Elder abuse and neglect - International Federation on Ageing

Elder abuse and neglect:
Discussion around comprehensive
assessment
Louise Belzile, Ph.D. student
Nicole Dubuc, Ph.D.
4 October, 2013
IFA - Istanbul (Turkey)
Background
• Elder abuse and neglect (EA): an important public social
and health concern (Québec, Ministère de la Famille et des
Aînés, 2010)
• An important question: how support practitioners in Elder
abuse detection process?
• Education
• Tools
• Clinical supervision
• Interprofessionnal collaboration pactice
• Etc.
Tools
• What we know:
• 15 validated screening tools (Laforest, Maurice, Beaulieu & Belzile,
2013)
• Few of these tools are actually in use
• Some ones in use are not validated or translated ones
• APS (USA): have integrated detection tools in protocols and take
as important to complete a general assessment.
Comprehensive assessment tools are they an
interesting way to detect EA?
Comprehensive assessment tools
• Characteristics:
• Global approach
• Bio-psycho-social dimensions (multidimensional)
• Collect information for planning clinical interventions
• Selected tools criteria
• Presented as comprehensive assessment tool
• Actually in use
• Large or prescriptive diffusion
• Analysed tools
• RAI
• GEVA-A
• OÉMC-bonifié (Dubuc, in cours)
Methodology
• 1- EA indicators identification
• 2- tracking in tools
• 3- comparison between 3 identified tools
1- EA indicators
• Sources:
• Cohen, et al., (2006): Expanded Indicators of Abuse Questionnaire
(E-IOA)
• Fulmer (1984): Elder abuse indicators (EAI)
• Anetzberger et al.,(2001). Screening tools and referral protocol for
Stopping Abuse Against Older Ohioans (STRP):
• 1) Actual Abuse Screening Abuse Tool
• 2) Suspected Abuse Screening Tool
• 3) Risk of Abuse Screening Tool
EA indicators
Abuse (physical mistreatment) (6 + 2)
• Unexplained injuries or unsatisfactory explanations
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for them
Injuries/internal hemorrhage
Bruises or fractures (various stages of healing)
New and old scars (on upper parts of both arms)
Burns (on not usually parts of the body)
Unusual burn or shape of burn (matching certain
objects such as cigarette or flatiron), or dipping
burns
Subjective complaint of abuse
Disclosure of episodes of physical abuse
Sexual abuse (5 + 2)
• Torn or stained underwear
• Difficulties walking or sitting (for no evident
reason)
• Sexual organs—pain/bleeding/burns
• Urinary tract infections
• Sudden changes in behavior, demeanor, or
affect.
• Subjective complaint of sexual abuse
• Disclosure of sexual abuse
Psychological abuse (13 + 2)
• Confusion (if not a symptom of cognitive
deterioration)
• Exaggerated fears
• Loss of interest in self and in social activities
• Ambivalence toward family members
• Apathy
• Extreme stress symptoms
• Being called derogatory names, treated as a
child, being frightened, humiliated, intimidated,
threatened or isolated.
• Elder states being left alone for long periods of
time or being ignored
• Sense of resignation and hopelessness with
vague references to mistreatment
• Behavior that is passive, helpless, withdrawn
• Anxious, trembling, clinging, fearful, scared of
someone/something
• Self-blame for current situation and
partner/caregiver behavior
• Elder states failure to receive companionship,
news, changes in routine, information
• Subjective complaint of psychological abuse
• Disclosure of maltreatment, shouting, cursing,
threatening, coercing
EA indicators
• Financial or material exploitation
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(6 + 2)
Sudden inability to pay bills, purchase food
or other commodities
Refusal, by the older person or a family
member, of any treatment or assistance
involving financial expense
Transfer of money, property or materials
from the older person to family members
Exaggerated interest by a family member
in the older person’s financial situation
A family member forces or persuades the
elder person to give him/her money
A family member takes charge of the older
person’s financial affairs when this is not
required or seems not to be the older
person’s wish
• Subjective complaint of financial or material
exploitation
• Disclosure of material exploitation
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Neglect (14 + 2)
Dehydration
Poor nutrition
Poor hygiene
Hypo/hyperthermia
Unsuitable clothing
Lack of teeth, spectacles, hearing aid
Sudden and unexplained decline in health
situation
Bed sores
Exaggerated/lack or unsuitable use of
medicine
Contractures, Decubiti
Diarrhea or Constipation
Urine burns
Repetitive hospital admissions due to
probable failure of health care surveillance
Depression
Subjective complaint of neglect
Disclosure of neglect
2- Tracking in tools
Question et endroit où on retrouve cette
maltraitance/négligence information dans l’OEMC bonifié
Interventions/
interprétations
Indices de
Maltraitance physique
Blessures ou
lésions :
contusions,
lacérations,
marques de
coups,
fractures,
hémorragies
internes,
cicatrices,
brulures,
Plainte
subjective
Auto-déclaration
de violence
physique
ÉTAT DE SANTÉ :
1.Histoire de santé personnelle et familiale et
diagnostics actuels :
Lésions traumatiques et certaines autres
conséquences de causes externes
Diagnostic avec facteur de risque :
Hospitalisation(s) dans la dernière année
2. SANTÉ PHYSIQUE
Histoire de chute
Fonctions sensorielles : Condition de la peau
PERCEPTION DE L’USAGER : Croyez-vous…


Blessures ou trauma
incompatibles avec les
faits rapportés
Blessure non
expliquées ou dont les
explications sont
insuffisantes ou nonconvaincantes
Toujours prendre au sérieux
la plainte subjective d’une
personne
La personne est-elle en
danger?
Si oui, appliquer les
mesures de protection.
3- Comparison
Signes cliniques de
maltraitance
OÉMC-Bonifié
Maltraitance physique
 Blessures ou
lésions :
contusions,
lacérations,
marques de coups,
fractures,
hémorragies
internes,
cicatrices,
brulures,
 Plainte subjective

 Auto-déclaration
de violence
physique

Légende :
 item précis
■ appréciation générale
RAI
GÉVA-A

■
■
■
Results (1)
• EA is not easy to objective (except physical abuse…
maybe)
• Lowest EA screened by Comprehensive assessment tools
are:
• Financial or material exploitation,
• psychological abuse
• sexual violence
• Self-neglect is a major point of interest for practitioners
but difficult to comprehend and to know what to do now.
More research are necessary in this way.
Results (2)
• GEVA-A is the less efficient for EA detection (not
conceptualized for elders and more centered on access
criteria than clinical ones)
• RAI is interesting because the integrated protocols and
guides
• OÉMC includes many items. OÉMC-bonifié will upgrade
the content and the friendly-using because electronic form
and integrated care pathways (ICPs).
Results (3)
• It’s not easy to isolate EA
• EA is related with many others geronto-geriatrics
problems
• Every author include EA assessment in a larger
assessment (ex.: Fulmer includes General, Social and
Usual Lifestyle Assessments sections in the tool)
• Stakeholders have to link and interpret information
(clinical judgement) before conclude to EA
Conclusion
What’s the best way:
• add specific detection tools?
• upgrade using tolls?
In two cases, be aware to have to much hope in the
artefact.
Clinical support doesn't limited to tool’s presence.
Clinical pathways or protocols are essentials
to support practices
to provide services with equity and efficience.
References
• Anetzberger, G. J. (2001). Elder Abuse Identification and Referral: The Importance
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of Screening Tools and Referral Protocols.Journal of Elder Abuse & Neglect 13(2),
p. 3-22.
Cohen, M., Levin, S. H., Gagin, R., & Friedman, G. (2006). Development of a
Screening Tool for Identifying Elderly People at Risk of Abuse by Their Caregivers. J
Aging Health 18(5), 660-685.
Dubuc, N., Bonin, L., Tourigny, A., Mathieu, L., Couturier, Y., Tousignant, M., Corbin,
C., Delli-Colli, N., & Raiche, M. (2013). Development of integrated care pathways:
toward a care management system to meet the needs of frail and disabled
community-dwelling older people. Int J Integr Care, (Apr–Jun), 1-13.
Fulmer, T., Street, S., et Carr, K. (1984). Abuse of the Elderly: Screening and
detection.Journal of Clinical Nursing 10(3), p. 131-140.
Fulmer, T., (s.d.). Elder Mistreatment. Training Manual and Protocol. On line.
http://hartfordign.org/uploads/File/Fulmer_EM_full.pdf
Laforest, J., Maurice, P., Beaulieu, M. & Belzile, L. (2013). Synthèse de
connaissances sur la recherche de cas de maltraitance envers des personnes
aînées par des professionnels de la santé et des services sociaux en première
ligne. Institut national de santé publique du Québec (INSPQ). Québec (Canada).
On line. http://www.inspq.qc.ca/publications/notice.asp?E=p&NumPublication=1687
Ministère de la Famille et des Aînés (2010). Plan d'action gouvernemental pour
contrer la maltraitance envers les personnes aînées 2010-2015. Québec :
Gouvernement du Québec.