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Elders Seeking Treatment

Elders Seeking Treatment

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Elders Seeking Treatment

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  1. Elders Seeking Treatment Boston Center for Refugee Health and Human Rights Boston, Mass. USA Lin Piwowarczyk, MD, MPH Jennifer Sato, MA

  2. Continuing Medical Education Commercial Disclosure Requirement I, Linda Piwowarczyk, have no commercial relationships to disclose.

  3. Methods • Retrospective chart review • Elders defined as 60 years of age and older (n=61) of which 51 were torture survivors themselves or family members • Referral to mental health services of a torture treatment program in the United States • Patient information collected between January 1, 2004 and August 15, 2015 • Approved by the Institutional Review Board of Boston University Medical Center

  4. Basic demographics (n=51)

  5. Immigration status (n=51)

  6. Marital status intake (n=51)

  7. Sources of widowhood or spouse missing (n=51)

  8. Major medical diagnoses n=51)

  9. Number of children (1-15)(n=51)

  10. Loss of children (n=51) 3.9% (total of 2 children) 43.1% (total of 42 children) 5.9% (total of 10 children)

  11. Causes of persecution (n=51)

  12. Perpetrators of persecution (n=51)

  13. Forms of torture (n=41) Age of first torture: 40 – 65 (mean 51.93 years) Physical scars: 10

  14. History of head trauma n=31/51(62%)

  15. History of head trauma if provided

  16. Consequences of head trauma

  17. Other events of violence • 3 sons escaped when house hit – not seen since (ages 6,14, 17) • Home hit by anti-aircraft, 2 families killed by Ethiopian artillery when fleeing by car • Witnessed two sons shot in the head when attacked due to tribe, and jewelry stolen • Blindfolded and put in a dark room • Husband and brother killed in MVA when fleeing • Daughter raped and her husband died trying to protect her • Home hit by artillery, witnessed murder of brother-in-law • Husband detained many times, also son, husband’s business confiscated • Husband grabbed gun and was shot

  18. Other events of violence 2 • Sons jumped out of window to escape death • Patient raped in front of son • Several family members died when locked in house set on fire • Shot when trying to save her daughter • Son wounded when trying to protect his mother • Interrogated by secret police in her home • Struggles as ex-student could have helped him get of concentration camp but did not • Threatened that house would be burned with family inside • Town under siege • Wife raped in front of him, patient hit with shrapnel • Witnessed death of brother, mother shot in spine and died a few days later • Witnessed murder of nephew • Witnessed rape of 13 year old daughter • Witnessed murder of close sister and three male cousins

  19. Family history of torture

  20. Associations with torture

  21. Seeking treatment

  22. Prior treatment

  23. Psychiatric diagnoses at intake (n=51)

  24. New diagnoses(n=51)

  25. Problems with concentration

  26. Associations with PTSD

  27. Age at first torture and presentation