Gerald J. Jogerst

Domestic Elder Abuse and the Law

OBJECTIVES The authors evaluated the impact of state adult protective service legislation on rates of investigated and substantiated domestic elder abuse. METHODS Data were collected on all domestic elder abuse reports, investigations, and substantiations for each US state and the District of Columbia for 1999. State statutes and regulations pertaining to adult protective services were reviewed. RESULTS There were 190 005 domestic elder abuse reports from 17 states, a rate of 8.6 per 1000 elders; 242 430 domestic elder abuse investigations from 47 states, a rate of 5.9; and 102 879 substantiations from 35 states, a rate of 2.7. Significantly higher investigation rates were found for states requiring mandatory reporting and tracking of numbers of reports. CONCLUSIONS Domestic elder abuse documentation among states shows substantial differences related to specific aspects of state laws.

Elder Abuse Research: A Systematic Review

The purpose of this research was to provide a systematic review of, and assign an evidence grade to, the research articles on elder abuse. Sixteen health care and criminal justice literature databases were searched. Publications were reviewed by at least two independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria; omitting duplicates, 590 publications were annotated and graded.

Statute Definitions of Elder Abuse

ABSTRACT Differences in elder abuse definitions hinder the comparison of research and state elder abuse data (Jogerst, Daly, Brinig et al., in press). The purposes of this paper are to describe and summarize the elder abuse definitions in the state statutes and present current definitions used in practice, education, and research. The definitions of elder abuse for the 50 state and District of Columbia laws addressing protective services for domestic elder abuse were analyzed. No one single term describing elder abuse was used uniformly across all statutes. “Abandonment,” “mental anguish,” “exploitation,” “neglect,” “self-neglect,” and “sexual abuse” were predominant terms used in the statutes. It is unlikely that legislation for the 50 states and District of Columbia would be implemented to change the statutes definitions of elder abuse but it is possible to develop a list of definitions that can be used as model definitions for researchers, practitioners, and for future policy changes.

Factors Associated With Self-Reported Elder Mistreatment in Iowa’s Frailest Elders:

The purposes of this study were to determine associated characteristics of community-dwelling older persons, their access to care and social provisions, and self-reported elder abuse, and to assess how having help in completing a questionnaire affected these associations. A questionnaire was mailed to 1,017 randomly selected elders in the Iowa Medicaid Waiver Program. The overall prevalence of self-reported abuse was 20.9%. Fifty-nine percent of respondents had help completing the questionnaire. Abuse was associated with low social provisions, more emergency room visits, being alone, and not having enough money. For those having help completing the questionnaire, abuse was associated with older age, low social provisions, being alone, and not having enough money. For those having no help completing the questionnaire, abuse was associated with depression, being alone, more emergency room visits, and low social provisions. Among community-living elders needing services in their homes, the prevalence of abuse was higher than that found in general population studies.

Iowa Family Physician's Reporting of Elder Abuse

ABSTRACT Purpose: To determine family practice physicians knowledge of state laws regarding elder abuse, perceived barriers to reporting suspected cases of elder abuse, and factors associated with reporting elder abuse in practice. Methods: Mailed questionnaire to 1,030 Iowa Academy of Family Practice Physicians with 378 (37%) returned. Chi-square tests modified for trend and stepwise logistic regression were used to determine influences on whether physicians saw a case of elder abuse in the past year, and whether physicians chose to report those cases. Results: A strong predictor for number of cases seen and if cases had been reported, was the physician asking the elderly patient direct questions about elder mistreatment. Other positive associations were if the physicians office had a protocol for reporting elder abuse, and if physicians lived in the most rural areas. Conclusion: Knowledge of elder abuse legislation increases physician likelihood of reporting elder abuse, but not of seeing cases of elder abuse, so education alone is not the answer to increase physician ability to detect elder mistreatment.

Exploring Self-Neglect in Older Adults: Preliminary Findings of the Self-Neglect Severity Scale and Next Steps

Despite the public health implications of self‐neglect, no tool exists for characterizing this condition. Self‐neglecters often have no caregivers or surrogates to interview regarding the neglect and are often too cognitively impaired to provide valid self‐reports. In response to this need, researchers from the Consortium for Research in Elder Self‐neglect of Texas (CREST) collaborated with other experts in the field of elder self‐neglect to design the Self‐neglect Severity Scale (SSS). The SSS assesses three domains of self‐neglect (hygiene, functioning, and environment) and relies on observational ratings assigned by trained observers. After pilot testing and revision, the SSS was field tested in the homes of subjects who had been reported to and substantiated by Texas Adult Protective Services (APS) as self‐neglecting and compared with results of subjects recruited from a local geriatric clinic who were reported to APS but had no history of self‐neglect.

National Elder Abuse Questionnaire: Summary of Adult Protective Service Investigator Responses

ABSTRACT The purpose of this paper is to characterize investigative structures and investigator characteristics for each APS office in all 50 states and the District of Columbia. Through mailed questionnaires and follow-up telephone calls, 1,409 questionnaires were completed for a return rate of 80%. The mean age of respondents was 46.4 years and ninety-nine percent of the respondents worked full-time and has been in his or her current position for an average of nine years. Half of the respondents reported using abuse screen or risk factor instruments when investigating an alleged elder abuse report. Seventy-three percent reported that they investigate only adult and elder allegations. Sixty percent of the respondents reported that a formal training program for elder abuse evaluations was in place for employees with an average length of two to four days. Sixty-nine percent of the investigators consider an elder to be “better off” most of the time following intervention, and that this improved status was a direct result of the resources provided. Nearly three-fourths of investigators reported that elder abuse was under reported in their area. Those on the front lines, the APS investigators, provide valuable insights regarding the systems in which they work.

APS Investigative Systems Associated with County Reported Domestic Elder Abuse

ABSTRACT Objectives: To evaluate the association between state-defined elder abuse investigation systems and rates of reported, investigated and substantiated domestic elder abuse. Methods: A mailed survey was administered to 1,763 adult protective service (APS) office investigators in 44 states and the District of Columbia. Information about investigative structures and investigations was obtained from 1,409 of the APS investigators, an 80% return rate. County/district domestic elder abuse report, investigation, and substantiation numbers for each state for 1999 was obtained for APS state administrators. Results: Elder abuse reports to APS offices ranged from 0 to 191.7 per 1,000 elder population. Investigation and substantiation rates ranged from 0 to a high of 150.0 and 116.7, respectively. Investigation rates were higher in counties having investigators only evaluating elder abuse cases, having a social work educational background and feeling that the elders were usually better off after investigation. Longer length of training programs for investigators was associated with high substantiation rates. Discussion: Differences in investigative structures do impact the rates of identified elder abuse. Elder abuse should be examined at the county level to distinguish both state and county/district differences in reported, investigated, and substantiated elder abuse.

Ombudsman Program Characteristics Related to Nursing Home Abuse Reporting

Abstract The purpose of this research is to determine if there is an association between ombudsman report rates of abuse, gross neglect, and exploitation from 1997 through 2002 and ombudsmens public and staff education, investigative process, program expenditures, and census demographics. Data were obtained from the National Ombudsman Reporting System. Ombudsman annual reports of nursing home abuse, neglect, and exploitation are representative of that states individual program. These reports should not be construed to represent all abuse in nursing homes. Physical abuse and resident-to-resident abuse were the highest rates of abuse reported. Census demographics and ombudsman program characteristics were associated with rates of abuse.

State Policies and Nursing Home Characteristics Associated With Rates of Resident Mistreatment

BACKGROUND A federal complaint/incident system was implemented in 2004 with the stated purpose of promoting and protecting the health, safety, and the welfare of residents receiving health care services. This system provided the first national database of mistreatment in the nursing home setting. METHODS The purpose of this research was to identify state and nursing home characteristics associated with the rates of nursing home resident mistreatment. Outcomes were incident reports filed by nursing home staff and complaints filed by persons other than service providers obtained from the federal complaints/incidents tracking system. Predictor variables used in the analysis of the reporting system included state legislation, census demographic data, and characteristics of the nursing home including aggregate characteristics of the residents. RESULTS In 2004, based on complaint and incident reports, 1.6% of the nursing home population was reported to be mistreated. The average rates per 1000 residents were 16 reports, 14 investigations, and 4 substantiations. Incident report rates per 1000 ranged from 0.04 in Virginia to 46 in Alabama. Complaint report rates ranged from 0.42 in Hawaii to 52 in New Mexico. Incident outcomes were significantly lower in states that had nursing home statutes that require the facility, rather than the individual, to report mistreatment or in states that defined mistreatment in the nursing home differently from the definitions used by adult protective service statutes. Higher complaint outcomes were associated with lower levels of staffing. After controlling for resident characteristics, mistreatment measures remained associated with nursing home staffing levels but not with elements of statutes. CONCLUSIONS Documentation of nursing home mistreatment shows substantial differences in report rates across states. These differences cannot be explained by variations in the laws.