With an increasing life expectancy and an aging American society, the challenges of later life adulthood are becoming increasingly important. Therefore, it is essential that those who help manage and coordinate care for the elder population be attentive to both normal and problematic issues of aging. In particular, elder abuse is a pressing and not always well-recognized challenge for those who work with aging populations. In fact, a 2008 review by the World Health Organization found that physical abuse; psychological abuse; financial abuse; and neglect for the elderly were a significant public health problem (Perel-Levin, 2008). There is a significant association between elder mistreatment and abuse, and increased risks for morbidity and mortality. Some of the health consequences of elder abuse include excessive emergency room utilization, multiple hospitalizations, non-adherence to medical care, living in substandard conditions, risks of falls, and untreated psychiatric and medical illness.
Optum recognizes the importance for those involved in the care and management of services for the elder population to be aware of the potential issues of elder abuse, and to recognize the challenges and opportunities for improving the health outcomes of this population. Optum provides staff training, and partners with elder care providers to promote a clear understanding of the definitions of abuse, neglect, and exploitation. Abuse is the behavior by someone with an ongoing relationship to an elder, and a duty towards that individual that may constitute: willful infliction of physical pain or injury or unnecessary restraint (physical abuse); the willful nonconsensual sexual contact (sexual abuse); and willful infliction of emotional harm (psychological abuse). Neglect involves the failure of a caregiver to provide for the needs and protection of a vulnerable elder. Exploitation is defined as the nonconsensual appropriation of an elderly person’s resources, for the benefit of another person, by someone either caring for or who has an ongoing relationship with that elderly individual.
The highest rates of elder abuse are generally found in women and in persons 80 years of age and older. And in approximately 90 percent of cases the abuser is a family member (usually a spouse or adult child). (Nelson, Nygren, McInerney and Klein, 2004). Since many elders may be either cognitively impaired and don’t recognize or remember the offenses, or are reluctant to report abuse or neglect for fear of being removed from their own homes, or implicating abusive family members, elder mistreatment is often undisclosed. Therefore, there is an important role for those involved in the care and management of services for this population to be aware of the potential risks and consequences they face.
Awareness of the potential risks of elder abuse includes the awareness of potential clues and signs. This includes the signs of depression, social isolation, and feelings of loneliness, all of which have been associated with self-reported elder mistreatment. Additionally, financial exploitation can be suggested by a change in the ability of an elder individual to pay for their medical services, medications, food, housing, or utilities. Warning signs that may suggest elder physical abuse can include abrasions, lacerations, burns and bruises that are not adequately explained, or have occurred in unusual locations. While falls are also common in the elderly, some fractures can be warning signs of abuse or mistreatment. Spiral fractures of long bones, and fractures in sites other than the wrist, hip or vertebrae may be suspicious for possible physical abuse. Warning signs of neglect include malnutrition (which can also be an indicator of financial exploitation if an elder is left without resources to purchase food) and dehydration (indicated if the elder needs assistance for sufficient fluid intake).
Screening and assessment are key components of an elder abuse program. The purpose of screening is to determine if an elderly person has an impaired capacity for self-care and may be vulnerable and in need of supplemental support or protection. It is also important to assess if there is someone who is expected to help and protect the elderly person who may be abusing, neglecting or exploiting them.
Across all clinical settings it is important to assure that there is adequate and routine screening of signs of potential elder abuse. This should be conducted by clinicians, who have an ethical obligation to take care of vulnerable patients, and are best qualified to distinguish normal aging from the manifestations of abuse. Clinical screening is best when patients are interviewed alone. Patients should be asked directly about abuse, neglect or exploitation, and also questioned about family composition and living arrangements. Screening of elder patients should include asking directly about abuse, neglect or exploitation.
When there is a suspicion of elder abuse, there are three levels of intervention that should be considered. These include reporting abuse, medical intervention, and social interventions. If a health care worker has reason to believe that an elder is in a state of abuse, neglect, or financial exploitation, appropriate reporting should be promptly initiated. A primary obligation for all health care workers is to assure the health and safety of the at-risk elder. There are also a number of social interventions that should be encouraged. Adult protective services agencies can provide resources or help activate resources from other agencies in the community. Law enforcement should also be considered when there is a need for safety, a more supportive living environment, or when guardianship is necessary.
For those that provide services for elderly populations, it is important to be aware that New York and other states have enacted legislation providing for the protection of elders found to be abused, neglected, and financially exploited. This is provided by the state’s adult protective services agencies (APS). These agencies are chartered to receive and investigate allegations or complaints, and provide social, legal, medical and material interventions to help identified victims. Elders in institutional settings are also protected by the state’s Long-Term Care Ombudsman Programs (LTCOP) that receive complaints and advocate on behalf of long-term care residents.
The awareness and prevention of elder abuse is the responsibility of the entire health care team. The mistreatment of the elderly is a significant public health concern and Optum is committed to educating its staff to be able to help all elder care stakeholders to address this problem. Working together it is possible to improve health outcomes for this significant public health issue and prevent abuse of older adults. Information is the key, collaboration is essential, and persistent attention is required.
Optum does not recommend or endorse any treatment or medications, specific or otherwise. The information provided is for educational purposes only and is not meant to provide medical advice or otherwise replace professional advice. Consult with your clinician, physician or mental health care provider for specific health care needs, treatment or medications. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services.
References
Perel-Levin S. (2008). Discussing screening for elder abuse at primary health care level. World Health Organization publication.
Nelson HD, Nygren P, McInerney Y, Klein J. (2004). Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force. Originally in Ann Intern Med 2004;140(5)387–96. Agency for Healthcare Research and Quality, Rockville, MD.
