A statewide elder mistreatment virtual assessment program: Legal, ethical, and practical issues.

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies. The arrangement between APS and the geriatricians at McGovern Medical School in Houston, Texas is novel. The structure of the arrangement is important for the success of the program. Legal, ethical, and practical considerations are discussed in this article, including approaches to the Health Insurance Portability and Accountability Act, physician liability, state law, and resource limitations. It is hoped that sharing how one such collaboration has addressed these important issues will suggest approaches for the structuring of similar programs.

Perceived Types, Causes, and Consequences of Financial Exploitation: Narratives From Older Adults.

OBJECTIVES: The goal of this study was to investigate the perception of financial exploitation and its causes and consequences by older adults who have firsthand experience of being exploited. METHOD: Thirty-one cognitively healthy older adult participants aged 50 or older were drawn from the Finance, Cognition, and Health in Elders Study. In-depth, one-on-one interviews were conducted. Interview transcripts were analyzed using an iterative, data-driven, thematic coding scheme and emergent themes were summarized. RESULTS: Categories of financial exploitation included (a) investment fraud, (b) wage theft/money owed, (c) consumer fraud, (d) imposter schemes, and (e) manipulation by a trusted person. Themes emerged around perceived causes: (a) element of trust, (b) promise of financial security, (c) lack of experience or awareness, (d) decision-making, and (e) interpersonal dynamics. Perceived consequences included negative and positive impacts around (a) finances, (b) financial/consumer behaviors (c) relationships and trust, (d) emotional impact, and (e) future outlook. DISCUSSION: These narratives provide important insights into perceived financial exploitation experiences.

WebPalestra: violência contra a pessoa idosa. Conhecer para identificar, notificar para cuidar

Violência contra a pessoa idosa; Papel do setor saúde; Por que não falar sobre o envelhecimento?; Tipos de violência contra a pessoa idosa; Principais causas da violência; Principais vítimas; Possíveis agressores; Como prevenir a violência contra a pessoa idosa?

Webconferência: a violência contra a pessoa Idosa - Telessaúde ES 24/06/2014

Webconferência: prevenção de violência contra as pessoas Idosas - Telessaúde ES 30/06/2015

Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases.

STUDY OBJECTIVE: Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls. METHODS: We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014. RESULTS: We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%). CONCLUSION: Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.

Effects of the COVID-19 Outbreak on Elder Mistreatment and Response in New York City: Initial Lessons.

New York City is currently experiencing an outbreak of COVID-19, a highly contagious and potentially deadly virus, which is particularly dangerous for older adults. This pandemic has led to public health policies including social distancing and stay-at-home orders. We explore here the impact of this unique crisis on victims of elder mistreatment and people at risk of victimization. The COVID-19 outbreak has also had a profound impact on the organizations from many sectors that typically respond to protect and serve victims of elder mistreatment. We examine this impact and describe creative solutions developed by these organizations and initial lessons learned in New York City to help inform other communities facing this pandemic and provide guidance for future crises.

Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data.

Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response.

Perceptions of plea bargaining in cases of elder financial abuse.

The present study investigated perceptions of plea bargains in elder financial abuse. Approximately 78-90% of felony convictions are the result of plea bargains, yet very little work examines the public's perceptions of it. Additionally, elders lose an estimated $2.6-36.5 billion dollars each year to financial abuse and exploitation. Participants were recruited from Mturk (N = 74) and completed a mixed-factors 2 (Amount of Money Stolen: $5,000 vs. $50,000) x 2 (Relationship of Victim and Perpetrator: son vs. caretaker) x 2 (Type of Sentence: reduced jail sentence vs. probation) x 2 (Participant Gender) design. Amount, relationship, and sentence were within-participant factors, while gender was between-participant. It was found that there were main effects of amount, sentence, and relationship between victim and defendant such that participants showed a preference for plea bargains when the amount in question was lower ($5,000 vs. $50,000), when the sentence given was harsher (a reduced jail sentence vs. probation), and when the defendant was the victim's son (vs. a caretaker).

Toward a better understanding of the elder abuse forensic center model: comparing and contrasting four programs in California.

Resolving elder abuse, neglect, and self-neglect often requires the authority and expertise of multiple providers. Prior research of the elder abuse forensic center (FC) model, although limited, has indicated strong member support, increases in prosecution of abusers, and increases in conservatorship for those lacking capacity. This study expands on previous single-site research by conducting a cross-site multimethod evaluation of four established FCs to better describe the model and inform its replication with fidelity. Data were compiled from FC administrative data, site visits completed from 2011-2012, and a follow-up telephone interviews conducted in 2018. Site characteristics, processes, desired outcomes, and long-term sustainability were compared. All FCs had dedicated staff who convened a multidisciplinary team (MDT) of medical, legal, and social services providers to jointly engage in case review, consultation, and provision of supportive professional services. Similar results were observed across all sites in team effectiveness and member-perceived improvements in personal practice and inter-agency relationships. While three programs had unified philosophies and practice approaches, one employed a distinct model and was no longer in operation at follow-up. Commonalities in case characteristics, program structure, processes, and outcomes provide insight into the core model components and a foundation for continued program replication and standardization.

Italian healthcare professionals' attitude and barriers to mandatory reporting of elder abuse: An exploratory study.

INTRODUCTION: Elder abuse in recent times has reached a remarkable international importance. This complex phenomenon is still little understood and studied in Italy. The aim of this study was to explore Italian healthcare professionals' attitude and barriers toward elder abuse, with a glimpse on the current scenario and evidences to develop an action plan. MATERIALS AND METHODS: 42 healthcare professionals filled a questionnaire with 13 open-ended questions, analyzed with a qualitative content analysis. Data were grouped under the following 4 core-themes: description of elder abuse, abuse detection and perception, barriers to reporting, and professional orientation and approach; then they were analyzed to find their central component and discussed jointly. RESULTS: The respondents described physical (64%) and psychological (50%) abuse and neglect (50%) as the three main characteristics of elder abuse; the 59% of them reported at least one experience in detecting or suspecting elder abuse. The 76% of participants believed the report has to be submitted to the Judicial Authority only in presence of compelling evidences. Furthermore, the 73% of the sample perceived that healthcare professionals are the main figures who have to cope with elder abuse, however they did not feel as their exclusive role the assessment of the patients' potential abuse. CONCLUSION: Knowledge about elder abuse was limited to physical/psychological issues and, moreover, the legal obligation to report was only poorly known. Imperative is the creation of specific education and training courses, in addition to the need for a multidisciplinary and empathetic approach.

El delito contra la libertad sexual en el anciano: una realidad escondida difícil de detectar / Sexual abuse of the elderly: A hidden, difficult to detect, reality

El maltrato a personas mayores es un problema de salud pública; existen diversos tipos de maltrato; el abuso sexual en el anciano es uno de los menos estudiados y comúnmente no se detecta. Este trabajo presenta el caso de una paciente que fue llevada al hospital por la sospecha de que pudiera haber sido víctima de un delito contra la libertad sexual. La paciente se encontraba ingresada en una residencia geriátrica y presentaba una demencia de 10 años de evolución. En el artículo se expone la vulnerabilidad de este tipo de pacientes y las dificultades encontradas para el diagnóstico, y se reflexiona sobre la necesidad de trabajar en la prevención e intervención efectiva desde el ámbito sanitario

Abuse of the elderly is an important public health problem. There are different types of abuse, with sexual abuse being one of the least studied, and usually underdiagnosed. A forensic case-study is presented on a female patient who was taken to the hospital under the suspicion that she had have been a victim of sexual assault. The patient was admitted to a geriatric centre and had been diagnosed with senile dementia type I of 10 years onset. In this article, an analysis is carried out on the vulnerability of this kind of patient, the difficulties in diagnosis, and on the need to work on prevention and effective intervention from a health care perspective

European council of legal medicine (ECLM) guidelines for the examination of suspected elder abuse.

Article 25 of the Charter of Fundamental Rights of the European Union (adopted in Nice on 7 December 2000) recognizes and respects the rights of older people to lead a life of dignity and independence and to participate in social and cultural life. It also highlights the importance of prevention and recognition of elder abuse, especially since exposure to violence is likely as the population ages, either in familial or in institutional settings. Elder abuse has some issues in common with child abuse but in spite of this fact currently is less recognized. Health professionals have a major role to play in early detection and management of cases of elder abuse. This protocol summarizes some key concepts and approaches to assist in the timely detection and investigation of elder abuse cases by healthcare professionals and forensic practitioners.

Improving medicolegal death investigative gaps of fatal elder abuse.

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Inherent limitations of resources and practical realities of death investigation are discussed and recommendations are made for future research. Viewed broadly, deficiencies in elder death investigations can lead to the underreporting of elder abuse and the reduction of legal options for victims, which may reflect a systemic pattern of social injustice.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney's office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser's substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.

Comparing Older Persons' Human Rights: Exploratory Study of the International Older Persons' Human Rights Index (IOPHRI).

BACKGROUND AND OBJECTIVES: Over the last 2 decades, several international indices have been developed to describe the status of older persons. None, however, have examined their human rights. The International Older Persons' Human Rights Index (IOPHRI) fills in this gap by analyzing the formal legislative foundation of human rights for older people. The objective of this exploratory study is to examine the IOPHRI while comparing the legislation in 6 countries. RESEARCH DESIGN AND METHODS: A comparative international exploratory study comparing the human rights legislation of 6 countries: United States, Chile, Ireland, South Africa, India, and Australia in 5 different human rights domains: constitutional, protection, familial and informal support, planning, and empowerment. RESULTS: The findings suggest that the actual relationship between formal human rights of older persons and the real world is complex: for example, while the IOPHRI index places South Africa in first place, it is far behind compared with all other participants in the Global AgeWatch Index (which measures objective elements such as life expectancy at 60, or poverty rates in old age). DISCUSSION AND IMPLICATIONS: Measuring and indexing human rights of older persons reveal significant methodological issues. Beyond these methodological challenges, comparing the ranking of the IOPHRI to nonlegalistic indices raises significant questions about the relationship between formal human rights and the actual living experiences of older persons.