Elder Abuse and Neglect

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1 Elder Abuse and Neglect Project EXPORT Dr. Neil Nusbaum Chair, Dept. of Medicine University of Illinois College of Medicine at Rockford

2 Ref. Nusbaum NJ, Cheung VM, Cohen J, Keca M, and Mailey B. Role of First Responders in Detecting and Evaluating Elders at Risk, Archives of Gerontology and Geriatrics,, 43: , 2006.

3 The study was supported by Grant Number 5 P20 MD 524-2, 2, from the National Center of Minority Health and Health Disparities, National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

4 Tools Tools for Screening of Elders by First Responders

5 Research study Voluntary training offered to first responders Education on tools first responders may choose to use in their interaction with elders

6 Collection of consent forms to participate

7 Collection of completed study questionnaire

8 Assign numbers to responders for followup surveys

9 Follow up to collect subsequent questionnaires

10 When you encounter an older person in your work, you want them to be safe.

11 Is the older person at risk for elder abuse or neglect by others around them?

12 Is the older person at risk for self- injury because they cannot take care of themselves?

13 Is the older person at increased risk because of items in the home like guns or automobiles?

14 Size of the Problem Ref.The National Center on Elder Abuse, accessed 1/12/04 Illinois annual data: 7,157 reports of elder abuse 4,103 of these were substantiated

15 Size of the Problem Ref. is.htm accessed 1/12/04 4,100 likely an underestimate of elders at risk in Illinois An unknown number of cases go undetected. (Illinois Dept on Aging website offers the suggestion that only 1 in 13 community abuse cases is reported. )

16 First responders may be able to recognize some of the silent victims of elder abuse or neglect, when the first responders interact with these elders in the community. First responders may also be able to recognize some of those elders who have difficulty caring for themselves.

17 Alzheimer s Disease and Aging Ref. cdc dementia epidemiology gov accessed 1/12/04 Not inevitable with aging, but far more common with aging Among the oldest old (85+ years), found in nearly half of individuals

18 Living alone Of those persons over 60 years old in Illinois, over one third live alone This group comprises half a million people statewide

19 Elders may also place themselves at risk Elders with early dementia often may choose to live alone in their home Items in their home environment may have been acquired by the elder when they could use them safely, but now can no longer do so.

20 Two items that pose a risk of injury or death if the elder has poor judgment: Automobiles Firearms

21 Automobile crashes The Good News About Older Drivers: More likely to wear seat belts Less likely to drink and drive Less likely to drive at night or in bad weather BUT Fatality rate per miles driven is high Reference

22 Ref.

23 Firearm Risks Accident Suicide Also potential risks to others

24 Geriatric Firearm Suicides in Illinois in 2001 Ref. CDC, WISQARS Injury Mortality Report, bin/roker.exe accessed 1/12/04 Age Group Number Deaths Total 65yo and older 130

25 Suicide and firearm deaths 2001 Illinois Ref. CDC, WISQARS Injury Mortality Report, bin/roker.exe accessed 1/12/04 Of the total of 147 firearm deaths in Illinois of individuals 65 or older, 130 were from suicide. Of the total of 202 suicides in Illinois in individuals 65 and over, 130 were from firearms. Conclusion: Reduction in geriatric firearms fatalities requires action close to home

26 Cars, firearms An elder with dementia in fact may no longer want these items, but may now lack cognitive ability to dispose of them without assistance.

27 If you don t suspect there s a problem the elder is having, you won t be able to help that person yourself or to direct them to others who can

28 When you encounter an elder in your work, are there ways you can better identify if that elder is at risk for : Abuse by others? Neglect by others? OR Hurting or killing themselves because of their own lack of judgment?

29 Study of first responders in northern Illinois Questionnaire to evaluate what they thought about elder vulnerability Questionnaire also evaluated their action pattern to detect elder vulnerability

30 Frequency questions regarding prior six months Responses : None; 1-3; 1 4-9; ; More than 20 During the past six months, how often did.

31 During the past six months, how often did you detect an older individual whom you suspected had been abused or neglected? {None; 1-3; 1 4-9; ; More than 20}

32 how often did you detect an older individual whom you suspected was living in a situation where he posed a danger to himself or others?

33 how often did you have occasion to suggest to an older individual for safety reasons that they give up driving their personal auto

34 how often you have occasion to suggest to an older individual for safety reasons that they give up possessing a personal firearm?

35 how often did you have occasion to screen an older individual for abuse or neglect?

36 how often did you have occasion to screen an older individual for poor judgment?

37 Two additional questions Do you have any standard approach to use to screen older individuals for abuse, neglect, and/or poor judgment? {Yes; No} If you have a standard approach you use to screen older individuals for abuse, neglect, and/or poor judgment, please describe it: {Blank lines provided for response}

38 What first responders said (preceding an educational intervention)

39

40

41 Conclusion Screening for vulnerability is underutilized

42 Ref.

43 Thank you. Drive home safely.

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