Enhancing and evaluating the capacity of elder abuse fatality review teams to assist victim services.

Fatality review teams (FRTs) have been historically helpful in identifying systemic issues that may lead to child and domestic violence deaths to improve responses, guide prevention efforts, and better serve victims. More recently, these teams have formed to address similar concerns in elder abuse matters. The American Bar Association Commission on Law and Aging received an early grant to study elder abuse fatality review teams (EAFRTs) and in 2005 created its first Replication Guide.

Medical implications of elder abuse: self-neglect.

Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencies across the United States, is an often unrecognized geriatric syndrome characterized by squalor and unsafe living circumstances. It is a result of medical, neurologic, or psychiatric disorders coupled with lack of capacity for self-care and self-protection in the absence of necessary services or medical care, and leads to increased morbidity and mortality. Clinicians should evaluate self-neglecters and plan interventions based on comprehensive geriatric assessment and capacity assessment.

Future research: a prospective longitudinal study of elder self-neglect.

In almost every U.S. jurisdiction, elder self-neglect is the most common allegation addressed by Adult Protective Service (APS) agencies.

Healthcare costs and utilization of vulnerable elderly people reported to Adult Protective Services for self-neglect.

Objectives: To assess differences between diagnoses, healthcare utilization, and healthcare costs of vulnerable elderly people reported to Adult Protective Services for self-neglect and those of matched controls.

Design: A case-control study of 131 self-neglect cases and 131 matched controls.

Setting: All participants were patients in a public hospital geriatrics program.

Assessing capacity in the setting of self-neglect: development of a novel screening tool for decision-making capacity.

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool.

Vitamin D deficiency associated with self-neglect in the elderly.

Background: Vitamin D deficiency is common in elders. However, little is known about the implications of vitamin D deficiency in elder self-neglect.

Specific Aims: To characterize a group of self-neglecting elders with vitamin D deficiency based on clinical, cognitive, and functional status.

Is pain a significant factor in elder self-neglect?

Purpose: Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls.

Social networks: a profile of the elderly who self-neglect.

Background: Self-neglect is an independent risk factor for early mortality in older people and has been linked to depression and the occurrence of mental and physical decline. Sound social networks have been shown to slow the process of decline in the elderly, and currently little is known about the social networks associated with elder self-neglect. The aim of this study was to explore the social networks associated with elder self-neglect compared with a matched-control group.

What is the association between self-neglect, depressive symptoms and untreated medical conditions?

Objective: There have been no studies describing the occurrence of untreated medical condition(s) in elders with depression who self-neglect. This study compares the prevalence of depression as indicated by an abnormal score ( > or = 5) on the Geriatric Depression Scale-Short Form (GDS-SF) between self-neglecters and matched non self-neglecting community-dwelling elders. It also describes the relationship between untreated medical condition(s) associated with self-neglect and abnormal scores on the GDS-SF.

The making of a self-neglect severity scale.

Background: Research in elder self-neglect has lagged behind that of other forms of mistreatment, despite the fact that self-neglect is the most common allegation reported to Adult Protective Service agencies throughout the US. The lack of a gold standard to measure self-neglect has hampered efforts to study this phenomenon.

Methods: Researchers designed the Self-Neglect Severity Scale (SSS) based on interviews with Adult Protective Service workers and a national expert panel.

Severe self-neglect: an epidemiological and historical perspective.

Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses.

Self-neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team.

Objectives: We sought to identify the functional, cognitive, and social factors associated with self-neglect among the elderly to aid the development of etiologic models to guide future research.

Methods: A cross-sectional chart review was conducted at Baylor College of Medicine Geriatrics Clinic in Houston, Tex. Patients were assessed using standardized comprehensive geriatric assessment tools.

Do medical examiners determine elder mistreatment as a cause of death?

This study examines the decision-making process of medical examiners in determining elder mistreatment in cases that present to the county morgue. Harris County Medical Examiners were surveyed about factors that influence the determination whether elder abuse or neglect was a contributor to the cause of death. At the time of the survey, all 11 Harris County Medical Examiners participated.

Enhancing victim safety through collaboration.

Elder abuse is associated with morbid and lethal outcomes. In some cases of elder abuse, particularly involving domestic violence, uninformed or improperly executed interventions can result in serious harm to the victims. Professionals from various disciplines may themselves be at risk during encounters with perpetrators.

The key elements of elder neglect:a survey of adult protective service workers.

Description of the key elements of elder neglect is critical to the development of a case definition. In this brief report, experienced protective service workers were surveyed to capture their field experiences with neglected elders. The workers cited environmental filth, poor personal hygiene and health related factors as the three most common observations.

Frail older patient care by interdisciplinary teams: a primer for generalists.

Frail older patients-unlike younger persons in the health care system or even well elders-require complex care. Most frail older patients have multiple chronic illnesses. Optimum care cannot be achieved by following the paradigm of ongoing traditional health care, which emphasizes disease and cure.

Progress in elder abuse screening and assessment instruments.

The responsibility of identifying elder mistreatment (EM) often falls on the healthcare professional. Many different screening and assessment instruments have been developed to aid healthcare professionals in making determinations about EM. The purpose of this article is to review existing EM screening and assessment instruments to examine progress in this field.

The hidden health menace of elder abuse. Physicians can help patients surmount intimate partner violence.

As many as 2 million elderly persons in the United States experience physical, psychologic, or sexual abuse each year. Nationally spouses or intimate partners commit between 13% and 50% of elder abuse.1 Physicians can be instrumental in preventing and intervening in intimate partner violence in their elderly patients.

How geriatricians identify elder abuse and neglect.

Background: Up to 2 million elderly persons are abused or neglected in the United States each year. Although elderly patients see their physicians an average of five times per year, physicians make only a small percentage of reports to Adult Protective Services (APS) agencies. The purpose of this study was to learn how practicing geriatricians define, diagnose, and address abuse and neglect to provide some guidance to the busy general internist regarding this complex issue.