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AGS POSITION STATEMENT ON ELDER MISTREATMENT
AGS Elder Abuse Special Interest Group

Background:

Elder mistreatment (EM) is the umbrella term for a widespread public health problem of elder mistreatment that encompasses physical and sexual abuse, emotional abuse, financial exploitation, as well as neglect by others and self-neglect. Elder mistreatment is seen in both community and institutional settings. Although there has never been a systematic study of the prevalence of elder mistreatment in long-term care settings, the published prevalence in the community ranges from 1.3% to 5.4%. ^1,2,3,4 The risk factors for elder mistreatment include: advanced age, female gender, poverty, depression and cognitive and functional impairment.⁵ A seminal study of elder mistreatment showed that community dwellers with mistreatment severe enough to merit a report to the Adult Protective Service agency were at higher risk for death than community dwellers that were never reported.⁶

The National Academy of Science has convened two panels in the last three years that dealt with elder abuse. The first panel concerned educating health professionals about family violence and called for "multidisciplinary education and research centers with the goal of advancing scholarship and research on the magnitude and impact of family violence on society" and the creation of curricula on family violence.⁷ The second panel addressed the risk and prevalence of elder abuse called for increased research beginning with accurate epidemiologic studies.⁸

The purpose of this statement is to inform health professionals about the need for education and research in elder abuse and to propose that geriatric assessment and intervention serve as an intervention model.

POSITIONS:

1. Elder mistreatment should be considered an essential curricular element in geriatric and gerontology training programs at all levels of health professional training.
   
   Rationale: Older persons make frequent contacts with their medical providers and/or social agency providers. Contact with senior citizens occurs in a variety of settings (health care, daycare, facilities, and retirement centers). Geriatric and gerontology health professionals are in a unique position to identify elder mistreatment in these various settings and intervene through reporting and/or the appropriate medical treatment.
   
   
   1. The basic training of all health profession students should include content on recognizing elder mistreatment.
   2. The residency training of primary care physicians, emergency room physicians, gynecologists, geriatric fellows and other surgical subspecialists likely to see older persons (orthopedics, etc.) should include topics on the recognition and reporting of elder mistreatment.
   3. Geriatric social workers and geriatric nurse practitioners should receive both basic and advanced training in the care of mistreated elders including the topics of identification, reporting and intervention.
   4. Continuing medical education courses for practicing physicians who come in contact with senior citizens, should include descriptions of state reporting laws and a review and update of the elder mistreatment literature.
   5. Geriatricians and gerontologists should increase public awareness of elder mistreatment .
   
   
   
2. Explicit research funding initiatives for elder mistreatment research should be solicited from both the public and private sources of research funding at the federal, state, and foundation levels.
   
   Rationale: Research in the area of elder mistreatment is sparse.⁹ There are few published papers with primary data. Research is expensive and limited by: the complex, multidimensional nature of EM, the availability of data and lack of funding.
   
   
   1. The field would be served if the National Institutes of Health (NIH) put forth more requests for applications or program announcements that support research to help inform the field.
   2. Research could be advanced if more private foundations set elder mistreatment as one of their funding priorities.
   3. Leaders of academic geriatric and gerontology programs should encourage and support faculty and trainees to undertake elder mistreatment research.
   
   
   
3. Interdisciplinary geriatric assessment programs should serve as the model for the coordinated response to elder mistreatment issues between health care professionals and those agencies legislatively charged with investigating and responding to elder mistreatment.¹⁰
   
   Rationale: Many geriatricians and gerontology professionals regularly treat seniors who match the risk factor profile described for victims of elder mistreatment and who often experience complex social problems in the setting of advanced or chronic disease. Interdisciplinary geriatric assessment and intervention, which is appropriate for both community and institutional settings, is a proven model for the care of frail elders and should be applied to the care of the vulnerable mistreated elder.
   
   
   1. Routine screening for elder mistreatment should be included in geriatric assessment.
   2. Adult protective service specialists and ombudsmen should enlist the services of a geriatric interdisciplinary team when possible since these professionals have expertise in issues commonly addressed by these agencies, such as decision-making capacity, cognitive impairment, pressure ulcers and malnutrition.
   3. Interdisciplinary geriatric assessment and intervention team members or individual gerontologic practitioners could provide advice or expert testimony on behalf of vulnerable mistreated seniors.

Conclusion

Geriatricians and gerontology professionals are well-suited to address the widespread public health problem of elder mistreatment. To do so they must begin by educating trainees at various levels as well as practicing physicians. They must undertake meaningful, quality research that advances the knowledge in the field. They should take an active role within their own community in the recognition and treatment of elder mistreatment. Application of interdisciplinary geriatric assessment and intervention can aid in the identification, diagnosis, and intervention of elder mistreatment.