Elder Abuse: Health Implications

XinQi Dong, MD MPH

Director, Chinese Health, Aging and Policy Program

Associate Director, Rush Institute for Healthy Aging

Associate Professor of Medicine, Nursing and Behavior Sciences

Rush University Medical Center, Chicago, IL

&

Senior Policy and Research Advisor

Administration on Community Living

Department of Health and Human Services

Aristotle:384-322: BC

“Old people are pessimistic, distrustful, malicious, suspicious,

small minded, lacking in generosity, and cowardly.”

Physician <====> Patient

Historical Development – Patriarchal Roots

• Doctrine of Covertures- women loses separate legal identify once married

• Husbands both obligated and permitted to “chastise” wife and children to maintain discipline

• “a husband is responsible for the acts of his wife, and he is required to govern his household, and for that purpose, the law permits him to use towards his wife such a degree of force, as is necessary to control on unruly temper, and make her behave herself”

State vs. Black, 60 N.C. 262 (1864)

Burston GR. BMJ 1975:iii

Epidemiology

• 2-5 Million Cases/yr in the US

• Prevalence 3 - 25% : Incidence 3 – 15%

• 1 out of 14 Cases are Elder Abuse Reported

• 1 out of 25 Cases of Financial Exploitation Reported

• Utah 2009: 52 Million Lost

• Nationally: 2.9 Billion Lost Per Year

Pillimer, Gerontologist 1995, NCEA, 2005, Podeniek, JEAN 2008, Dong, JEAN 2009, Acierno, AJPH 2010, Lauman, JGSS 2009, Lachs, NYC

report 2011, MedLife Report 2011, Utah State Report 2010, Mosqueda & Dong, JAMA 2011, Beach, Gerontologist 2010

Dementia Course

Mini Mental State Examination

Risk Factors:

• Functional Impairment

• Cognitive Impairment

• Psychological Distress

• Personality Traits

• Psychiatric Disorder

• Social Wellbeing

• Medical Comorbidities

Tatara, NCEA 1990; Cooper, Int J Geri Psych 2007; Mouton, AJPH 2004(94), Wolf, NCPEA 1997; Paveza, Gerontologist 1992(32),

Lachs, JAGS 1994 (42); Dyer, JAGS 2000(48); Compton, Int J Geri Psych 1997 (12); Laumann, JGSC 2008(63); Bristowe, JEAN

1989(1), Homer, BMJ 1990(301), Fulmer, J Em Nursing 2000(26)

Consequences: • Premature Death

• Death Due to Heart Disease

• Nursing Home Placement

• Emergency Room

• Hospitalization

• Hospice Use

• Quality of Life

• Worsening Health Conditions

• Guardianship

Dong et al, JAMA 2009

Dong & Simon JAMA 2011

Dong et al, Jr Am Emerg Med 2011

Dong et al, JAGS 2011

Mosqueda & Dong, JAMA 2011

Dong et al, JGMS 2011

Dong, Clinics Geriatric Med, 2005

Dong et al Gerontology 2010

Halliday et al, Lancet 2000

Begal et al, Jr Interper Vio 2011

Schonfield Gerontologist 2006

Smith et al, Jr Nutrition 2006

Lach et al, JAMA 1998

Lach et al, Gerontologist 2002

Shield et al, Jr Forensic Sci 2004

Franzini et al, JAGS 2008

Baker et al. Jr Geri Soc Work 2009

Mouton et al, Ann Fam Med 2010

Pillemar, Gerontologist 1998

Screening for Elder Abuse:

• Are you afraid of anyone in your family?

• Has anyone close to you tried to hurt or harm you recently?

• Does someone in your family make you stay in bed or tell you that you are sick when you know you are not?

• Has anyone close to you called you names or put you down or made you feel bad recently?

• Has anyone forced you to do things you didn’t want to do?

• Has anyone taken things that belong to you without your Ok?

Research barriers

– Diversity

Traditional

開 圖 樂 學 Simplified

开 图 乐 学 Open Picture Happy Learn

Cantonese

Néih Hóu

Dōjeh Deui m̀h jyuh M̀h'gōi.

Mandarin

Nǐ Hǎo Xiè Xiè Duì Bu Qǐ Bú kèqì.

How are you?

Thank you.

Sorry. You’re welcome.

Chinese Exclusion Act 1882 – US Apology 2011

Advocacy:

Maslow’s Hierarchy of Needs

“For years, I suffered silently, unable to muster the courage to seek the help I knew I needed….I felt

trapped, scared, used and frustrated. And above all, when a man feels helpless, it's terrible. And I was

helpless.”

Mr. Mickey Rooney, Elder Abuse Victim