it’s rare for them to be called on or even think to report suspicious financial transactions.”

What Constitutes Financial Abuse?
A 2007 survey of state adult protective services from the National Center on Elder Abuse (NCEA) defines financial abuse as “the illegal or improper use of an older person’s or vulnerable adult’s funds, property, or assets.” Examples cited in the survey include cashing checks without authorization or permission, forging a signature, misusing or stealing money or possessions, coercing or deceiving someone into signing a document, and the improper use of conservatorship, guardianship, or power of attorney.

Randolph Thomas, MA, past president of the NCEA and a former law enforcement officer, trains police and social workers around the country to help recognize and prevent financial abuse of the elderly. In his training sessions, he makes clear that financial abuse is defined as taking place in the context of a trusted relationship between the victim and the perpetrator. “The public seems to be more aware of things like telemarketing and crimes perpetrated by strangers. We look for a family member or someone else who the victim trusts,” he says.

Sharon Merriman-Nai, NCEA co-manager, says abuse sometimes is as blatant as the outright theft of cash, jewelry, or credit cards. But often it is more subtle. “Frequently the perpetrator is very strategic in the way they go about gaining access to a person, weaning them away from other people, then manipulating the person into turning over their assets. It is the definition of undue influence.”

An Underreported Problem?
Pinning down the frequency of elderly abuse is difficult. Adult Protective Services around the country investigated about 38,000 cases in 2003. But many experts believe the true number is much higher. “For every case reported to any type of authority, studies show that between 12 and 15 cases go unreported,” says Bennett Blum, MD, a geriatric psychiatrist and consultant.

Merriman-Nai explains that underreporting occurs for a number of reasons. “Often the victim is embarrassed and doesn’t want to talk about it, or they may be in denial or afraid of the consequences of what might follow such a disclosure.” Common fears are that the perpetrator will retaliate by stealing even more or that the perpetrator will be jailed, leaving the victim without a caregiver and forced into a nursing facility. “Even if the person is aware they are being abused, if the perpetrator is a family member or loved one, the feelings of love can override everything else,” she says.

Screening might catch more cases of elder abuse

By Amy Norton1 hour, 6 minutes ago
Screening elderly adults for signs of abuse may catch many more cases than otherwise would be, a new study suggests.
Israeli researchers found that while 6 percent of older adults in their study admitted to being abused by a family caregiver when asked directly, many more had evident signs of abuse or were at high risk of abuse.
The findings suggest that older adults should be routinely screened for signs of abuse, or risk factors for it, when they enter a hospital or a community service, the study's lead author told Reuters Health.
The study, which is published in the Journal of the American Geriatrics Society, involved 730 men and women age 70 and older who were hospitalized in one of two major Israeli medical centers. All were living at home, but relied on a family member for help with day-to-day living.
When asked directly, just under six percent acknowledged that they'd suffered some form of abuse from a family member. The types of abuse ranged from physical and verbal abuse to neglect to financial exploitation.
But when the researchers used two additional methods of detecting potential abuse, the results were significantly different. When nurses and social workers assessed the patients after they entered the hospital -- interviewing them and conducting physical exams -- they found evidence of abuse in 21 percent.
These signs included suspicious bruises and burns; angry or indifferent behavior in the caregiver; and evidence that the patient was being neglected at home, such as poor hygiene or dehydration.
What's more, the third measure of abuse -- which looked at risk factors for abuse -- indicated that one-third of patients were at high risk.
Risk factors for abuse included problems such as emotional instability and poor family relationships, in both caregivers and elderly patients.
The findings point to a need for routine screening of elderly adults to "rule out the possibility of abuse," said lead study author Dr. Miri Cohen, head of the department of gerontology at Haifa University.
Screening could be done at hospitals, Cohen noted, or at centers that provide social services to the elderly. Because few older adults may admit to abuse when questioned directly, it's "most important" to look for evident signs of abuse, as well as risk factors for it, according to Cohen.
Elderly adults judged to be at high risk could then be assessed further to see whether abuse is in fact taking place.
SOURCE: Journal of the American Geriatrics Society, August 2007.