Maine Partners for Elder Protection

1. Maine Partners for Elder Protection The University of Maine Center on Aging Presentation at the 22nd Annual Maine Geriatrics Conference June 8, 2012

2. Disclosure The content of this presentation does not relate to any product of a commercial interest. Therefore, there are no relevant financial relationships to disclose.

3. Elder Abuse Stats • Estimates across types of abuse range from 2%-10%.1 A recent study indicated that 11.4% of individuals age 60-97 reported some type of abuse in the previous year.2 • 84% of elder abuse and neglect cases in domestic settings were not reported to Adult Protective Services.3 • It is estimated that 14,000 cases of elder abuse occur in Maine annually.

4. Elder Abuse Definitions • Abuse: The infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish; sexual abuse or exploitation; or the willful deprivation of essential needs • Neglect: A threat to an adult’s health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these • Exploitation: The illegal or improper use of an incapacitated adult or his resources for another’s profit or advantage • Other: • Sexual Abuse • Abandonment • Self-Neglect

5. Elder Abuse Profiles • Most abusers are family members • Adult children • Spouse • Grandchildren • Women are more often abused than men • NEGLECT most common followed by FINANCIAL EXPLOITATION

6. Risk Factors/Correlates • Correlates of elder abuse may vary by types of abuse and are still being understood. Some factors that are correlated with abuse include4,5: • Low social support • Having experienced traumatic events in the past such as domestic violence • Personal problems of abuser • Dependence of abuser on victim.

7. Risk Factors/Correlates • The following are not highly correlated with elder abuse and have been subject to disagreement: • Caregiver stress • Victim personal traits • Cognitive impairment of the victim • Physical impairment of the victim

8. Maine Partners for Elder Protection • Victims have twice as many physician visits6 • 2/3 of elderly victims of abuse have been seen in emergency room at least once in 5 years • One study found that older adults who are abused had three times the risk of dying within three years than those who had not been abused7

9. Maine Partners for Elder Protection • Major support provided by the Maine Health Access Foundation • The Maine Health Access Foundation (MeHAF), created in 2000, is the state’s largest health care foundation. MeHAF promotes affordable and timely access to comprehensive, quality health care and seeks to improve the health of every Maine resident. In particular, MeHAF targets projects that serve the medically uninsured and underserved.

10. Pilot Sites • Partnership among Primary Care Physician Offices in Penobscot and Piscataquis Counties, the Eastern Agency on Aging, The University of Maine Center on Aging, and elder abuse community advocates. • Norumbega Medical Specialists, Ltd. & Dover-Foxcroft Family Medicine, Dexter Family Practice, Miliken Medical Center, Penobscot Community Health Center

11. Technical Advisory Board • Office of Elder Services • Department of Health and Human Services • Eastern Agency on Aging • Eastern Maine HealthCare • Elder Abuse Institute of Maine • Home Resources of Maine, Inc. • Legal Services for the Elderly • Maine Health Alliance • Penobscot County Sheriff’s Department • Penobscot Community Health Center • Skelton Law Offices, LLC • Spruce Run • Sunbury Primary Care • University of Maine School of Nursing • Womancare

12. Central Project Goals • Design and implementation of an elder abuse screening protocol in rural primary care offices • Enhancement of the service linkage between primary care physician’s offices and Area Agency on Aging network resources

13. Screening Pilot Model • Brief screen tool used at PCP offices to identify seniors at risk. PCP reviews tool with patient and notifies elder care specialist from their area agency on aging. • A referral to Adult Protective Services is made as needed. • Elder care specialist provides counseling, coordinate service provision as needed, provide education, and act as advocate in protective process.

15. Screening Tool

16. 4.56% of patients screened were identified to be at-risk in year one

17. Provider Education • Quality education provided to area professionals through “Lunch & Learn” Series • Online screening and education module created and available for free to healthcare and allied professionals

18. Online Module http://www2.umaine.edu/mainecenteronaging/mpep/

19. Public Outreach & Education Materials • Aging and Safety Booklet for older adults • Older adult’s rights poster

20. Quotes from Participating Offices “I think that you’re there to help patients and that should be the key. Protecting the patients is just as important as keeping them healthy.”~ Nurse at participating screening office talking about the importance of the screen to their practice“Even the people who aren’t [at risk] are impressed that we take the time to ask.” ~ Physician from participating screening office talking about the patient reaction to screening

21. Lessons Learned • Screening can be done efficiently and effectively in primary care practice settings from small rural offices to large scale multi-site practices • Training of ALLmedical office staff for elder abuse, exploitation, and neglect screening is crucial • “Lunch and learn” format of continuing medical education is an effective and efficient training methodology

22. Replication Materials http://mainecenteronaging.umaine.edu/ publications • Replication manual • Poster • Screening tool • Project flow chart • Aging & Safety Booklet-Maine & national formats

23. Contact Information Jennifer Crittenden UMaine Center on Aging Camden Hall 25 Texas Ave Bangor, ME 04401 207-262-7923 jennifer.crittenden@umit.maine.edu

24. Elder Abuse Stats References • 1 Lachs, M. & Pillemer, K. (2004). Elder abuse. Lancet, 364, 1263-1272. • 2 Acierno, R., Hernandez, M., Amstadter, A., Resnick, H., Steve, K., Muzzy, W. & Kilpatrick, D. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292-297. • 3 National Center on Elder Abuse. (1998). The national elder abuse incidence study: Final report. Retrieved from: http://aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf. • 4 Acierno, R., Hernandez, M., Amstadter, A., Resnick, H., Steve, K., Muzzy, W. & Kilpatrick, D. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292-297.

25. Stats References - Continued • 5National Center on Elder Abuse. (2011). Risk factors for elder abuse. Retrieved from: http://www.ncea.aoa.gov/NCEAroot/Main_Site/FAQ/Basics/Risk_Factors.aspx • 6Sellas, M. & Krouse, L. (2011). Elder Abuse: Retrieved from: http://emedicine.medscape.com/article/805727-overview#a0101 • 7Lachs, M., Williams, C., O’Brien, S., Pillemer, K., & Charlson, M. (1998). The mortality of elder mistreatment. Journal of the American Medical Association, 280(5), 428-432.

26. Screening Tool Reference • Adapted from the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) • Schofield, M.J., Reynolds, R., Mishra, G. D., Powers, J.R., Dobson, A.J. (2002). Screening for vulnerability to abuse among older women: Women's health Australia study. The Journal of Applied Gerontology, 21, 24-39.