Laura Mosqueda

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.

Bruising as a Marker of Physical Elder Abuse

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

Elder Abuse and Self-neglect: “I Don't Care Anything About Going to the Doctor, to Be Honest. . . . ”

Elder mistreatment encompasses a range of behaviors including emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. This article discusses the range of elder mistreatment in community-living older adults, associated factors, and consequences. Although self-neglect is not considered a type of abuse in many research definitions, it is the most commonly reported form of elder mistreatment and is associated with increased morbidity and mortality. The case on which this article is based describes a 70-year-old woman who neglects herself and dies despite multiple contacts with the medical community. Despite significant gaps in research, enough is known to guide clinical practice. This article presents the practical approaches a health care professional can take when a reasonable suspicion of elder mistreatment arises. Public health and interdisciplinary team approaches are needed to manage what is becoming an increasing problem as the number of older adults around the world increases.

Does risk adjustment of the CMS quality measures for nursing homes matter

Background:The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment. Objectives:To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings. Research Design:Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were used to estimate risk adjustment models for 5 outcomes: pressure ulcers for high and low risk patients, physical restraints, and pain for long- and short-stay patients. These models were used to create 5 QMs with extended risk adjustment, enhanced QMs (EQMs). The EQMs were compared with the corresponding QMs. Subjects:All (17,469) nursing homes that reported MDS data in the period 2001–2005, and their 9.6 million residents. Measures:QMs were compared with EQMs for all nursing homes in terms of agreement on outlier identification: Kappa, false positive and false negative error rates. Results:Kappa values ranged from 0.63 to 0.90. False positive and negative error rates ranged from 8% to 37%. Agreement between QMs and EQMs was better on high quality rather than on low quality. Conclusions:More extensive risk adjustment changes quality ranking of nursing homes and should be considered as potential improvement to the current QMs. Other methodological issues related to construction of the QMs should also be investigated to determine if they are important in the context of nursing home care.

The life cycle of bruises in older adults

Objectives: To summarize the occurrence, progression, and resolution of accidentally acquired bruises in a sample of adults aged 65 and older. The systematic documentation of accidentally occurring bruises in older adults could provide a foundation for comparison when considering suspicious bruising in older adults.

Elder Financial Abuse: An Evaluation Framework and Supporting Evidence

Objectives: To develop a valid and reliable framework for evaluating cases of alleged elder financial abuse.

Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.

Person‐centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed‐upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient‐centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most‐prominent domains of PCC were holistic or whole‐person care, respect and value, choice, dignity, self‐determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound—with many commonalities and some overlap—the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment.

The Prevalence of Elder Self-Neglect in a Community-Dwelling Population Hoarding, Hygiene, and Environmental Hazards

Objectives: To examine the prevalence of self-neglect and its specific behaviors in a community-dwelling population of older adults. Method: A population-based cohort study conducted between 2007 and 2010 rated participant’s personal and home environment, particularly with regard to hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Prevalence estimates were presented across health-related variables of health status, physical function, and cognitive function. Results: There were 4,627 older adults (1,645 men and 2,982 women). Prevalence of self-neglect in older adults increased with lower health status in both men (4.7% in very good/excellent health, 7.9% in good health, and 14.9% in fair/poor health) and women (4.5% in very good/excellent health, 7.9% in good health, and 10.6% in fair/poor health). For those with ≥3 Katz impairments, the prevalence of self-neglect in older adults was 12.8% in men and 13.8% in women. For those with MMSE (Mini-Mental State Examination) ≤20, the prevalence of self-neglect in older adults was 18.8% in men and 13.6% in women. Discussion: Self-neglect was clearly prevalent among older adults, especially among those with lower health status and physical and cognitive function.

Elder Abuse Forensic Centers

Elder abuse forensic centers present a new model of multidisciplinary collaboration on elder abuse cases. The “clients” of a forensic center are Adult Protective Services (APS), law enforcement, and the Long-term Care Ombudsman. Centers take the basic multidisciplinary team model and add a geriatrician and a psychologist. Additionally, forensic center team members make home visits with APS and others for the purposes of conducting psychological or medical evaluations, lessening the burden of multiple interviews for the alleged abuse victims, and gathering evidence for possible prosecution. The challenges and successes of the four California forensic center teams are discussed.

What Is a Geriatrician? American Geriatrics Society and Association of Directors of Geriatric Academic Programs End-of-Training Entrustable Professional Activities for Geriatric Medicine

Entrustable professional activities (EPAs) describe the core work that constitutes a disciplines specific expertise and provide the framework for faculty to perform meaningful assessment of geriatric fellows. This article describes the collaborative process of developing the end‐of‐training American Geriatrics Society (AGS) and Association of Directors of Geriatric Academic Programs (ADGAP) EPAs for Geriatric Medicine (AGS/ADGAP EPAs). The geriatrics EPAs describes a geriatricians fundamental expertise and how geriatricians differ from general internists and family practitioners who care for older adults.