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Geriatrics, Health, Prevention & Treatment

Missed opportunities to identify elder abuse

credit: Anique (cc license)

Elder abuse affects approximately 1 in 10 older adults in the United States with serious, long-lasting effects on physical and mental health. With over 23 million emergency department visits by older adults annually, the ED is an important setting to identify elder abuse, initiate interventions to ensure patient safety, and deal with unmet care needs.

But according to a recent study, emergency providers make a formal diagnosis of elder abuse in just one in 7,700 visits. This indicates that a majority of victims of elder abuse pass through the emergency department without the problems being identified, according to senior study author Timothy Platts-Mills, MD, assistant professor of emergency medicine and co-director of the division of geriatric emergency medicine at the University of North Carolina School of Medicine. The research appears in the September 2016 issue of the Journal of the American Geriatrics Society.

Platts-Mills said that given the burden of this problem, this is a major missed opportunity. Emergency providers strive to make sure that for each patient who comes through the door, all serious and life-threatening conditions are identified and addressed, but “for elder abuse, EDs across the country are falling short.”

Identifying elder abuse is challenging. Older adults who are physically frail or have cognitive impairment are vulnerable to injuries and may have difficulty caring for themselves.

“It can be very difficult distinguishing whether a bruise is from a fall or physical abuse, or whether poor hygiene is a result of a patient asking to be left alone or the result of overt neglect on the part of a care provider,” Platts-Mills said. “But those difficulties don’t change the reality that elder abuse is common, takes a tremendous toll on its victims, and is frequently missed.”

In New York State, 76 out of every 1,000 older New Yorkers were victims of elder abuse in a one year period. The Elder Abuse Prevalence in New York State study found a dramatic gap between the rate of elder abuse events reported by older New Yorkers and the number of cases referred to and served in the formal elder abuse service system. The reported incidence rate is nearly 24 times greater than the number of referred cases. This suggests that many elders are not seeking – or getting – the assistance they need.
Elder abuse comes in many forms:

Emotional Abuse: causing mental anguish and despair by name calling, or by insulting, ignoring, threatening, isolating, demeaning, and controlling behavior.
Financial Abuse: illegally or unethically exploiting an older person through use of his/her cash, credit cards, funds or other assets without permission or through coerced permission. An analysis by the office of New York State Attorney General Eric Schneiderman recently found that phone scams aimed at the elderly are on the rise.
Physical Abuse: slapping, bruising, coercing (including sexual coercion), cutting, burning, or forcibly restraining an older person.
Neglect: refusing or failing to carry out caretaking responsibilities (e.g., withholding food, medicine, glasses or dentures); also, abandoning a dependent older person.

Tackling this problem takes education and resources, including more health provider training and greater access to social workers who can identify and address unmet care needs, according to Platts-Mills. His team is currently looking at ways to improve the identification of elder abuse in the emergency department through new setting-specific screening tools.

Anyone who suspects elder abuse can contact their state’s Adult Protective Services, the Eldercare Locator online or at 1-800-677-1116. If someone is in immediate danger, please call 911.

October 24, 2016

author: Editorial Staff

1 Comment

[caption id="attachment_11769" align="alignright" width="240"] credit: Anique (cc

Geriatrics, Policy

Report: better policies needed to help family caregivers

We need a national strategy to address the needs of family caregivers. That’s the conclusion of last week’s 280 page report, Families Caring for an Aging America, from the National Academies of Sciences, Engineering and Medicine. Findings from a panel of experts call for forward-thinking policies and community efforts to help the estimated 18 million family members who care for an aging parent, or a spouse or child with a serious medical condition.

While each caregiving situation is different, one thing they have in common is that family caregiving affects their physical, emotional, and financial health, said Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, one of the report’s co-sponsors. Fulmer was a co-chair of the committee prior to joining the Foundation. Many caregivers say they are stressed out, overwhelmed, and feel like the entire challenge rests on their shoulders.

There’s increasing urgency in finding solutions to caregiver concerns. People are living longer, but with more chronic conditions. Many hope to age in place and avoid institutional care for as long as possible. According to the report, the need to address caregivers’ concerns is growing more urgent. Demand for caregivers is rising dramatically, especially among those age 80 and older, but the number of available caregivers is shrinking. Smaller families, more never-married or divorced older adults, geographic distance are some of the reasons.

More caregivers, still primarily women, work outside of the home. They find themselves caught between juggling job responsibilities and providing needed care to their loved one at home. Without community supports, more flexible employment options, and financial assistance, family caregiving in the U.S. is quickly reaching crisis levels.

I spoke with Fulmer about these challenges, and possible interventions. And, we discussed what policy changes are needed at all levels to overcome systemic barriers that family caregivers face every day.

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September 29, 2016

author: Editorial Staff

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We need a national strategy to address

HealthCetera, Media Engagement, Radio/Podcast

Silent Narratives that Kill: Again and Again…and Again

The Different Faces of Mr. Ross Smith

“That looks like a bad dude” was a police officer’s assumption in regard to Terence Crutcher, a black male whose car stalled out in the middle of a road in Tulsa, Oklahoma. What made this black male appear “bad” to an officer who was flying above in a helicopter? Was Mr. Crutcher wielding a gun at cops or shouting obscenities? Was it the way he was dressed? Or was it the color of his skin?

I recently posed this question to a relative who is an attorney. She expressed that the officer may have considered that Mr. Crutcher was “bad” because he was walking away, albeit with his hands up, and not following instructions. She added that individuals should not give police officers any excuse to shoot them. This could help remove the “excuse to shoot” and force police departments to address inherent biases. While her scenario sounds plausible, it misses the totality of how we cognitively determine whether someone is “bad”.

So what do you see first when you examine the different faces of Mr. Ross Smith? Do you see an award winning journalist, a visual artist, an intelligent son, a loving sibling or a multimedia artist? Mr Bayeté Ross Smith, through the use of his expertise in photojournalism, creatively illustrates how the single face can conjure up many beliefs about who he is. Some of the above images might have him falsely tagged as bad, mischievous or even dangerous. When you associate any of the above images of Mr. Ross Smith with the word “bad”, you are demonstrating the power of narratives that dwell in the subconscious and prompt you to form biased assumptions.

Should visual clues alone corroborate the assumption that one is “bad” or justify the killing of a 40 year old unarmed black male? Of course not. In fact, if you search for tangible evidence in isolation from the story you may find yourself duped. That’s because what makes us believe that someone is bad is not always or solely based on what we can visualize with the naked eye. It could include the silent narrative, or the culturally biased story that resides deep inside our mind.

Did the description of Mr. Crutcher originate from a subconscious space that is fortified by a false historical narrative of the black male? Big and Black male does not equate to harmful and dangerous. However, so many of us have unknowingly walked into and joined an unrelenting and perilous narrative about the Black male. A story that influences our behavior and could take over our actions. And so, although tired of and frustrated at what appears to be similar events stuck on rewind, we secretly know it’s not over. Another black male will, yet again, be unknowingly placed in the role of “bad” again and again… and again, unless we change the narrative.

Is the achievement of a socially just America truly possible? We all have prejudices for or against individuals or groups. So how do we create a safe space for a discourse about the reality of our prejudices and how it influences our behaviors? And then, how do we limit the influence that our prejudicial thoughts and actions have on employment rates, the academic achievement gap, patient outcomes, judicial hearings and so much more?

Silencing the narratives that harbor prejudices could weaken the fight for social justice. While the U.S. Justice Department begins to examine the tangible evidence to determine if Mr. Crutcher’s civil rights were violated, Mr. Bayeté Ross Smith will join me on HealthCetera to expose the silent narrative that kills and discuss ways to move forward. Join us on September 29, 2016, at 1:00 on WBAI, 99.5 FM in New York City or streaming at www.wbai.org; and be a part of the discourse that saves lives.

You can listen to the interview on iTunes here: