IRVINE – On any night in Orange County, a child or woman may suffer abuse, neglect or exploitation, while down the street a vulnerable elder endures mistreatment by a caregiver or other person in a trust relationship.
The situation involving the child or female will attract the most attention, but elder advocates are encouraged that there is growing awareness of elder abuse, particularly with the national health reform law addressing elder abuse issues and the observation of World Elder Abuse Day last month.
"We say elder abuse is 20 years behind both domestic violence and child abuse," said Mary Twomey, co-director of the Center of Excellence on Elder Abuse & Neglect. The geriatrics program at UC-Irvine's School of Medicine houses the center.
"Elder abuse is finally getting the attention it deserves. People don't like to talk about getting old and about crimes against older people," Twomey said.
Celebrating five years of operation, the first-of-its-kind center -- established with a grant from the local Archstone Foundation -- has become a central, statewide source of technical assistance, best-practice information, multidisciplinary training, research and policy issues.
The Colors of Abuse
Unprecedented research from UCI's geriatrics experts examines the issue of inflicted elder bruising, often considered an unpleasant, misunderstood subject. "That information is answering basic questions for the first time in the field," said Twomey.
The three studies, under the direction of UCI gerontologist Aileen Wiglesworth, show that the cause of bruises can be remembered by most seniors, even those with memory disorders. A bruise can be almost any color on the day it appears, and it's nearly impossible to tell the age of a bruise by its color.
"The study to identify bruising patterns in older adults subjected to elder abuse is an important tool for law enforcement, Adult Protective Services and the (state's long-term care) ombudsman to protect our most vulnerable seniors," said Lynn Daucher, director of the California Department of Aging. "I am particularly proud that this effort has originated in Orange County."
The time for increased awareness of elder abuse has come, according to Carol Mitchell, program manager for Orange County Adult Protective Services. She said reports received by APS increased by 188% from 1994 through 2009. They continue to steadily increase, up from almost 4,000 in 1999 to nearly 7,000 last year. There were approximately 700 reports in both April and May this year.
"There is more awareness, and times are really hard for some people," said Mitchell. "People are calling; people are reporting."
Experts estimate that for each incident reported, five others are not. Nearly two million older Americans are abused each year, and studies show that between 2% and 10% of the nation's older adult population experiences abuse, neglect, financial exploitation or self neglect each year.
Abuse occurs in private homes, as well as commercial institutions. The most common type of abuse reported is self neglect, the failure to provide for one's own care. Individuals abused by others are most likely to have been neglected or financially abused, or both. The vast majority of abusers are relatives of the victims. The incidence of elder abuse increases significantly with age, with those ages 85 and older six times more likely to be suffering from abuse than those ages 65 to 69.
"We have a lot of support," Mitchell said, but with 43 social workers and seven supervisors, she's working with 17% fewer employees than she did in 2008. "They're great, well-trained," she said, "but we're unable to grow to meet the demand. We are, however, better prepared and equipped to deal with the problem."
Mitchell's office plays weekly host to the Orange County Elder Abuse Forensic Center, another first-of-its-kind effort. The center is an independent arm of UCI's Center of Excellence and is dedicated to changing how abuse cases are investigated. Following an initial documentation, law enforcement, social workers, a geriatrician and neuropsychiatrist join forces. Representatives from nine local agencies work in a multidisciplinary team. UCI and APS are joined by the office of the district attorney, sheriff's department, public administrator/public guardian, the Anaheim Police Department and others.
"Our meetings provide consistency. Before, we'd have to muddle our way through the process," said Delrey McKenzie, veteran investigator for the Special Victims Detail of the Orange County Sheriff's Office. "Now we ask, as conscientious participants, 'How can we best triage this situation?'"
With UCI's center as a focal point, combined efforts of people sharing contacts and skills are putting a strong Band Aid on a problem that can otherwise feel mind-boggling to those dealing with it, McKenzie said.
No Time to Waste
"There's no way to know how many people are abused in America -- it's not just a Blue State or Red State issue," Twomey said.
The landmark, bipartisan Elder Justice Act, signed into law March 23 as part of health care reform, establishes new guidelines for dealing with elder abuse. "Now, we need to rally the troops. Now the real slugfest (to get funds appropriated to implement the law) starts," Twomey said. "Anything is better than what we had, which is nothing from a policy perspective. Ours is a small piece, but for us it's the biggest thing since Lady Gaga's last outfit."
The biggest thing will be procuring funding, according to Marie-Therese Connolly, an author of the act, attorney and elder abuse expert. Connolly -- a Woodrow Wilson senior scholar; former coordinator of the Elder Justice and Nursing Home Initiative with the U.S. Department of Justice; and director of the newly created advocacy group Life Long Justice -- has been involved with elder abuse for years, including participating in early drafts of the legislation almost a decade ago.
"We know a lot more now than when the law was written in 2002," Connolly said.
She said the legislation has the potential to safeguard individuals through the development of elder forensic centers, enhancing forensic capacity and coordinating agencies and disciplines.
Only part of the original Elder Justice Act survived to be included in the national reform law. Missing are provisions that were designed to improve the knowledge base through research, data collection and development of centers of excellence; to create emergency safe havens; to enhance law enforcement and justice system capacity to address elder abuse; and to expand training in some areas.
The UCI Center of Excellence, Connolly said, is a great example of what can be accomplished when a good idea and an understanding funder -- Archstone Foundation in this case -- come together. But, Connolly pointed out "success also requires a dynamic individual who has expertise, motivation, can inspire other people and put together a great team." She called UCI Program Director Laura Mosqueda "a significant leader and visionary, one of four leading geriatricians in the field and a dynamic force among collaborative partners."
"I've had enough of this attitude that, 'It's not abuse; he's just old, and old people bruise easily or fracture easily,'" Mosqueda said in a prepared statement. "It's time for us to stop thinking this way."
Connolly couldn't agree more. "We're a long way from where we need to be to deal with the rising risk of elder abuse due to the looming 'trifecta' of an aging population, more people with dementia and acute shortages of caregivers."
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