Aileen Wiglesworth

Screening for abuse and neglect of people with dementia

OBJECTIVE: To investigate characteristics of people with dementia and their caregivers (CGs) that are associated with mistreatment in order to inform clinicians about screening for mistreatment.

Behavioral perinatology: biobehavioral processes in human fetal development.

Behavioral perinatology is as an interdisciplinary area of research that involves conceptualization of theoretical models and conduct of empirical studies of the dynamic time-, place-, and context-dependent interplay between biological and behavioral processes in fetal, neonatal, and infant life using an epigenetic framework of development. The biobehavioral processes of particular interest to our research group relate to the effects of maternal pre- and perinatal stress and maternal-placental-fetal stress physiology. We propose that behavioral perinatology research may have important implications for a better understanding of the processes that underlie or contribute to the risk of three sets of outcomes: prematurity, adverse neurodevelopment, and chronic degenerative diseases in adulthood. Based on our understanding of the ontogeny of human fetal development and the physiology of pregnancy and fetal development, we have articulated a neurobiological model of pre- and perinatal stress. Our model proposes that chronic maternal stress may exert a significant influence on fetal developmental outcomes. Maternal stress may act via one or more of three major physiological pathways: neuroendocrine, immune/inflammatory, and vascular. We further suggest that placental corticotropin-releasing hormone (CRH) may play a central role in coordinating the effects of endocrine, immune/inflammatory, and vascular processes on fetal developmental outcomes. Finally, we hypothesize that the effects of maternal stress are modulated by the nature, duration, and timing of occurrence of stress during gestation. In this paper, we elaborate on the conceptual and empirical basis for this model, highlight some relevant issues and questions, and make recommendations for future research in this area.

Bruising as a Marker of Physical Elder Abuse

OBJECTIVES: To describe bruising as a marker of physical elder abuse.

Injury patterns and causal mechanisms of bruising in physical elder abuse.

ABSTRACT The recognition of injury patterns can aid forensic nurses to identify victims of elder abuse. This study examined the mechanism of injury of bruises endured by physical elder abuse victims. A sample of 67 elders aged 65 years and older who reported to Adult Protective Services for physical elder abuse was included in the analysis. A research nurse conducted assessments and documented the presence and characteristics of all bruises. Data regarding the abusive incident were collected through victim descriptions and the Revised Conflicts Tactic Scales (CTS2) physical assault scale. The most common bruising locations were the lateral/anterior arms (n = 23, 34.3%), head and neck (n = 10, 14.9%), and posterior torso (n = 7, 10.4%). Victims’ odds of having head and neck bruises were greater when reporting being choked (OR = 7.71, 95% CI [1.29, 45.90], p = 0.039), punched (OR = 13.53, 95% CI [2.55, 71.80], p = 0.001), and beaten up (OR = 5.60, 95% CI [3.26, 74.45], p = 0.001). The odds of having lateral/anterior arm bruises were eight times greater when the victim reported being grabbed (OR = 8.43, 95% CI [2.67, 26.65], p < 0.001). The findings suggest similarities between injuries experienced in elder abuse and those in intimate partner violence. Findings highlight injury patterns that elder abuse victims sustain and can be informative for forensic nurses.

Elder Mistreatment Reporting: Differences in the Threshold of Reporting between Hospice and Palliative Care Professionals and Adult Protective Service

BACKGROUND Underreporting of elder mistreatment by health professionals is a significant problem. PURPOSE To investigate differences in elder mistreatment reporting threshold between hospice/palliative care (HPC) professionals and Adult Protective Services (APS); explore factors for not reporting elder mistreatment. DESIGN Cross-sectional questionnaire. SETTING/PARTICIPANTS Four HPC teams and 42 APS workers in one county. METHODS Five hypothetical elder mistreatment case vignettes along a spectrum of severity were scored on Likert scales for likelihood of reporting or accepting the cases. HPC professionals were surveyed about their knowledge and beliefs about reporting elder mistreatment. RESULTS All 42 APS workers and 74% of 73 (n = 54) HPC professionals completed the survey. In all but the most severe case of abuse, APS was more likely to accept reports of elder mistreatment than HPC professionals were in reporting (p < 0.002). HPC professionals had reported a mean of 2.5 (+/-2.8, standard deviation [SD]) cases in the last 5 years. Thirty percent of HPC professionals had suspected cases of elder mistreatment that was not reported in the last 5 years. The median difference between the total number of suspected and reported cases was 2 (+/-4.6, SD). Eleven percent had ethical concerns about reporting and 63% were concerned about practical consequences of reporting. Only 37% correctly identified the reporting agencies that have jurisdiction over abuse that occurs in long-term care. Correct identification of long-term care reporting agencies correlated with whether the HPC professional had training in elder mistreatment (r = 0.35, p = 0.009). Although 96% would report physical abuse that they witnessed, only 63% would report abuse verbalized by the patient. CONCLUSION There is evidence that significant differences exist in elder mistreatment reporting thresholds between APS and HPC professionals. This finding should encourage HPC professionals to discuss with APS the cases they are unsure about reporting. Future research is need on elder mistreatment in the HPC setting.

Variability in Findings From Adult Protective Services Investigations of Elder Abuse in California

Adult Protective Services (APS) workers in California investigate complaints of elder abuse and must determine the validity of a complaint with minimal guidelines. It is unclear whether APS workers reach similar conclusions given cases with similar circumstances. To assess variation in case findings and reasons for them, we used data from monthly reports of completed investigations, and investigation outcomes from all 58 California counties from September 2004 to August 2005, telephone interviews with 54 of 58 counties, and site visits to 17 counties. We also compared the data from 2004–2005 with more recent data from 2013. Large variability was found from county to county in the proportions of cases found to be conclusive, inconclusive, and unfounded. The combined analyses revealed significant differences in how individual APS workers interpret definitions of different types of case outcomes, varying skill and experience of the APS workers, individual and county agency factors, and other reasons that influence variability in case findings. Widespread inconsistencies in the outcomes of elder abuse investigations raise issues to be addressed on multiple levels, including the use of APS data for developing policy, standardizing training of APS workers, and seeking just outcomes for the victims of elder abuse.

Combating Elder and Dependent Adult Mistreatment: The Role of the Clinical Psychologist

ABSTRACT Among the many different professionals who work to address elder and dependent adult mistreatment, the clinical psychologist performs a function that is not well documented. The experiences of a clinical psychologist attached to a medical response team and an elder abuse forensic center provide insight into this complex and multifaceted role. Case examples from an elder abuse forensic center illustrate the breadth of referral questions that a clinical psychologist addresses. This information may be of use to those who would argue that these services be made widely available to elder abuse professionals such as social workers, public guardians, and those in the criminal justice system. The case studies also may be useful for training purposes.