How Do We Protect Elder Frail Americans?

Posted on | November 17, 2008 | Comments Off on How Do We Protect Elder Frail Americans?

Recently, issues of elder abuse have resurfaced in both home and institutional settings. As Stephanie Lederman, executive director of the American Federation for Aging Research notes, “A large segment of our population is both dependent and frail. Studies on elder abuse now alert us that seniors are also vulnerable and in need of help.”

How large is the at-risk segment? One study of 2,812 adults over age 65 revealed that 6 percent of them were seen by elderly protective services over a nine-year period. Nearly three-quarters of these cases involved self-neglect, but the remaining 27 percent were traced to the actions of others – nearly 6 percent of the elderly people experienced physical abuse, 17 percent had been neglected, and almost 5 percent suffered exploitation.

What is elder abuse? The U.S. National Academy of Sciences defines the problem as “intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder; or, failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.”

Elder abuse not only implies that a person has suffered injury or neglect, but also that a specific individual, entrusted to provide care, is responsible. The abuse may take a variety of forms, including physical abuse, psychological abuse, sexual assault, exploitation of material resources, or neglect. But studying elder abuse is easier said than done. For example, was under- or over-medicating a patient the result of forgetfulness or malevolence of the caregiver?

Risk factors associated with elder abuse are increasingly clear. Most incidences occur in shared living situations where there is prolonged access by a family member, friend or entrusted surrogate. Caring for a frail, dependent and vulnerable senior is challenging under the best circumstances.

Screening elders for abuse requires high awareness and good clinical judgment. General concern should be raised when physicians, nurses, and other members of the care team observe a poor social network, poor social functioning, and signs of conflict between a patient and a caregiver. Trust your instincts, experts say. Conduct a thorough evaluation with a focus on cognitive function, question the patient in private, and be cautious in discussions with the caregiver, extending empathy while uncovering the caregiver’s training and coping skills.

Be on the lookout for problems. Is mom or dad declining without an obvious reason? What is the level of cleanliness of the patient and the home setting? What is the patient being fed? Are there unexplained bruises, blisters, or painful areas?

Addressing senior abuse requires a continuum of committed individuals from home to care sites and back home again. Such a network must be built, and a good place to begin is with an informed discussion of the issue between family members and their care teams. As always, watch the video embedded with this blog post for more detailed commentary; then send us a comment. Do you have experience with this problem?