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Clearinghouse on Abuse and Neglect of the Elderly (CANE)
Elder Abuse and Neglect Research Published and Entered From August 2002-June 2003
The following is a listing of the research and scholarship pieces appearing in peer-reviewed journals* from August 2002-June 2003 that were entered into the CANE database. Some articles deal directly with issues of elder abuse and neglect, and others, such as P5195-7 and P5047- 34, address issues such as ageism in the health and long-term care system that contribute to neglect and self-neglect of the elderly. Entries are categorized as either "research," "scholarship," or "research review/lit review."
*Several free-standing reports and books have also been included.
To Order Articles from the Annotated Bibliography:
The following collection of resources highlights various aspects of elder financial abuse and exploitation. Many of these publications are literally at your finger tips as they are online.* Unless otherwise indicated, reference materials may be obtained through CANE. Some resources, such as videos and manuals, are only available directly through the agencies that produce them; in such instances the contact information is provided.
The digits following the hyphen in the file numbers indicate the total number of photocopied pages. For example, if the file number is A78-11, then this article (number A78-11) is 11 pages in length. Generally, articles of interest will be forwarded to you at a cost of $.20 per page. However, it may be possible to send you single copies of a few short articles at no cost. CANE endeavors to fulfill your requests as quickly as possible, and we urge you to contact us regarding your interest in receiving any of the following. CANE may be contacted by telephone (302/831-3525), by email ([email protected]) or by mail at:
University of Delaware
Clearinghouse on Abuse and Neglect of the Elderly/CANE
Department of Consumer Studies
Alison Hall West (annex) - Rm. 211
Newark, DE 19716
To find other resources on elder abuse and neglect, visit the CANE web site at
(A note about web addresses: like the enchanted staircases at Hogwort's, web pages can mysteriously move. In the event that a web address given is no longer accurate, we recommend that you search for the title on a generic search engine, such as Google. Please contact the CANE office if you need assistance.)
Akaza, K. et al.
Elder Abuse and Neglect: Social Problems Revealed from 15 Autopsy Cases
Legal Medicine; Vol. 5 (1) p7-p14 2003
This retrospective study examined cases of individuals aged 65 and older who died and were autopsied from 1990 through 2000 in the Department of Legal Medicine at the Gifu University School of Medicine in the prefecture of Gifu, Japan. The analysis revealed that in the sample of 125 cases, 15 deaths were attributed to elder abuse and neglect. Among the 13 domestic cases classified as abuse, the perpetrator was most often the victim's son. Eight of the perpetrators were unemployed, four had a history of mental illness, and two were alcoholics. Each case is briefly described. In seven cases, criminal investigations were initiated and three perpetrators were psychiatrically hospitalized. (Elder Abuse Fatality Review, Autopsy)
Bassett, S. & Smyer, T.
Health Screening Practices in Rural Long-Term Care Facilities
Journal of Gerontological Nursing; p42-p49 April 2003
This study assessed the health screening practices in 41 long term care facilities in a rural Midwestern state. Breast self examinations, clinical breast examinations, mammography, manual prostate examinations and prostate-specific antigen testing are assessment tools specifically recommended in the American Cancer Society (ACS) screening guidelines. Although 87 per cent of the Directors of Nursing of the nursing homes participating in the research were aware of the ACS guidelines, only 23 per cent of the facilities implemented the guidelines. Less that 13 per cent had written policies for screening. Nurses are encouraged to promote health screening practices among older patients including nursing home residents.
Ho, B., Friedland, J. Rappolt, S. & Noh, S.
Caregiving for Relatives with Alzheimer's Disease: Feelings of Chinese-Canadian Women
Journal of Aging Studies; Vol. 17 (3) p301-p321 2003
Noting that both the Chinese population and the elderly segment of society in North America are growing, this article explores the impact of culture, caregiver stress and social support upon Chinese-Canadian women caring for relatives with Alzheimer's disease. Twelve women who had emigrated from China were interviewed regarding their experiences as caregivers, within the framework of the model of caregiver stress outlined by Pearlin, Mullan, Semple and Skaff. Secondary stressors, such as role strain and intra-psychic strain, were the main focus of the five open ended questions. Inductive qualitative analysis revealed multiple common themes such as filial obligation, anticipation of the role, differences between Chinese and western attitudes towards caregiving, intergenerational and other family conflicts, work role conflicts, loss of self and "role captivity." One poignant sentiment held by many of these caregivers was that their own children would be unlikely to follow in their footsteps and likewise provide care for themselves. Mediating factors that emerged included positive attitudes and formal and informal supports that were culturally congruent with their values and circumstances. Despite the belief in filial obligation, most of these caregivers intended to institutionalize the care recipient when they could no longer provide adequately for their needs. The authors postulate that the acceptance of this outcome is likely due to the perception that institutionalization is an extension of already utilized formal supports.
Keith, P. & Schafer, R.
Expected and Actual Difficulties of Volunteer Resident Advocates in an Ombudsman Program
The Journal of Applied Gerontology; Vol. 21 (4) p421-p436 December 2002
This research was designed to compare the difficulties that Ombudsman volunteers anticipated prior to beginning advocacy for long-term care residents with the actual difficulties they experienced once practicing. The study involved 778 participants who advocated for residents throughout 320 nursing homes in a Midwestern state. While 37 per cent of those surveyed anticipated "no difficulties," every participant realized some degree of difficulty in the actual role. Time constraints were the most significant problem experienced and reported by 37 per cent of the advocates. The depressing aspect of the role, anticipated as problematic by none of the participants, was experienced by 22 per cent of the volunteers. Although no participants anticipated it, communicating with the residents was experienced as problematic by 16 per cent, and 14 per cent experienced difficulty with the complaint process. One significant implication is that volunteers would benefit from knowing how much time they should expect to dedicate to this role.
Lachs, M., Williams, C., O'Brien, S. & Pillemer, K.
Adult Protective Service Use and Nursing Home Placement
The Gerontologist; Vol. 42 (6) p734-p739 2002
This article considers whether Adult Protective Service (APS) use for elder abuse and self-neglect is an independent predictor of nursing home placement after the adjustment of other predictive factors. Data was drawn from the New Haven Established Population for Epidemiologic Studies (EPESE) cohort, a community-based cohort that was established in 1982. Of the sample of 2,087 community residents, 202 had been referred to APS between 1982 and 1990, with a rate of 81.2 per cent verification of allegations. Fifty-two per cent of those mistreated and 69.2 per cent of the self-neglectors were placed in nursing homes, significantly higher rates than for those members of the cohort who had no APS contact. Although the researchers recognize that APS professionals encourage autonomy more now than in the 80's and early 90's, the results raise the possibility that nursing home placement is considered a solution for difficult abusive situations.
Litwin, H. & Zoabi, S.
Modernization and Elder Abuse in an Arab-Israeli Context
Research on Aging; Vol. 25 (3) p224-p248 May 2003
As quoted from the abstract: "The study examines two interrelated indicators of modernization - urbanization and social isolation - in relation to elder abuse among Arab-Israelis, a population in rapid transition from agrarian to urban culture. The analysis matches a sample of abused elder (N=120) with a control group from the same population (N=120). Urbanization is measured by community type and social isolation is assessed by five measures of social network. The analysis finds that Arab-Israeli elderly persons who had been abused were more socially isolated than nonabused elders. In addition, abused elders who resided in cities had lower network scores than abused elders from rural and semiurban localities. The study provides preliminary empirical backing to modernization explanations of elder abuse and neglect."
Otto, J. & Bell, J., National Association of Adult Protective Services Administrators (NAAPSA) for the National Center on Elder Abuse
Survey Report - Problems Facing State Adult Protective Services Programs and the Resources Needed To Resolve Them 2003
National Association of Adult Protective Services Administrators (NAAPSA) for the National Center on Elder Abuse
During October and November, 2001, a telephone survey of Adult Protective Services administrators was conducted to assess the most significant problems encountered in attempting to provide APS services. The second purpose of the NAAPSA survey was to generate recommendations for policy development to address these shortcomings. Forty-two states participated. Fifty-seven percent of the respondents identified insufficient funding as the primary obstacle and 43 percent identified inadequate staffing. Lack of emergency placement was sited by 24 per cent. In all, 12 problem areas were identified. Among the resources necessary to address the deficits include increased federal funding, improvements of training and the use of best practice models, and a national public awareness campaign. (Note: This report can be accessed online at http://www.elderabusecenter.org/pdf/publication/NAAPSA7.pdf)
Peake, M. et al.
Ageism in the Management of Lung Cancer
Age and Ageing; Vol. 32 p171-p177 2003**
In this study, data was gathered concerning the diagnosis and treatment of 1,652 lung cancer patients in the U.K. between 1997-1998. The results indicate that there are age-related differences regarding the management and survival of non-small cell lung cancer (NSCLC) patients. Although age alone does not appear a significant prognostic factor in NCSLC, and elderly patients response rates to chemotherapy are comparable to younger patients, older patients appear under treated. This research suggests that ageism in treatment may account for higher mortality rates of NSCLC in the U.K. as compared to the U.S. and most of Europe. (Health care)
Rantz, M. et al.
International Field Test Results of the Observable Indicators of Nursing Home Care Quality Instrument
International Nursing Review; Vol. 49 p234-p242 2002
This article reports upon the international field testing of the Observable Indicators of Nursing Home Care Quality instrument, which was developed by researchers at University of Missouri-Columbia. The instrument was used to assess quality of care in 12 nursing homes in Reykjavik, Iceland, in a 14 unit veterans home in Ontario, Canada, and in 20 nursing facilities in Missouri. The tool was designed as a half an hour walk-through assessment and focused on care basics, communication, environment, family involvement, staff and the concept of home. Content validity was high in testing for all three countries; test-retest reliability was high in Missouri and Iceland. The Canadian study was meant to detect differences in quality of care between units of the same facility, and the test-retest reliability was not sufficient enough to recommend the instrument be used in this capacity. The authors encourage practicing nurses to use the tool to assess current institutional quality of care and to develop improvement plans guided by the results.
Richardson, B., Kitchen, G. & Livingston, G.
Developing the KAMA Instrument (Knowledge and Management of Abuse)
Age and Ageing; Vol. 32 (3), p286-p291, May 2003
This article discusses the development and testing of the vignette-based Knowledge and Management of Abuse (KAMA) instrument to assess the applied and practical knowledge of staff regarding abusive and potentially abusive situations involving older inpatients. Seventy-nine staff members working for a local trust in the U.K. participated in this study by completing two versions of the tool. Results indicate that both versions are valid tools that can identify gaps in knowledge among this group of professionals so that effective training and education initiatives may be developed. A copy of each version of the KAMA is included in the appendices.
Rogan, F. & Wyllie, A.
Engaging Undergraduate Nursing Students in the Care of Elderly Residents in Australian Nursing Homes
Nurse Education in Practice; Vol. 3 (2) p95-p103 2003
This paper explores the response to an education program designed to foster enhanced attitudes towards caring for the aged. The program, implemented at the University of Technology in Sydney, Australia, combined ongoing clinical experiences with classroom education. For six weeks, student nurses spent one day a week at the same nursing home caring for the same resident. Following the six weeks, the student continued with a four day training at the same institution. Following the training, 112 students completed a survey regarding their experiences and 18 of these respondents participated in focus groups. Results indicate that students developed a person-centered approach towards the elderly through continuity of care. Thirty-seven per cent of the 112 reported being highly interested in working with the elderly, 23.3 per cent were moderately interested, 33 per cent had low interest, 1.7 per cent had no interest and one student had less interest following this course. Authors recommend that this approach be further developed as a means to combat ageism among students and thus address a potential crisis in the health care system as the population continues to age.
Effectiveness of Prehospital Trauma Triage Guidelines for the Identification of Major Trauma in Elderly Motor Vehicle Crash Victims
Journal of Emergency Nursing; Vol. 29 (2) p109-p115 April 2003
Motor vehicle accidents (MVA) are the most common cause of trauma in older persons prior to age 75. However, studies have indicated that older MVA victims are the most undertriaged group when being assessed for transfer either to a trauma center or a non-trauma hospital. This retrospective study examined the outcome of over 2000 MVA victims (New Jersey) who died subsequent to discharge from the hospital. Those patients 65 and older were compared to patients 25 through 64 years of age. Undertriage was 8 per cent for young and middle-aged men, 12 per cent for young and middle-aged women, 15 per cent for older women and 18 per cent for older men. The researchers indicate that age should be a factor considered during prehospital triage. (Health care)
Schofield, M. & Mishra, G.
Validity of Self-Report Screening Scales for Elder Abuse: Women's Health Australia Study
The Gerontologist; Vol. 43 (1) p110-p120 2003
This article reports on a study of the reliability and validity of the Vulnerability to Abuse Screening Scale (VASS). The factors of vulnerability, dependence, dejection and coercion are examined in this 12-item self-report. The baseline survey was completed in 1996 with follow-up in 1999. While determining the predictive validity of the VASS would require further research, the findings indicate that the tool demonstrates construct validity. A review of existing elder abuse screening tools is included.
Shugarman, L., Fries, B., Wolf, R. & Morris, J.
Identifying Older People at Risk of Abuse During Routine Screening Practices
Journal of the American Geriatrics Society (JAGS); Vol. 51 p24-p31 2003
This study explored the links between various characteristics of older, community-dwelling individuals and the potential for elder abuse. Research was based upon data from 701 application interviews from the Michigan Home and Community Based Services (HCBS) waiver program and the Care Management program (November 1996 - October 1997). Five measures of elder abuse and neglect were used to identify those potentially victimized, and characteristics were analyzed to determine if an association was suggested. Thirty-three of the 701 demonstrated at least one of the signs of potential abuse. Short-term memory, psychiatric illness, alcohol abuse, and four measures of poor social functioning and impaired support were associated with the potential for mistreatment. While this index had a high degree of sensitivity for identifying potential abuse, it did not appear to have a high degree of specificity. The researchers suggest health care professionals combine these indicators with key questions from the Minimum Data Set for Home Care (MDS-HC) for screening and care planning.
Bergeron, L.R. & Gray, B.
Ethical Dilemmas of Reporting Suspected Elder Abuse
Social Work; Vol. 48 (1) p96-p105 2003
In this article, the role of caregiver support group facilitator is considered in light of the need to report suspected elder abuse or neglect. Case studies are used to illustrate various ethical dilemmas that may arise as social workers and counselors facilitate group sessions. Balancing the right to confidentiality with the benefit of the care recipient as well as that of the group is discussed. Questions raised regarding caregiver abuse by the care recipient add to the complexity. The authors advise the facilitators to become familiar with both the reporting laws for the area and the elder abuse literature. In addition, participants should be made aware, in advance, of exceptions to confidentiality. Samples of confidentiality statements are provided.
Breaux, J. & Hatch, O.
Confronting Elder Abuse, Neglect, and Exploitation: The Need for Elder Justice Legislation
The Elder Law Journal; Vol. 11 p207 2003
In this overview, Senators Breaux (ranking member of the U.S. Senate Special Committee on Aging) and Senator Orrin Hatch present a history of congressional efforts to promote the awareness of elder abuse and neglect. They summarize the purpose of the recently introduced federal legislation, the Elder Justice Proposal, and present it in its entirety. The establishment of the Department of Elder Justice, which will be housed in both the Department of Health and Human Services and the Department of Justice, contains provisions for a National Elder Justice Library, five Centers of Excellence for the development of promising practices, the development of forensic capacity, victim advocacy and the establishment of safe havens, along with provisions for leadership, training and education.
Carney, M., Kahan, F. & Paris, B.
Elder Abuse: Is Every Bruise a Sign of Abuse?
Mount Sinai Journal of Medicine; Vol. 70 (2) p69-p74 March 2003
This article presents a case study that illuminates the roles that physicians and other health care professionals can play in the prevention, detection and management of elder abuse and neglect. The author presents a summary of the patient's history over a two-year period. The medical team suspects that the 84 year old woman is being neglected and physically abused by her adult son, who is disabled, unemployed and financially dependent upon his mother. Following a home visit by the social worker, Adult Protective Services are notified. Office, family, and home visits, multidisciplinary assessments and referral for supportive services are among the interventions documented and discussed as part of the treatment plan for this complex case.
Chaffin, J. & Richter, P.
Making Prevention of Abuse and Neglect through Dental Awareness Green
Military Medicine; Vol. 167 (11) p920-p922 November 2002
Noting that the military community prevalence rates of family violence are commensurate with those of the civilian community, and that reports indicate that up to 94 per cent of family violence injuries effect the head and neck, the U.S. Army Dental Command developed a program to increase awareness of this societal problem. The Prevent Abuse and Neglect through Dental Awareness (P.A.N.D.A.), initially developed by Delta Dental of Missouri, was adapted by the military to promote awareness of family violence and to enhance the dental professional's ability to identify symptoms of abuse and neglect. The six components of the protocol are outlined: assessment of the patients' physical appearance, behavioral assessment, a thorough patient history, (including separate histories of sponsor and patient in the event of trauma), an oral examination, documentation (including photographs, if indicated) and consultation and reporting of any suspected abuse to the designated personnel.
Crosby, E. & Nathan, R.
Adult Guardianship in Georgia: Are the Rights of Proposed Wards Being Protected? Can We Tell?
The Quinnipiac Probate Law Journal; Vol. 16 p249 2003
After providing a broad background regarding the nature of guardianship in the U.S> and the problems that were found in virtually ever state system, this article focuses on Georgia's system and efforts to achieve reform. Forums throughout the early and mid-90's generated the following recommendations: 1) the development of a functional definition of capacity; and 2) advocacy to ensure that wards retained "rights to the greatest extent possible." A recent guardianship survey was conducted between 2001-2002, utilizing records from 2000. The findings of the survey are discussed, including the criticism that in Georgia, capacity remained defined by diagnosis, not functional ability. Other recommendations are presented. (Legislation)
Dixon, C. & Richard, M.
Contemporary Issues Facing Aging Americans: Implications for Rehabilitation and Mental Health Counseling
Journal of Rehabilitation; Vol. 69 (2) p5-p12 April-June 2003
In this article, intended for rehabilitation and mental health counselors, an overview of some of the most significant issues to impact the aging population are discussed. Financial concerns related to employment, retirement and long-term care, grandparenting, victimization and abuse, and mental illnesses are among those topics discussed. Program development is in the areas of advocacy, guardianship, case management, benefits planning, gerontology counseling, employment and training, and multicultural competencies.
Dyer, C. & Fisher, J.
The Hidden Health Menace of Elder Abuse. Physicians Can Help Patients Surmount Intimate Partner Violence.
Postgraduate Medicine; Vol. 113 (4) p21-p24, p30 April 2003
National estimates suggest that up to one half of all elder abuse cases involve domestic violence. This overview focuses on the role that physicians can play in the detection of intimate partner violence amongst elderly patients. Shame, fear, economic vulnerability, cultural differences, and an underestimation of the problem on the part of health care professionals contribute to the invisibility of the problem. Identifying the nature of the abuse (caregiver stress versus a power and control issue) is a vital step that influences clinical direction. Assessment of competency and dangerousness, along with safety planning, should be continuously addressed in the management plan. Documentation and reporting are also discussed. A practical guideline for screening and intervention and a comparison of appropriate intervention/documentation and incomplete intervention/documentation is included.
Symposia: Lashed to the Mast and Crying for Help: How Self-Limitation of Autonomy Can Protect Elders From Predatory Lending
Loyola of Los Angeles Law Review; Vol. 36 p693 Winter 2003
The purpose of this article is to address the dilemma of preserving the autonomy of elders while protecting them from financial abuse and fraud, including predatory lending practices. The author proposes that seniors record an instrument called the Elder Home Equity Loan Instrument (or the Elder HELP Instrument) which would allow homeowners to have loans reformed that have excessive fees or interest rates. Other models of self-limitation are also discussed. (Lawyers, Protecting assets)
Financial Abuse of the Elderly in California
Loyola of Los Angeles Law Review; Vol. 36 p667 Winter 2003
This article provides an overview of the most common types of elder financial abuse perpetrated in California. It also describes the state legislation that addresses such abuses. Annuity scams, living trust scams, sweepstakes and volume sale scams (such as the Canadian Lottery and Nigerian Money Scams) identity theft, unfair and misleading funeral and burial practices, and predatory lending are among the topics highlighted.
Try This: Best Practices in Nursing Care to Older Adults - Elder Abuse and Neglect Assessment
Journal of Gerontological Nursing; Vol. 29 (1) p8-p9 January 2003
Reprinted with permission from Try This: Best Practices in Nursing Care to Older Adults - Elder Abuse and Neglect Assessment; Issue No. 15, May 2002, John Hartford Foundation Institute for Geriatric Nursing
This brief article presents pertinent information on the Elder Assessment Instrument (EAI), which has been used since the 1980's to identify potential elder abuse and neglect. A copy of the EAI, a screening tool containing 44 Liker-scale items, is included. The tool takes approximately 15 minutes to administer, and is recommended for use in clinical settings.
HIV and AIDS in People Older Than 50 A Continuing Concern
Journal of Gerontological Nursing; Vol. 29 (4) p18-p24 2003
According to the Centers for Disease Control (CDC), there are over 75,000 Americans aged 50 and over who have been diagnosed with AIDS, representing approximately 11 per cent of those in the U.S. diagnosed. While AIDS cases are decreasing nationally, the rate in this segment of the population remains stable, with unprotected heterosexual contact representing the highest risk group. Women and minorities are at increasing risk. Ageist myths regarding older people as non-sexual, non-injection-drug using contribute to the invisibility of the problem, as even health care professionals are less likely to suspect a diagnosis of AIDS or HIV. One recommendation for gerontological nurses is the need for comprehensive screening of all patients that includes a thorough sexual and substance abuse history.
Kahan, F. & Paris, B.
Why Elder Abuse Continues to Elude the Health Care System
Mount Sinai Journal of Medicine; Vol. 70 (1) p62-p68 2003
The Mount Sinai Hospital Elder Abuse Program was created in 1998. The purpose was to identify elderly patients in the hospital who had experienced elder abuse or neglect, to assist them in attaining compensation, and to provide counseling, support, advocacy and referral. A case study is presented to illustrate the difficulties in providing services. Over a two-year period, 182 cases were identified and assessed, with approximately half of those referred patients having a diagnosis of memory impairment. This article presents information regarding the population served through this model program, and addresses the obstacles found in the health care setting. Interdisciplinary/multidisciplinary team work is pivotal, along with the continued education of health care professionals regarding the symptoms of elder mistreatment.
Resident Safety and Medical Errors in Nursing Homes - Reporting and Disclosure in a Culture of Mutual Distrust
Journal of Legal Medicine; Vol. 24 p51-p76 March 2003
This article explores the nature of medical errors in nursing homes and the legal and regulatory trends that act as significant barriers to reporting and redressing such errors. Research indicates that almost half of the U.S. nursing home population is over 85 and that dementia is the most common condition among residents. Therefore, the resident population presents significant challenges for all levels of care providers, from medical directors through nurses' aides. Medication errors, pressure ulcers, resident falls, and feeding tubes are the most likely sources for medical errors. Systemic failures such as poor inter- and intra-facility communication, high staff turnover and limited physician oversight, typically underlie the specific incident. A lack of coordination between inspection/licensing agencies and other regulatory and accrediting bodies, coupled with an increasing tendency towards civil suits and other legal and financial consequences, limits the likelihood of reporting. The author recommends "...the initiation of a nonadversarial and nonthreatening dialogue among recognized learders of the nursing home industry, resident advocacy groups, regulatory agencies, the liability insurance industry, and pertinent representatives of the plaintiff and defense bar. These talks must be aimed at agreeing on ways to honestly assure nursing home personnel that they and their facilities will not be penalized legally, financially, or professionally for reporting and disclosing medical errors as part of an educational and/or remedial process..." (Note: This article is available electronically through Lexis-Nexis subscription services.)
Second Childhood: What Child Protection Systems Can Teach Elder Protection Systems
Stanford Law & Policy Review; Vol. 14 p175 2003
In this article, the author describes ways in which the adult protection system could benefit from lessons learned through the child protection system. After providing an overview of elder abuse and neglect, it describes the historical development of both of these movements in the U.S. A campaign to change ageist beliefs and advocate for the rights of elders is necessary, along with greater involvement of the medical community. Differences between mandatory reporting of child maltreatment and elder maltreatment are discussed. Active training of health care professionals and enforcement of mandatory reporting laws are presented as means to improve identification. An in-depth discussion as to how to provide appropriate civil and criminal penalties for perpetrators is presented. Like child abuse, elder abuse should be seen as a community-wide problem, and the strengthening of the community and family will be necessary to address the problem. (Lawyers, Prosecution)
Mahler's Developmental Theory - Training the Nurse to Treat Older Adults with Borderline Personality Disorder
Journal of Gerontological Nursing; p22-p28 February 2003
According to researchers, adults with Borderline Personality Disorder (BPD) are at greater risk of morbidity and mortality secondary to neglect, increased risk of self-destructive behavior including drug abuse, and premature institutionalization. After presenting an overview of Mahler's developmental theory of BPD, the authors present a case study of an older nursing home resident who exhibits the characteristics of the disorder including interpersonal conflicts with staff and other residents that arise from demanding, abusive and splitting behaviors. The need for nurses, CNAs, physicians and other health care professionals to be aware of the dynamics of this mental health issue and to provide a unified and consistent care plan is essential for the resident's benefit and to diminish caregiver stress.
Bergman v. Chin: Why an Elder Abuse Case is a Stride in the Direction of Civil Culpability for Physicians Who Undertreat Patients Suffering from Terminal Pain
New England Law Review; Vol. 37 p313 Winter 2003
Research continues to indicate that the undertreatment of pain is a major concern throughout most medical specialties. This article considers why pain and suffering is not a legitimate medical malpractice complaint. As physicians typically do not adequately manage pain, undertreatment of pain does not deviate from the standard of care, which is often the basis for malpractice suits. The literature reviewed on assessing pain management reveals discrepancies for patients along the characteristics of age, race and gender. The author examines the legal arguments of the landmark case, Bergman v. Chin, which was filed under the Elder Abuse Act in California, and goes on to describe the impact of this decision upon the standard of care in California. (Lawyer, Case law, Law suit)
Symposia: Golden Age in the Golden State: Contemporary Legal Developments in Elder Abuse and Neglect
Loyola of Los Angeles Law Review; Vol. 36 p589 Winter 2003
This article provides an in-depth legal discussion of current mechanisms in place in California to address elder abuse and neglect. Mandatory reporting laws, common law negligence liability, negligence per se, nursing home oversight, civil remedies, and criminal laws are discussed. Current legal issues that are highlighted include criminal background checks in nursing homes, "granny cams," expedited legal process, family violence in later life, retaliatory discharges, behavior-based inheritance (which would treat children who abused or neglected their parents as unworthy heirs), hearsay exceptions for elder abuse, and minimum nurse staffing ratios in long-term care facilities. (Legislation, Lawyers)
Simon, S. & Gurwitz, J.
Drug Therapy in the Elderly: Improving Quality and Access
Clinical Pharmacology & Therapeutics
Vol. 73 (5) p387-p393 May 2003
This article addresses the use of inappropriate drugs, the inappropriate use of drugs, and the underutilization of potentially beneficial medications in the elderly. While there has been a decline in the use of inappropriate medications, there are approximately 1,900,000 adverse drug events among Medicare enrollees annually, 180,000 of which are life-threatening or fatal. These events, many preventable, typically occur as a result of how the drug is administered (drug interactions, inaccurate dosage, etc.) Underutilization of medication in the following conditions have been observed in treatment of the elderly: asthma, cardiovascular disease, hypertension, dyslipidemia, stroke prevention, osteoporosis prevention, pain management and depression. The exclusion of older patients in clinical trials regarding medication forces physicians either to under-prescribe certain medications, or to prescribe without adequate evidence of efficacy and safety. One significant factor in the underutilization of appropriate medications is the lack of prescription coverage for many seniors. Computerized Physician Order Entry (CPOE) systems are described as one possible means of enhancing coordination of prescription management throughout various aspects of health care that would improve the quality of pharmaceutical use. (Pharmacology)
Thunder, J. (Scholarship)
Quiet Killings in Medical Facilities: Detection & Prevention
Issues in Law & Medicine; Vol.18 p211 Spring 2003
This article is intended to prompt a discussion of the phenomenon of "quiet killings," those deaths occurring in hospitals, nursing homes and other health care settings, that are categorized as either due to negligence or medical error rather than intentional acts, and therefore are not viewed as criminal in nature. The author presents numerous cases where patients and residents were intentionally murdered, many with lethal injections, that were investigated and prosecuted, but he also describes examples that imply these acts may go undetected more often than the public realizes. Motivations for such killings appear quite varied, ranging from sexual gratification to overcoming issues of inadequacies. The victims are often too impaired to communicate. Defenses that are commonly used are examined and include mercy killing, patient's consent, medical error, administration of pain medication. Prosecution may become even more complicated when ageist beliefs enter into the equation, such as the notion that older people will die soon, anyway. Ten suggestions are outlined to enhance prevention and detection of quiet killings, and include improved background checks, surveillance cameras, the establishment of Elder Death Review Teams (fatality review teams) and an increase in forensic autopsies.
The Aging of the AIDS Epidemic: Emerging Legal and Public Health Issues for Elderly Persons Living with HIV/AIDS
The Elder Law Journal; Vol. 10 p47 2002
This comprehensive article explores a variety of legal implications regarding the "graying AIDS epidemic." The author indicates that ageism is a factor in the frequent misdiagnosis or late diagnosis of AIDS in older patients, since they are rarely tested for AIDS. As a result, little research is available and treatment is less effective in ameliorating the effects of this increasingly chronic, rather than terminal, disease. The research that is available demonstrates that women, particularly minority women, are the fastest growing segment of AIDS patients over age 50. It also indicates that older individuals experience significant clinical differences from younger patients. Poverty of the elderly impacts prevention and treatment, while AIDS discrimination has been responsible for barring admission to nursing homes for some patients. The (at the time proposed) Medicare Chronic Care Improvement Act of 2001 and The Medicare Wellness Act of 2001 are also discussed. (Note: This article is available electronically through Lexis-Nexis subscription services.)
Preventing Risk in Long-Term Care: Lessons Learned
Journal of AHIMA; p65-p66 January 2003
This brief article presents a thumbnail sketch of measures that managers of long-term care facilities can employ in order to reduce the risk of abuse and neglect of residents, and in addition reduce the prevalence of lawsuits. The author emphasizes the need for openness when addressing concerned family members regarding a resident's care and treatment. The necessity of appropriately maintained medical records is highlighted.
Books and Reports:
Bonnie, R. & Wallace, R., editors
Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America
National Academy Press, Washington, D.C. 2003 http://books.nap.edu/books/0309084342/html/index.html
As a result of the lack of systematic, empirical, peer-reviewed research on elder abuse, the National Institute on Aging commissioned the National Research Council to produce this study and to develop a research agenda on related issues. Part I addresses deficiencies of existing research (in particular, a lack of population based data, prospective studies, control group studies, and systematic evaluations of interventions) and recommendations for future studies based on the LEAD standard (longitudinal, expert, all data). Included are tables on the strengths and weaknesses of existing elder mistreatment identification strategies, summaries and citations of major studies, and a state by state discussion of legal definitions of elder abuse and neglect. The panel emphasizes that operationalized terms and validated, standardized measurement tools are elemental to producing research that can be effective in addressing elder abuse. A discussion regarding the distinction between cognitive impairment and decisional incapacity is included, along with other ethical considerations. An overview of this topic by the late Rosalie Wolf is included among the appendices. Part II includes background papers on epidemiological assessment methodology, clinical and medical forensics issues, domestic financial abuse, elder mistreatment in residential care settings, and interventions. (This publication is currently accessible online at the National Academy Press site http://books.nap.edu/books/0309084342/html/index.html and may also be ordered in hardback by contacting 1 800-624-6242. Price: $57.95)
Bureau of Justice Statistics, U.S. Department of Justice
Sourcebook of Criminal Justice Statistics 2001 Online
Bureau of Justice Statistics, U.S. Department of Justice
This is an online version of the Sourcebook, which is continually updated to reflect statistical information regarding multiple aspects of criminal justice in the U.S. in 2001. Six sections focus on characteristics of the criminal justice system, public attitudes regarding crime, nature and distribution of known offenses, characteristics and distribution of persons arrested, judicial processing of defendants, and persons under correctional supervision. Information on various age cohorts can be found in tables describing characteristics of victimization. (Note: This publication is available online at http://www.albany.edu/sourcebook/ Print and CD-ROM versions of the Sourcebook may be ordered for $9.00 for U.S. buyers, $39.00 buyers from Canada and other countries, by contacting the BJS Clearinghouse at 1 800 732-3277.)
Department of Health and Human Services, Office of Inspector General (Janet Rehnquist Inspector General)
Nursing home Deficiency Trends and Survey and Certification Process Consistency
Office of Inspector General, Office of Evaluation and Inspections, OEI-02-01-00600
The goal of this report is to study trends in nursing home deficiencies since 1998. Data was gathered from multiple sources: the Online Survey and Certification Reporting (OSCAR) system; responses to a mailed questionnaire; telephone interviews with 10 regional Centers for Medicare and Medicaid Services (CMS) representatives; observations and reviews of surveys from 6 sample states; and telephone interviews with 32 surveyors and 32 nursing home administrators from 8 states. Significant findings indicate that 89 per cent of nursing facilities in 2001 had at least one deficiency, up from 81 per cent in 1998. The total number of deficiencies and average number also increased. In addition, there were wide variations among the states in the number of deficiencies, and also in how specification citations were determined. Factors contributing to such variations are identified and discussed. Recommendations are made that include further clarification of the guidelines for citing deficiencies. (Note: This report may be accessed online at http://oig.hhs.gov/oei/reports/oei-02-01-00600.pdf)
Guardianship Monitoring Committee
Guardianship Monitoring in Florida: Fulfilling the Courts Duty to Protect Wards
Office of the State Courts Administrator; Tallahassee, Florida, March 2003
In 1999, the Guardianship Monitoring Committee was established for the state of Florida and included judges, court staff, officials from public guardian associations, social workers and academics. This report presents the findings of the Committee's review of the state's current guardianship system. As quoted in the report introduction, "The mission of guardianship monitoring is to collect, provide and evaluate information about the well-being and property of all persons adjudicated of having a legal incapacity so that the court can fulfill its legal obligation to protect and preserve the interests of the ward, and thereby promote confidence in the judicial process." Input regarding existing monitoring efforts and programs are described, and the four major components of an effective model are described. They include the need for initial and ongoing screening of guardians, a reporting of the well-being of the ward, a reporting of the protection of the ward's asset, and case administration as part of court oversight. (Note: This report is available online at http://www.flcourts.org/gen_public/pubs/bin/guardianshipmonitoring.pdf)
National Center for Victims of Crime (NCVC)
Elder Victimization Statistics
Washington, D.C. 2003
This brief fact sheet (including 5 pages of references) highlights details of criminal victimization of elders in America from 2001 and 2002. Among the findings, 25 per cent of victims reporting telemarketing fraud were age 60 and over. (Note: This report is available online at http://www.ncvc.org/resources/statistics/)
United States General Accounting Office (GAO)
Nursing Homes Public Reporting of Quality Indicators Has Merit, but National Implementation is Premature
United States General Accounting Office (GAO); October 2002
The U.S. General Accounting Office was asked to evaluate the new Centers for Medicaid and Medicare Services (CMS) quality indicators of nursing home care, along with the data used to calculate them. Although the publication of these indicators and ratings based upon them was to be implemented in November, 2002, the GAO report recommends that the publication be delayed in light of perceived problems with data collection and analysis. Six states participated in the pilot project: Colorado, Florida, Maryland, Ohio, Rhode Island and Washington. Concerns arose over the appropriateness of certain quality indicators, risk adjustment of indicators, the consistency of evaluation, and the lack of clarity for public interpretation. (Note: This report, including comments on the draft by the CMS, can be accessed online at http://www.gao.gov/new.items/d03187.pdf)
Articles on topics that are indirectly related to elder abuse/neglect, self-neglect, etc.
Neither Hearth Nor Home: The (Un)making of Elder Care Responsibility
Journal of Aging Studies; Vol. 17 (1) p17-29 2003
Drawing upon a decade of news coverage from the Washington Post and the New York Times (1987-1997), this article examines the media's perception and presentation of the illusive concept of elder care. The evolution of the Family Medical Leave Act is traced as it emerged in response to child care issues and later addressed the needs of employees providing elder care. Among other concerns, the author indicates that the voice of the elderly is unheard as older individuals are portrayed as burdensome to the family and the economy. Issues of gender and race are also discussed.
P5173-5 (Research review/lit review)
Patterns of ED Use and Perceptions of the Elderly Regarding Their Emergency Care: A Synthesis of Recent Research
Journal of Emergency Nursing; Vol. 29 (2) p122-p126 April 2003
This article provides a literature review of research on elderly patients' perception of emergency treatment. Ten studies (1986-1999) were identified and systematically evaluated using the Nursing Practice Research Analysis Tool. Overall, the elderly experienced increased length of stays, more diagnostic tests, higher rates of recidivism and less satisfaction. It is unclear if the lower rates of satisfaction (resolution of presenting problem) are related to ageism on the part of emergency health care professionals, or due to health and social complications related to the aging process. Geriatric education for emergency room (ER) professionals and studies focusing on interactions between elderly patients and ER staff is recommended.
P5144-11 (Research review/lit review)
Hsieh, H. & Wang, J.
Effect of Reminiscence Therapy on Depression in Older Adults: A Systematic Review
International Journal of Nursing Studies; Vol. 40 (4) p335-p345 2003
In order to evaluate the effectiveness of reminiscence therapy for depressed older adults, the authors conducted a meta-analysis of nine randomized control trial studies. Three comparisons were conducted: treatment group versus treatment group; treatment group versus placebo control group; and treatment group vs. standard care control group. Results varied from study to study which indicated that reminiscence therapy did not consistently significantly decrease depression when compared to the control group. However, as some participants experienced significantly less depression, the authors indicate that further research is warranted, and suggest analysis of the interaction of personal characteristics and reminiscence therapy and the impact of this intervention upon self-esteem, life satisfaction, and other areas.
Manthorpe, J. & Watson, R.
Poorly Served? Eating and Dementia
Journal of Advanced Nursing; Vol. 41 (2) p169-p169 2003
This article presents a broad discussion of the issues surrounding the eating habits of individuals with dementia. The literature review reveals very little information about dementia patients living in the community, and the ambiguity of terms while assessing feeding and eating difficulties among nursing home residents adds to the complexity of the problem. Interventions to consider include the enhancement of choice and the dining atmosphere, the use of finger foods, the involvement of the patient in food preparation, and maximizing opportunities by feeding individuals when they are most alert and cooperative. (Nurse, Neglect)
P5187-2 (Research summary)
Does Good Quality Care in Nursing Homes Cost More or Less than Poor Quality Care?
Nursing Outlook; Vol. 51 (2) p93-p94 March/April 2003
This brief research review presents the findings of a statewide cost comparison between nursing homes in Mississippi. Medicaid cost reports for the year 2000 were analyzed and the cost of care in 21 facilities with consistently good resident outcomes of care, as measured by the Minimum Data Sets (MDS) were compared to 93 facilities with consistently poor resident outcomes. The total median cost per resident per day (ppd) for the facilities with high quality ratings was $85.35, and the median for facilities with poor quality ratings was $92.31 ppd. Direct care service costs were also lower for the higher rated facilities.
Watson, R. & Manthorpe, J.
Learning From Carers' Experiences: Helping Older People with Dementia to Eat and Drink
Nursing Older People; Vol. 14 (10) p23-p27 February 2003
This continuing education article (CEP, U.K./England) is intended to allow nurses some insight into the difficulties that caregivers experience while helping relatives with dementia to eat and drink, and to assist them in overcoming these problems. The focus is mainly on individuals residing in the community; however, a case study of a hospital patient is also presented. Content analysis of 2000 questionnaires (research sponsored by the Alzheimer's Society) forms the basis of input regarding carers' experiences. Topics covered include changes in food preferences, rejection of food, maintaining ordinary life (including dining out or with other friends and family), maintaining a safe environment and maintaining oral hygiene. (Note: The article includes directions for obtaining 10 CEP in the U.K.)
**Note: Some reference materials obtained through electronic resources do not include beginning and ending pages or issue number. However, the volume and/or publication dates are included and should provide enough information to locate the reference.
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