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Elder Abuse and Neglect Articles and Publications
July 2003 - June 2004


The following publications do not rely upon a scientific method to obtain results. However, they do present new ideas or information that contributes to our overall knowledge in the field of elder abuse and neglect.

82. P5490-5
Abramson, B.
Ethical Considerations in Potential Elder Abuse Cases
NAELA Quarterly - The Journal of the National Academy of Elder Law Attorneys; Vol. 16 (4), 15-19; Fall 2003.
(Note: This is an adaptation of a previously published article, available online at http://www.wisbar.org/wislawmag/2000/09/abram.html . See CANE file number L4498-10)
In this article, the "4 Cs" of ethical considerations are reviewed and illustrated: client identification, conflicts of interest, communication, and competency. Highlighting these issues are scenarios of possible violation of fiduciary duty by an agent, perceived abuse between spouses, physical abuse by an adult child, second marriage financial abuse and threatened criminal activity.

83. P5582-25
American Psychological Association (APA)
Guidelines for Psychological Practice with Older Adults
American Psychologist; Vol. 59 (4), 236-260; May-June 2004.
Due to shifting demographics, the need for psychological services for older Americans has increased significantly. A recent survey of psychologists throughout the country indicates that while 69 percent of participants provide therapy for older clients, only 30 percent had any graduate coursework in gerontological issues, and less than 20 percent had any supervised internship in this area. Seventy percent of the respondents indicated that they wanted training in geropsychology. This paper publishes the guidelines developed by the American Psychological Association (APA) for clinicians treating older adults. It is designed to allow practitioners to evaluate their qualifications to assist senior clients, and to assist clinicians in obtaining needed training. The 20 guidelines are categorized by these topics: attitudes; general knowledge about adult development, aging and older adults; clinical issues; assessment; intervention, consultation, and other provisions; and education. Ageist stereotypes and counter transference that interfere with clinical objectivity are addressed, along with the need to understand the impact of collective social and psychological influences present during the client's lifetime. Equally important is the need for clinicians to stay informed about health-related aspects of aging, including physical, psychological, cognitive and behavioral changes that may typically accompany the aging process versus those that are indicators of illness. Pharmacological issues area also described. A great deal of attention is given to the special ethical and legal issues that often accompany the treatment of older clients, such as autonomy, competency, and confidentiality.

84. P5551-23
Teaster, P. & Anetzberger, G., eds.; Fuller, L., Scannlain, K. & Connolly, M., contributors.
Protecting Older Americans: A History of Federal Action on Elder Abuse, Neglect, and Exploitation
Journal of Elder Abuse & Neglect; Vol. 14 (2/3), 9-31; 2002.*
This article describes the history of federal activity addressing elder abuse and neglect in the U.S., beginning with the 1981 report from the House Select Committee on Aging report entitled "Elder Abuse: An Examination of a Hidden Problem" and the subsequent introduction of the Prevention, Identification, and Treatment of Elder Abuse Act of 1981. It also includes a brief synopsis of the National Elder Abuse Incidence Study (NEAIS) and a review of Long Term Care Ombudsman Program reports concerning abuse, gross neglect and exploitation in 2000. Inadequate efforts to address elder abuse are compared to the relatively successful federal action taken to address child abuse and violence against women. The article contains a broad discussion of funding for elder abuse programs through the Department of Health and Human Services (including the adult protective services programs which are funded by Social Services Block Grants or SSBG, administered through individual states), and the Department of Justice (including the Violence Against Women Office and the Office of Victims of Crime, and the National Institute of Justice). Although the federal government spends $153.3 million on programs addressing elder abuse (2003), this appears inequitable to the funds allocated for victims' services for abused women ($520 million) and children ($6.7 billion). The overview concludes with a discussion regarding the barriers to delivery of services (most notably a lack of public awareness and reporting) and a highlighting of promising practices. (This article is part of a special issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)

85. P5559-49
Teaster, P. & Anetzberger, G., eds.; Fuller, L., Scannlain, K. & Connolly, M., contributors.
Senator John Breaux: The Elder Justice Proposal of 2002
Journal of Elder Abuse & Neglect; Vol. 14 (2/3), 37-85; 2002.*
This article presents a detailed overview of this bill introduced to the U.S. Senate by Senator John Breaux (initially in 2002 and reintroduced in February 2003). The proposal calls for the development of federal leadership and resources to assist in combating elder mistreatment on a family, community and state level. The article discusses the roles that specific offices from the Department of Health Human Services (HSS) and the Department of Justice (DOJ) will play in the implementation of the bill's provisions. (Note: This article is part of a special issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)

86. P5626-15
Aravanis, S.
A Profile of the National Policy Summit on Elder Abuse: Perspective and Advice on Replication
Journal of Elder Abuse & Neglect; Vol. 14 (4), 55-69; 2002.*
With assistance from the Administration on Aging and the U.S. Department of Justice, Office for Victims of Crime, the National Center on Elder Abuse (NCEA) convened the National Policy Summit on Elder Abuse (December, 2001, Washington, D.C.) in order to develop the national elder abuse action agenda. This article summarizes the planning and execution of the summit, which was attended by approximately 80 experts. The process of developing the agenda is described, which involved input from over a hundred national organizations from the country's aging network. The scope of the participant list is detailed along with the process of assigning individuals to various working groups. The article also reports upon the participant orientation process, along with media strategy, information dissemination, administrative and management support, and coordination with public agency representatives. The article is intended to provide guidance in replicating such a summit. The author concludes with a summation of the priorities identified through this initiative. (Note: This article is part of an issue of JEAN dedicated to the subject of the National Policy Summit on Elder Abuse.)

87. P5301-42
Barnes, A.
The Liberty and Property of Elders: Guardianship and Will Contests as the Same Claim
The Elder Law Journal; Vol. 11; 2003.
This article explores the similarities between guardianship proceedings and will contests, and also between the guardianship system reform and inheritance law reforms. The history of guardianship reform is outlined, which stems from newspaper investigations in the 1980's and includes the Wingspread conference (Wisconsin, 1987) and the Wingspan conference (Florida, 2001). In comparing the recommendations generated by these conferences, the author concludes that little has changed in the guardianship system. Similarly, the author points out that little reform has occurred in the laws of wills. Ambiguity regarding competency evaluation and the tendency for courts to follow "conventional" lines of property redistribution during inheritance disputes are among the other topics discussed.

88. P5646-26
Bergeron, L.
Elder Abuse: Clinical Assessment and Obligation to Report
Chapter 7, 109-128, Health Consequences of Abuse in the Family;

American Psychological Association, Washington, D.C.; 2004.
Research suggests that elder abuse contributes to such psychological and psychiatric conditions as depression, post-traumatic stress, learned helplessness and alienation. According to the author, the purpose of this chapter is to address the role of the mental health professional in the clinical assessment, reporting and intervention of familial domestic elder abuse (noninstitutional). When reporting suspected abuse, counselors, psychologists and others are urged to inform the client of this, while emphasizing consideration for the client's safety. Professionals are also reminded that it is their legal and/or ethical obligation to report suspected abuse, not to verify the suspected mistreatment. Practical guidelines (including specific questions) for assessing the situation and reporting are outlined. Physical and psychological risk factors are summarized, along with theoretical models of elder abuse. Case examples illustrate various scenarios of suspected elder mistreatment. (Neither self-neglect, nor mistreatment of individuals with developmental or other disabilities under age 60, is the subject of this chapter.)

89. P5392-6
Berreth, M.
Nursing Care of Transgendered Older Adults - Implications from the Literature
Journal of Gerontological Nursing; p44-p49; July 2003.
This article is intended to raise awareness in nurses, and other health care professionals, regarding treatment and care issues that may impact the lives of transgendered elders. One area of significance is the likelihood of limited support systems, as research indicates that they often do not feel part of either the homosexual or heterosexual community, and may have strained relationships with family members. It is estimated that one-third of all transgendered individuals have attempted suicide, and problems with substance abuse and depression are not uncommon, while the risk of abuse and neglect due to prejudice and insensitivity is increased. Health related complications of sexual reassignment surgery may be compounded by factors of aging and increased medication usage. Health screenings, such as PAP smears, breast examinations and screening for prostate cancer pose particular challenges (and insurance concerns) for health care providers of this population.

90. P5556-3
Blancato, R.
The Elder Justice Act: A Landmark Policy Initiative
Journal of Elder Abuse and Neglect; Vol. 14 (2/3), 181-183; 2002.*
This brief commentary describes the significance of the Elder Justice Act of 2003 as the most comprehensive federal legislation proposed to address elder abuse, neglect and exploitation. (Note: This article is part of an issue of JEAN dedicated to the subject of the Elder Justice Act.)

91. P5552-4
Breaux, J.
Senator Breaux's Elder Justice Proposal of 2002 Executive Summary
Journal of Elder Abuse and Neglect; Vol. 14 (2/3), 33-36; 2002.*
This article provides an overview of the four basic aspects of Senator John Breaux's Elder Justice Proposal of 2002: the development of federal leadership and resources to assist in combating elder mistreatment on a family, community and state level through the creation of dual Offices of Elder Justice in both the Departments of Health and Human Services and Justice; the implementation of prevention and intervention strategies through the development of an Elder Justice Resource Center; increased security, collaboration and consumer information in long-term care; and evaluation of programs to determine effectiveness and enhance the response to elder abuse, neglect and exploitation. (Note: This article is part of a special issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)

92. P5619-6
Breaux, J. & Hatch, O.
The Elder Justice Act, S. 333
Journal of Elder Abuse & Neglect; Vol. 14 (2/3), 1-6; 2002.*
This brief article outlines the historical developments and congressional efforts that evolved into the Elder Justice Act, S. 333, introduced to the Senate in February, 2003. It also summarizes the major components of the bill, including the establishment of the Offices of Elder Justice at the Departments of Health and Human Services and Justice. (Note: This article is part of a special issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)

93. P5488-4
Breaux, J. & Hatch, O.
The Elder Justice Act, S. 333
NAELA Quarterly - The Journal of the National Academy of Elder Law Attorneys; Vol. 16 (4), 4-7; Fall 2003.
In this overview, sponsors of the Elder Justice Act provide a summary of this proposed legislation. The act would establish dual Offices of Elder Justice in both the U.S. Department of Justice and the Department of Health and Human Services. It would promote national awareness of elder justice issues, such as elder abuse and exploitation, improve the quantity, quality and accessibility of research, provide victim assistance, develop forensic capacity, increase prosecution, enhance accountability, and improve training and education.

94. P5489-7
Brisk, W. & Flynn, J.
No Bad Deed Should Go Unpunished: Evaluation and Discovery of Cases of Financial Abuse of Elders
NAELA Quarterly - The Journal of the National Academy of Elder Law Attorneys; Vol. 16 (4), 8-14; Fall 2003.
As quoted from the article, "This article is intended to help attorneys who encounter cases of elder financial abuse, whether they are inclined to litigate or not. Upon learning of possible exploitation, attorneys have a duty to provide sound advice which requires at the very least, an understanding of 1) how to conduct initial evaluation of such cases, 2) what types of retainers are appropriate, 3) particular discover strategies, and 4) suitable remedies." The author emphasizes that the more effectively the earlier phases of the process are conducted, the greater the chances of a successful outcome. Topics highlighted include capacity/competence, discovery strategies (such as preservation of testimony), and remedies (such as statutory protections for victims of elder abuse and exploitation, temporary orders, consumer protection statutes, and punitive damages when allowed).

95. P5491-7
Bueno, J. C.
Reforming Durable Power of Attorney Statutes to Combat Financial Exploitation of the Elderly
NAELA Quarterly - The Journal of the National Academy of Elder Law Attorneys; Vol. 16 (4), 20-26; Fall 2003.
The very strengths of the Durable Power of Attorney (DPOA or DPA), such as inexpensiveness, simplicity and ease of use, also create the potential for abuse. Agents under DPA are not monitored within the court system as some states require guardians to be. Therefore, infractions easily go unnoticed. In this article, the author reports upon state legislation designed to respond to financial abuse and exploitation under DPA. Legislative initiatives were found in the following areas: execution (witnessing requirements); disclosure; accounting requirements; agents duties (including gift-giving authority); and the need for an affidavit from a physician.

96. P5487-13
Cowan, D. et al.
Nutritional Status of Older People in Long Term Care Settings: Current Status and Future Directions
International Journal of Nursing Studies; Vol. 41, p225-p237; 2004.
Research indicates that older people, particularly those in long-term care settings, are at increased risk for malnutrition. This article presents an overview of the topic. Causes associated with malnutrition can be classified as either individual or organizational. Individual factors are either physical, or due to one's social environment, or a combination of both, and include such causes as ageism, abuse, depression, dementia, pain and isolation. Organization factors include failure to assist residents with eating, failure to recognize signs of malnutrition, poor staffing, poor staff communication and poor enforcement of regulations. Among the recommendations are the development and evaluation of nutritional assessment instruments designed specifically for the frail and the elderly and increased education and training for those health care professionals working with this population. Several monitoring tools under development are discussed. (England/U.K.)

97. P5622-10
Faccinetti, J.
Making Strategic Communications Work to Prevent Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 14 (4), 11-20; 2002.*
This article discusses the ways in which mainstream marketing and communication can be used to enhance public awareness of elder abuse and neglect, which was identified as a priority in the Elder Abuse National Action Agenda. Strategic communication is simply defined as a "strict planning process," wherein objectives are developed, target audiences are identified, marketing and communication strategies are designed in a cost-effective manner, and outcome measures for evaluation are also designed. Since most successful outreach campaigns develop at a grassroots level, consideration for the participation of regional and local elder abuse groups is essential. Web-based interactive methodologies (such as online surveys) are suggested as a basis for gathering input. Integration of multiple marketing techniques may include public service advertising, public relations, direct marketing, Web-based database marketing, promotion, collateral materials, and training support and services for agencies of various levels. The concept of branding, or identity development, in a nationally-based prevention campaign is discussed. (Note: This article is part of an issue of JEAN dedicated to the subject of the National Policy Summit on Elder Abuse.)

98. P5520-19
Freeman, I.
Assuring Safety for People with Dementia in Long-Term Care Facilities: A Focus on Staffing
Ethics, Law, and Aging Review; Vol. 9, 107-124; 2003.
Research into institutional elder abuse and neglect suggests that the most preventable causes of mistreatment are staff shortages and inadequate staff training. This chapter focuses on four aspects of nursing home staffing: hiring practices; sufficient staffing; consistency in staffing; and appropriate training and education in dementia care. A discussion of the limitations of criminal background checks, along with recent state court decisions regarding the constitutionality of these screening practices, is presented. The author maintains that the criminal background check should be seen as only one tool for assessing the appropriateness of care facility employees. One interviewing/training strategy suggested is the use of vignettes to generate problem prevention and problem-solving strategies. A review of federal staffing standards along with staffing requirements implemented in various states is provided, although there are currently no federal guidelines on caring for dementia residents. Nor is there consensus regarding optimal staffing ratios for dementia care in nursing homes, and the guidelines for such care in assisted living facilities is even more vague. In addition to the minimum nursing aide training requirement of 75 hours, no specific dementia care training is mandated federally. Staff often feel inadequately prepared and note that training typically ceases once the employee is "on the floor." Research suggests that such training provides risk prevention for both employee injuries and resident abuse and neglect. Included in this discussion is the concept that caregivers should receive training in communications skills to better detect pain and other problems that a cognitively impaired patient may not be able to directly communicate. The article concludes with a recommendation for state and local advocacy for elder abuse prevention as well as for the federal Elder Justice Act.

99. P5510-9
Fulmer, T., Guadagno, L., Bitondo Dyer, C. & Connolly, M.
Progress in Elder Abuse Screening and Assessment Instruments
Journal of the American Geriatrics Society (JAGS); Vol. 52 (2), 297-304, 2004.
The purpose of this article is to review and critique the elder abuse and neglect screening instruments currently available to health care professionals. Tools are categorized as checklists and guidelines, qualitative assessments, quantitative assessments, and combinations of the above. The following instruments are evaluated: AMA Diagnostic and Treatment Guidelines on Elder Abuse and Neglect, Subjective-Objective-Assessment Plan, Elder Abuse Diagnosis and Intervention Model, Rathbone-McCuan and Voyles format, H.A.L.F., Elder Assessment Instrument (EAI), Brief Abuse Screen for the Elderly (BASE), Indicators of Abuse Screen (IOA), Conflict Tactics Scale, Hwalek-Sengstock Elder Abuse Screening Test, Comprehensive Geriatric Assessment, and the Screening Tools and Referral Protocol: Stopping Abuse Against Older Ohioans: A Guide for Service Providers.

100. P5544-10
Graziano, R.
Trauma and Aging
Journal of Gerontological Social Work; Vol. 40 (4), 3-21; 2003.
This article focuses upon the impact of earlier traumas on the lives of older individuals. It is intended to provide information on post-traumatic stress disorder (PTSD) to social workers, mental health professionals and other health care professionals who work with elders. Trauma can be categorized as a single, catastrophic experience, or ongoing or repeated violence, terrorization, or intimidation. It may also be characterized by the following symptoms: avoidance, intrusive ideation, hyper arousal, detachment, constricted affect, feelings of helplessness, dissociation, substance abuse, personality disturbance and interpersonal difficulties. Various case studies are used to illustrate different theories of how PTSD affects the aging individual. Several factors that may predispose elders for risk of PTSD are a prior history of interpersonal violence, history of service in combat, a history of immigration due to the presence of war or civil or political turmoil, a history of exposure to natural disasters or wide spread acts of terrorism. A number of options are outlined, including counseling, the use of pharmacology, and education regarding the nature of trauma (including the "depathologizing" of symptoms).

101. P5289-3
Greenspan, A. et al.
Federal Regulatory Agencies' Opinion Letter About Michigan's Bank Reporting Procedures
July 2003
In this letter, federal regulatory agencies governing financial issues respond to questions regarding the federal liability of reporting suspected elder financial abuse in Michigan to the Michigan Family Independence Agency (FIA). In conclusion, the regulators indicate that after reviewing the protocols in place, the reporters would be excluded from the Gramm-Leach-Bliley (GLBA) act privacy rules. (Note: This letter is available online at
http://www.elderabusecenter.org/pdf/publication/nceaabaletter030701.pdf . For further information on legal issues related to bank reporting of elder financial abuse, see CANE file # P5287-45 Can Bank Tellers Tell? - Legal Issues Relating to Banks Reporting Financial Abuse of the Elderly; Hughes, S., for the American Bar Association Commission on Law and Aging, Washington, D.C.; 2003, accessible online at: http://www.elderabusecenter.org/pdf/publication/bank_reporting_long_final_52703.pdf and CANE file # P5288-9 Legal Issues Related to Bank Reporting of Suspected Elder Abuse; Hughes, S., for the American Bar Association Commission on Law and Aging, Washington, D.C.; 2003, accessible online at: http://www.elderabusecenter.org/pdf/publication/bank_reporting_summary_final_52703.pdf .)

102. P5867-6
Hayes, M.
2003 Survey of Rhode Island Law: Survey Section: Health Care Law. Jalowy v. The Friendly Home, Inc., 818 A.2d 698 (R.I. 2003)
Roger Williams University of Law Review; Spring 2004.
This brief legal commentary describes the lawsuit of John Jalowy, who was temporarily banned from visiting his mother in the Friendly Home nursing home after he made complaints to the facility administrator and the Rhode Island's Department of Health and the Department of Elderly Affairs. Subsequent to the complaint, Mr. Jalowy was allegedly taunted by the staff in question and retaliated with verbal abuse and by shaking his fist. He brought suit under Rhode Island's Abuse in Health Care Facilities Act, which prohibits retaliation against anyone who makes complaints of elder abuse, neglect, or mistreatment. However, the court deemed that the banning of his visits could be attributed to a non-retaliatory motive (staff and resident safety).

103. P5623-25
Heisler, C. & Stiegel, L.
Enhancing the Justice System's Response to Elder Abuse: Discussions and Recommendations of the "Improving Prosecution" Working Group of The National Policy Summit on Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 14 (4), 31-54; 2002.*
This article elaborates upon two of the recommendations that the "Improving Prosecution" Working Group identified as priorities during The National Policy Summit on Elder Abuse (December 2001, Washington, D.C.): "improving the legal landscape by strengthening elder abuse laws" and "increasing awareness within the justice system." The following issues guided the workgroups discussions: the role of the federal and state governments in increasing elder abuse reporting and enhancing prosecution; the need for expert witnesses, support and technical assistance; the identification of barriers to accessing the criminal justice system; the improvement of outcomes in criminal cases; and the need for training of law enforcement, prosecutors, judges, coroners, court personnel and advocates. The authors also provide a historical perspective on the response of the criminal justice system to elder abuse. The need to provide a more comprehensive response throughout the nation was identified by the working group, which outlined the following themes and goals: the need to broaden the committee's focus to include all aspects of the criminal justice response, not only prosecution; to develop inter- and intra-disciplinary training (in order to improve the identification and investigation of elder abuse cases, to enhance the contact skills used with both victims and perpetrators, etc.); to develop a multidisciplinary response that incorporates expertise from the aging and social services field, health care and mental health services, domestic violence and sexual assault networks, etc.; to treat abuse as criminal conduct (not simply a social problem, or a private or civil matter); to provide more effective management of elder abuse cases through specialized law enforcement units, vertical prosecution units (experienced in addressing such problems as unavailable or unwilling victims), and improved forensic capabilities; to understand cultural differences; to improve data collection regarding the incidence and nature of elder mistreatment in both domestic and institutional settings; to identify and promote promising practices in the criminal justice response to elder abuse; and to identify a consistent funding stream in order to implement these recommendations. The article concludes with a highlighting of initiatives occurring since the summit, including the introduction of the Elder Justice Act, as well as efforts by the Office on Violence Against Women (OVW), the National District Attorney's Association, the American Prosecutor's Research Institute, and various states' Attorneys General. (Note: This article is part of an issue of JEAN dedicated to the subject of the National Policy Summit on Elder Abuse.)

104. P5466-6
Hogstel, M., Curry, L.C. & Walker, C.
Limiting Litigation in Long-Term Care (Part 1)
Annals of Long-Term Care; Vol. 11 (9), 27-32; September 2003.
Part one of this two part series emphasizes the need for prevention in order to address the increase in medical malpractice litigation in long-term care. The authors present an overview of the factors contributing to this trend, including decreasing Medicare and Medicaid reimbursement, staff shortages and an increasingly sicker and older population of residents. Case examples and prevention protocols for common causes of these suits (such as falls, pressure ulcers or "bed sores," dehydration and malnutrition, elopement, and medication errors) are provided. Stressed throughout is the importance of accurate risk assessment, individualized treatment planning to address the specific risks of each resident, and the need for, and monitoring of, standing policies (such as fall precaution protocols). The clear and accurate documentation of daily care in the medical record is essential not only for treatment planning and evaluation, but is the primary legal evidence in these lawsuits. (Note: This article may be accessed online at http://www.hmpcommunications.com/altc/displayArticle.cfm?articleID=altcac1828 .)

105. P5467-4
Hogstel, M., Curry, L.C. & Walker, C.
Limiting Litigation in Long-Term Care (Part 2)
Annals of Long-Term Care; Vol. 11 (10), 47-50; October 2003.
This article (part two of a two-part series) describes the litigation process of medical malpractice lawsuits in long-term care. The process typically begins when a family member raises concerns over a resident's care and seeks legal representation. Guidelines for discovery and trial, ranging from attire and deportment to preparation and review of the medical record, are provided. The standard of care and whether or not that standard was breached by staff is pivotal to the outcome of such cases, and may impact upon whether a nurse is legally represented by the facility's legal counsel or if he/she needs to obtain individual representation. The article outlines preventative initiatives for reducing or eliminating conditions that lead to legal action. (Note: This article may be accessed online at http://www.hmpcommunications.com/altc/displayArticle.cfm?articleID=altcac1850 .)

106. P5674-21
Ingram, E.
Expert Panel Recommendations on Elder Mistreatment Using a Public Health Framework
Journal of Elder Abuse & Neglect; Vol. 15 (2); 45-65; 2003.
This article presents the recommendations made to the Centers for Disease Control and Prevention to address elder abuse as a public health problem. In July, 2002, a multidisciplinary panel consisting of representatives from federal agencies, advocacy groups, medical institutions, and researchers was convened. The public health framework employs an approach that encompasses strategies that "utilize health-event monitoring, epidemiological analysis, and intervention design and evaluation focused on the prevention of illness and injury." Solutions must focus on social and economic factors as well as medical and psychological factors. The framework is also characterized by emphasis on primary prevention and consists of public health surveillance (including the identification of "protective" as well as "risk" factors), program development, implementation and evaluation. Among the recommendations is the need for the development of a surveillance system with support from the CDC. The work group also recommended that the CDC support mandatory reporting for all states. Other recommendations include the following: standardization of definitions, terminology, reporting procedures and case substantiation; nationalized central reporting for improved data collection and analysis; analysis of the effectiveness of adult protective services and evaluation of assessment and screening tools; development of family risk appraisals; and the customization of interventions to address specific perpetrators profiles.

107. P5557-7
Johnson, A.
Geriatric Education for Elder Justice
Journal of Abuse & Neglect of the Elderly; Vol. 14 (2/3), 185-191; 2002.*
The author describes how the proposed Elder Justice Act will enhance the training and education of professionals in disciplines with geriatric competencies. In particular, the Act provides specifically for forensic training for geriatricians that will enable these physicians to become vital members of interdisciplinary adult protective services teams. It is hoped that the development of curricula to address these competencies will also extend to other health care and social service professionals (such as geriatric nurse practitioners) in light of the shortage of geriatric physicians. (Note: This article is part of a special issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)

108. P5404-88
Johnson, K., for the U.S. Department of Justice, Office of Community Oriented Policing Services (COPS)
Financial Crimes Against the Elderly (Problem-Oriented Guides for Police - Problem-Specific Guides Series No. 20)
U.S. Department of Justice, Office of Community Oriented Policing Services (COPS); Washington, D.C.; 2003.
Part of the series of Problem Specific Guides for the police, this publication provides a comprehensive overview of financial elder abuse and guidelines for customizing a law enforcement approach to address the problem on a local level. The topic of financial exploitation is broadly divided into those acts committed by strangers and those committed by friends, family, and caregivers, by means of coercion, intimidation, undue influence, deception and/or emotional abuse. The author describes abuses of Power of Attorneys, living trusts, joint accounts, and transfers of titles. Factors that contribute to financial crimes, including victim vulnerabilities, are also discussed. The greatest predictor of future victimization is previous victimization, which is in part due to the practice of generating and sharing "sucker lists" among perpetrators. Understanding the victim's mental capacity and the issue of consent are vital in terms of investigation. In describing perpetrator characteristics, the "boiler-room" mobility structure of telemarketing fraud is highlighted. In order to tailor the response to financial elder abuse in a given community, law enforcement needs to analyze the current types of abuse occurring, and will need to develop multidisciplinary/interdisciplinary efforts. The guideline includes a detailed list of questions that responders should ask when assessing the crime(s). Pre- and post-intervention measurements are needed in order to determine the effectiveness of the implemented response, and quantifiable recommendations are provided. The publication also identifies strategies that have proven ineffective, such as "stand alone" information dissemination, mandatory reporting legislation, bonding telemarketers, and increasing sentences in existing legislation. (Note: This publication is available online at http://www.cops.usdoj.gov/mime/open.pdf?Item=963 .)

109. P5312-5
Kanapaux, W.
Litigation and Increasing Liability Insurance Devastate Long-Term Care
Geriatric Times; July/August 2003
This article summarizes recent trends in long-term care litigation that are having a tremendous impact upon the nursing home industry. In 2001, payment compensation for lawsuits filed against long-term care facilities totaled $2.3 billion nationally, with Florida representing $1.1 billion in claims paid. Annual commercial liability insurance premiums for nursing homes increased 143 percent between 2001 and 2002. Long-term care operators incur 14.5 claims per 1000 beds per year. Medical directors and physicians are finding it difficult to obtain insurance, and more treatment is being carried out by physician assistance and advanced registered nurse practitioners, and beds are becoming scarcer as facilities are closing under the financial pressure. (Note: This article is available online only at www.geriatrictimes.com/g030804.html .)

110. P5665-41
Kohl, T.
Comment: Watching Out for Grandma: Video Cameras in Nursing Homes May Help to Eliminate Abuse
Fordham Urban Law Journal; Vol. 30; September 2003.
This legal comment presents arguments both for and against the proposal to grant nursing home residents the right to install video cameras as a means of preventing abuse. Part I presents a discussion of the ineffectiveness of current nursing home regulations. Privacy issues (the complexities of distinguishing between public, private and semi-private zones, the difficulty of obtaining consent for video taping from incapacitated residents, and the privacy rights of roommates, employees, visitors and the nursing home institution) are considered in Part II. Part III addresses the costs associated with video surveillance. Inevitably, residents and/or their families would likely absorb the cost, directly or indirectly. Additionally, opponents of the technology fear that it would create even greater staffing instability. The author concludes that with careful legislative drafting, this could be an important elder abuse prevention technique.

111. P5644-5
Lafata, M.
Addressing Elder Abuse and Neglect
OT Practice; Vol. 8 (12), 12-16; July 2003.
This article presents an overview of elder abuse and neglect and describes the reporting responsibility of the occupational therapist. The author indicates that the Occupational Therapy Code of Ethics "compels" all practitioners to report suspected abuse, regardless of an individual state's statutory mandate. A case study is provided that highlights a number of the ethical difficulties that the practitioner faces when deciding to report. Sidebars include recommendations for therapists working in institutional care settings.

112. P5300-10
Lee, H. & Lyketsos, C.
Depression in Alzheimer's Disease: Heterogeneity and Related Issues
Biological Psychiatry; Vol. 54 (3), 353-362; August 2003.
Research indicates that rates of "noncognitive mental disturbances" are 3 to 4 times greater in Alzheimer's Disease (AD) patients than in patients without dementia. Depression is one of the most common conditions observed. Not only does it have a negative impact upon the quality of life of the patient and the patient's health, it also appears to increase caregiver depression and burden. This article briefly reviews the existing literature on depression in AD, including eight placebo-controlled studies of the efficacy of antidepressant therapy in AD patients. It presents a discussion of the difficulty in assessing depression accurately in the presence of dementia. The provisional diagnostic criterion for depression that was recently developed by the National Institute of Mental Health's Alzheimer's Disease Workgroup is also presented. Four subtypes of depression in AD are discussed and research initiatives are outlined.

113. P5688-9
Levine, J.
Elder Neglect and Abuse: A Primer for Primary Care Physicians
Geriatrics; Vol. 58 (10), 37-44; October 2003.
This article provides an overview for primary care physicians on the topic of elder abuse and neglect. Case scenarios are presented to exemplify self-neglect, physical abuse and neglect, sexual abuse, and abuse in institutional settings. Tables include routine screening questions for practitioners to use during the clinical interview. (Note: This article is available online at http://www.geri.com/geriatrics/data/articlestandard/geriatrics/412003/71640/article.pdf .)

114. P5672-18
Lingler, J.
Ethical Issues in Distinguishing Sexual Activity from Sexual Maltreatment among Women with Dementia
Journal of Elder Abuse and Neglect; Vol. 15 (2), 85-102; 2003.
This article considers the ethical complexities of distinguishing between sexual activity and sexual abuse of women with dementia. In particular, the author challenges the National Center on Elder Abuse (NCEA) definition of sexual abuse as "nonconsensual sexual contact of any kind with an elderly person." To illustrate the difficulty in assessing sexual abuse, she presents a case study of a loving couple who remains sexually active after the wife becomes moderately cognitively impaired. At issue is the impaired individual's ability to provide consent. Overly simplified definitions appear limiting and detrimental to the vulnerable spouse. The author presents a paradigm for the contextual ethical analyses of such situations that is based upon feminist bioethical approaches, and contends that "some, if not most, sexual activity between loving spouses may be morally permissible even when one partner has dementia and cannot consent." The approach involves assessment of various forms of oppression, such as ageism plus sexism, and hypercognitivism, which places a higher value on rationality and productivity as opposed to other elements of an individual's humanity. The trust level between the partners before the onset of dementia is an important consideration.

115. P5368-4
Mack, B. & Jones, K.
Elder Abuse: Identification and Prevention (Focus on Aging)
ASHA Leader (American Speech-Language-Hearing Association); Vol. 8 (14), p10; August 5 2003.
This article provides an overview of elder abuse and includes signs and symptoms of verbal, physical, psychological, sexual and financial abuse and neglect. It also provides general guidelines for health care professionals who encounter suspected abuse, including the need for documentation and reporting.

116. P5663-13
Marshall, J.
Elder Law Symposium - Practice Perspectives: Power of Attorney - Key Issues for Elder Care Planning
Pennsylvania Bar Association Quarterly; Vol. 74, 160-168; October 2003.
This article provides an overview of the Power of Attorney (POA) as a tool for elder care planning, particularly as it relates to Pennsylvania statutes. The need to customize the document to suit the principal's specific circumstances is emphasized. The capacity to execute a POA is discussed along with the following critical issues: asset protection (including the authority to transfer and gift); fiduciary duties of the agent (including responsibility for record keeping); health care decision making (including advance directives, limitations of living wills, and the complexities of the Health Insurance Portability and Accountability Act or HIPAA); drafting portable documents; avoiding abuse of a POA; and naming surrogate agents. The author, a certified elder law attorney, cautions that over reliance upon the default language in the Probate, Estates and Fiduciary Code may limit the effectiveness of the POA.

117. P5666-29
McIntire, T.
Is the Pain Getting Any Better? How Elder Abuse Litigation Led to a Regulatory Revolution in the Duty to Provide Palliative Care
The Elder Law Journal; Vol. 11; 2003.
In the article, the author, who is both a physician and attorney, describes the recent trend to bypass medical malpractice legislation and to instead use elder abuse statutes to hold physicians responsible for inadequate pain management. As an outcome, it appears that state legislatures and medical licensing boards are adopting intractable pain laws and treatment protocols which raise the standard of palliative care. The article contains a checklist of assessment and treatment guidelines for appropriate pain management for chronic and end-stage illness.

118. P5450-47
Miller, M. & Johnson, J., for the American Prosecutors Research Institute (APRI)
Protecting America's Senior Citizens: What Local Prosecutors are Doing to Fight Elder Abuse
Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice; Alexandria, VA; September 2003.
This report (one of APRI's Special Topics Series) presents a summary of a national survey of prosecutors' offices regarding the challenges of prosecuting elder abuse cases. Of the findings: nearly 30 percent of the offices have a specialized unit to address elder abuse; very few of the offices emphasize early intervention; less than 25 percent have advocates that work exclusively with elderly victims; nearly 60 percent engage in public outreach and prevention programs; one-third offer specialized training in addressing elder abuse cases. Case studies are highlighted to illustrate such issues as investigation techniques, coordination of services, operational protocols, vertical prosecution, and victims' advocacy. Challenges to prosecution that were identified include a lack of training in abuse issues on the part of law enforcement, a lack of both geriatric and abuse knowledge among physicians, limited service resources, retraumatization of the victim during investigation, and reluctance or inability of victims to provide testimony. (Note: This report is accessible online at http://www.ndaa.org/apri/ )

119. P5400-5
Mitchell, R. et al., for the Centers for Disease Control
Public Health and Aging: Nonfatal Physical Assault-Related Injuries Among Persons Aged (greater than) 60 Years Treated in Hospital Emergency Departments - United States, 2001
MMWR (Morbidity and Mortality Weekly Report);
Vol. 52 (34), 812-816; August 29 2003.
During 2001, it is estimated that 33,026 people in the U.S. aged 60 and over were treated in hospital emergency rooms for nonfatal assault-related injuries, based upon a CDC analysis of data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). Sixty-five percent of these patients were between the ages of 60 and 69. The most common injuries were contusion/abrasions, lacerations and fractures. In 83.7 percent of the cases, the injuries were caused by being struck by/against a hand, elbow, foot, a blunt object, or by being pushed. (Note: This report is available online at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5242a4.htm .)

120. P5555-5
Mixson, P.
Taking a Leap Forward: Adult Protective Services and the Elder Justice Act
Journal of Elder Abuse & Neglect; Vol. 14 (2/3), 193-197; 2002.*
In this brief commentary, the author describes the impact that Elder Justice Act may have upon adult protective services (APS). The national attention that this proposed federal legislation would bring to the topic of elder abuse is considered most significant, particularly in this time of shrinking APS resources. (Note: This article is part of an issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)

121. P5662-111
Moore, S. & Schaefer, J.
Remembering the Forgotten Ones: Protecting the Elderly From Financial Abuse
San Diego Law Review; Spring 2004.
As quoted from the Introduction, "The goal of this article is to encourage legislators to strengthen the laws against all types of elder abuse, particularly financial abuse." The article addresses various types of exploitation by professional perpetrators for which elders are often targeted. Independent elders lose 60 percent of the annual $60 billion lost to frauds and scams. The authors discuss issues related to their vulnerability and reluctance to report victimization. The strengths and limitations of current protections (civil and criminal justice systems, protective services, etc.) are considered. Existing legislation is outlined, and includes collaborative efforts between the Federal Trade Commission and the Department of Justice, along with such initiatives as the SCAMS Act, the Telemarketing Act, and the wire fraud statute. The proposed legislation, the Seniors Safety Act (SSA) is also described. Finally, the authors suggest that the simplest remedy may be enhanced sentencing guidelines for crimes committed against seniors. The appendix contains a listing of current laws, by state, that address elder abuse. It also includes general statutes that address telemarketing and charitable solicitation.

122. P5285-10
Mor, V., et al.
The Quality of Quality Measurement in U.S. Nursing Homes
The Gerontologist; Vol. 43 Special Issue II, 37-46; 2003.
This article examines the inherent difficulties of measuring quality of care in nursing homes. Technical complications in executing performance measures, data validity and reliability, transforming measurements for comparison, risk adjustment, and the multidimensionality of quality are the topics explored.

123. P5593-8
Moutier, C., Wetherell, J. & Zisook, S.
Combined Psychotherapy and Pharmacotherapy for Late-Life Depression
Geriatric Times; Vol. IV (5): September/October 2003.
A combined treatment approach of both pharmacological and psychotherapeutic interventions is warranted to manage the medical, cognitive and psychosocial complications of late-life depression. This article discusses the unique characteristics of geriatric depression, including the symptoms of irritability, somatic complaints, social withdrawal, and sudden changes in functional level. Observing that depression is often unrecognized in the presence of other medical conditions, the authors provide recommendations for primary care physicians, such as maintaining a "high index of suspicion" in patients with medical illnesses known to have a high correlation with depression. The interactive nature of the relationship between depression and cognitive dysfunction is also discussed. The article provides links to tables describing the consensus of geriatric psychiatrists regarding the use of pharmacological interventions and therapy/counseling modalities. (Note: This article is available online only at http://www.geriatrictimes.com/g031014.html)

124. P5684-18
Nelson, H., Nygren, P., McInerney, Y. & Klein, J.
Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force
Annals of Internal Medicine; Vol. 140 (5), 387-404; March 2 2004.
The purpose of this article is to review the evidence used in the U.S. Preventive Services Task Force (USPSTF) recommendation regarding the effectiveness of screening for family violence, including elder abuse. Drawing upon numerous health-related databases (such as CINAHL, MEDLINE, etc.), researchers selected English language studies that evaluated the performance of screening tools and interventions based in health care settings. Three studies were identified that evaluated the performance of screening instruments for elder abuse (Reis and Nahmiash, 1995; Neale et al., 1991; and Moody et al., 2000) that could be adapted to clinical settings. The Caregiver Abuse Screen (CASE) and the Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) were the subjects of these studies, which received fair quality ratings from the reviewers. No studies based within health care settings were identified that examined the effectiveness of elder abuse interventions in health outcome measures, or provided assessment of adverse effects of screening or intervention. Appendices include a description of the literature search methods, the quality rating criteria, and several of the tools. (Note: This article is accessible online at: http://www.annals.org/cgi/reprint/140/5/387.pdf . For more information on the USPSTF recommendation on screening for family and intimate partner violence, see CANE file #P5683-5.)

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