Elder Abuse Awareness - Lori Mars, JD, LLM

Disclaimer: Unedited AI Transcription

Announcer (00:06):

You are connected and you are listening to specifically for seniors, the podcast for those in the Remember When Generation. Today's podcast is available everywhere you listen to podcasts and with video at specifically for seniors YouTube channel. Now, here's your host, Dr. Larry Barsh

Larry (00:38):

Today's podcast is being recorded on June 15th, world Elder Abuse Awareness Day. We at, specifically for seniors and our guests from the National Center on Elder Abuse, encourage you to share this episode of the podcast with friends and relatives who know an older adult who may be in jeopardy. We are honored to have as our guest on specifically for seniors today, Lori Mars, j d l l M, the Deputy Director of the National Center on Elder Abuse. Lori is an assistant professor of Clinical Family Medicine in the Department of Family Medicine at the Keck School of Medicine at U S C After practicing law for more than 20 years, Lori's concentration lies at the intersection of law, aging, and elder abuse. She has a master's degree in law in alternative dispute resolution, and serves as a volunteer long-term care ombudsman. She is passionate about elder justice and advocating for the rights of all older adults to live with dignity and respect. Welcome to specifically for seniors, Lori.

Lori Mars (02:13):

You so much, Larry, for inviting me on behalf of the National Center on Elder Abuse, to appear on your podcast. It's truly an honor to be here with you today and to acknowledge and celebrate World Elder Abuse Awareness Day.

Larry (02:27):

Who and when was World Elder Abuse Awareness Day designated?

Lori Mars (02:34):

So the World Elder Abuse Awareness Day was launched in 2006 by a Canadian researcher, Dr. Elizabeth Nyak, in collaboration with the International Network for the Prevention of Elder Abuse. And then in 2011, the Awareness Day was formally recognized by the World Health Organization and the United Nations. And its, its purpose is to provide an opportunity for communities around the world to promote awareness of elder maltreatment in the hopes that awareness will lead to action and to the end of the abuse and neglect of older people.

Larry (03:12):

Tell us about the National Center on Elder Abuse. What's its Mission Gold Objectives?

Lori Mars (03:21):

The National Center on Elder Abuse is one of nine elder justice resource centers funded by the Administration for Community Living, which is part of the US Department of Health and Human Services. And as you mentioned earlier, we're housed at the Keck School of Medicine of the University of Southern California, and we provide the latest information and resources on research training policy and best practices in intervention elder mistreatment. And more specifically, we house a comprehensive publications and research repository. We synthesize and disseminate evidence-based practices. We curate web website content, and we host webinars. In fact, we hosted a, a very successful webinar in trauma-informed care for World Elder Abuse Awareness Day. And we also foster state and national collaborations to advance elder rights and justice. We also have a tremendous amount of training materials for professionals and consumer facing materials for the public. And we do have a helpline for professionals and the public. If they have any questions and they need resources or information, we're happy to assist them.

Larry (04:33):

Do you want to give us the number of that helpline?

Lori Mars (04:36):

It's 8 5 5 503 5 3 7. Now, we don't take direct reports of abuse that would go directly to Adult Protective Services or long-term care ombudsman or to law enforcement, but we can answer general questions.

Larry (04:58):

Let's get to the basics of elder abuse. What, what do you define as elder abuse?

Lori Mars (05:06):

Well, a, according to the Centers for Disease Control and Prevention, elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult. And under that definition, an older adult is defined as someone age 60 or older, and the abuse typically occurs at the hands of a caregiver or person. The older adult trusts in each state has its own statute defining what constitutes elder abuse and the various types of elder abuse. But it's important to understand that in addition to statutory definitions of maltreatment, cultural contextual and interpersonal perceptions of what constitutes abuse vary. So what, what one person may consider to be abuse may be different from what another person may think of as abusive. So, and these cultural con and conceptual understandings vary among different communities, and they can result in diverse definitions, perceptions of, and responses to maltreatment.

Larry (06:12):

So what are the most common types of abuse?

Lori Mars (06:16):

The most common types of abuse are physical abuse, psychological or emotional abuse, sexual abuse, financial abuse and neglect. Okay. So physical abuse is the use or application of physical force or coercion that may result in injury. And some examples may include hitting, beating, biting, kicking. It's, it's not an exhaustive or an exclusive list, just some examples, but also within the definition of physical abuse is any unlawful un unnecessary or excessive use of physical or chemical means to restrain or confine an older adult. And this can include force feeding someone overmedicating or under medicating or any form of physical punishment for the next category I mentioned emotional or psychological abuse. That's the infliction of anguish, pain or distress through verbal or non-verbal acts. And that can include insults, intimidation, harassment that sort of thing. Again, not an exclusive list. And sexual abuse is non-consensual sexual contact of any kind, including unwanted touching sexual harassment, and a sexual interaction with an older adult who lacks the capacity to consent for neglect. It's the refusal or failure to perform all or part of one's duties to an older person. And that can include failing to provide for food, clothing, shelter, medication management, hygiene and financial abuse is the misappropriation of someone's money, property or assets.

Larry (08:06):

And neglect itself is an outstanding problem of abuse.

Lori Mars (08:15):

It is, correct. It it, it absolutely is. And you bring up a related point, which is self neglect which is a related concept where individuals like the ability to care for their own medical or healthcare needs, and that's also a very big problem. It's the most commonly reported issue to adult protective services. And I should also mention that, that even though there are these discrete forms of abuse, they often can co-occur or occur sequentially over time. So, and that's called polyvictimization.

Larry (08:55):

In addition to the common types of abuse, there are certain risk factors for elder abuse as well. We've talked about on this podcast a number of times about the problem of ageism, but what are some of the others?

Lori Mars (09:16):

Okay, yeah, thank you for asking that question. Yeah, risk factors are are significant in elder abuse. And the way we view risk factors is through a model called the Abuse Prevention Intervention Model. It was developed by the director of the National Center on Elder Abuse, Dr. Laura sda, who's a geriatrician in collaboration with Dr. Bonnie Olson, JS psychologist and professor at Keck usc. And the model posits three domains. If you'd look at a pie chart and you divide that in three, one would be the vulnerable older adult, another section would be the trusted other. And then the third domain would be the context of their relationship. So for the vulnerable older adult section, there are certain risk factors that independently and in connection or relationship with any other risk factors could indicate an increased likelihood of exposure to abuse. So for that older adult domain, chronic medical and mental health conditions physical frailty functional deficits, cognitive impairment social isolation is a big one.

Lori Mars (10:34):

And poor coping mechanisms and skills. And then turning now to the trusted other domain, a lot of those indicators that I mentioned for the vulnerable older adult, they can also be applied to the trusted other domain. But what we also see in that domain is a trusted other who has substance abuse issues or who is financially or emotionally dependent on the older adult. And then we take those two sections and look at the context of their relationship. How connected socially are each of these two individuals to different community assets and resources. What is the culture of that relationship and what does that relationship look like? What, what has that relationship look like over time? For example, it could be in a older adult and an adult child and perhaps in early childhoods that they, or through the course of their relationship, they had a strange relationship and that could portend difficulties in later life if the older adult has caregiving needs and the adult child perhaps has latent or maybe not so latent anger or hostility.

Lori Mars (11:44):

So this can manifest. So looking at this model, the abuse prevention intervention model, which has been used with law enforcement, with judges, attorneys, and in different domains, what's really, I think, significant about the model is that we can identify those risk factors that are modifiable and those that are non-modifiable. And for the modifiable risk factors, there are interventions that can be applied in order to potentially reduce the risk of abuse. So for example, for the older adult domain, I mentioned that social isolation is a risk factor. If we can connect that person with community-based resources and supports and assistance, then they have that connectedness, they have that network that can be a protective factor and hopefully reduce the likelihood of abuse occurrence for the tru trusted. Other. I mentioned that substance abuse is a risk factor if that person gets help, treatment therapy, that could also reduce the likelihood of abuse occurrence or exposure to abuse. There are some risk factors that are non-modifiable, like dementia is a progressive and degenerative disease, and there's no cure. But even in cases where someone has dementia, there may be mechanisms to alleviate the situation in, in some way, provide caregiver respite, offer medication or therapies or treatment that can help reduce the likelihood of abuse and you know decrease that the, that association between those two.

Larry (13:30):

How, how prevalent is this? Especially in the United States?

Lori Mars (13:37):

It's actually, elder abuse is much more prevalent than one might think. It's estimated that one in 10 older adults experience some form of abuse each year. And half of the people, half of the 6 million people with dementia will experience some form of abuse. But what's even more compelling and troubling is that only one out of 24 cases of abuse is ever reported to authorities. Which means that most people who live with abuse are not getting the supports and resources they need to prevent abuse or mitigate harms. And that's a real concern. And there's lots of reasons for non-report. And I, I can go into a few of them. And one is, and I guess the primary reason is that much abuse is committed by people we know. People in our world trusted others family or chosen family caregivers and older adults are very reluctant to report family abusers.

Lori Mars (14:41):

They, they have, this is a, a sense of shame and embarrassment and stigma that's attached. So there's an unwillingness to report. Older adults may also be reliant on a family member chosen family caregiver for food, clothing, and shelter. And they may be concerned, number one of retaliation if they report, but number two, they may be concerned that they'll be evicted or left homeless or placed in a, in a nursing home. Another big concern also isolation and loneliness is a big issue. And the Surgeon General just issued a report in May about social isolation and loneliness across the lifespan. And this certainly has an impact on older adults. There are other reasons as well. Some older adults may lack the capacity to report abuse when it occurs and they may lack the facility to communicate it to the appropriate authorities. So lots of reasons.

Lori Mars (15:41):

And another reason is older adults may be protective of a loved one. They may not want to report them and expose them to any type of criminal liability. So there are lots of factors that family that go into this, these family dynamics and decisions. Not to report, but in terms of going back to the prevalence issue that you asked me at the beginning the prevalence of abuse actually increased during covid. So whereas it was one in 10 before it went to one in five during the pandemic, which given the circumstances of the pandemic is not surprising with compulsory quarantining lots of financial strain, social strain, families, cohorting increased caregiver burden and less access to resources in the community. So unfortunately the, the instance of abuse did, did rise during that period of time.

Larry (16:45):

Are there ways we can prevent this from happening?

Lori Mars (16:50):

I mean, there are things that we can do. I mentioned that social support is a key risk factor. So to the extent that we're able to provide individuals with that social support, connectedness, faith family friend networks, that's, that can be very protective on the front end to as a force to prevent abuse from occurring in the first place. And even if abuse has occurred, having those networks in place can be protective and can somewhat blunt the adverse impact of, of abuse or the aftermath of abuse. So social support is one thing. Consumer education and awareness, podcasts like this, creating awareness so people understand the risk factors involved, understand the prevalence and can become aware of it. Financial literacy is really important. Developing an advanced planning tools or advanced planning toolkits, so planning healthcare documents arranging for powers of attorney, things like that, that can be helpful also to be protective of older adults in later life.

Larry (18:06):

The question comes up, if someone just suspects abuse but really isn't sure, but is concerned for the older adult, what should they do?

Lori Mars (18:20):

That's a, a really good question cuz the people sometimes are unsure. There are people who are mandated reporters and that's designated by state and they must report abuse if they see or suspect it. But anyone who observes abuse, if someone is being abused, they can, they should report it. If someone even just suspects that abuse is occurring, they should report it in the community to Adult Protective Services, which is the social service agency that investigates allegations of abuse and neglect. And if there's abuse and facilities, they can report to the long-term care ombudsman who act as resident advocates and act at the behest o of residence and can investigate complaints. Of course, if someone sees abuse occurring, they can call law enforcement directly and immediately to prevent i imminent harm.

Larry (19:22):

But a reporter doesn't have to be a hundred percent sure.

Lori Mars (19:27):

No, no, no, no. Adult Protective Services or long-term Care ombudsman or police will investigate. They can conduct a welfare check, they can check in on the older adult, but it's, it's a very important issue if you suspect it, report it.

Larry (19:46):

How does somebody get in touch with an ombudsman?

Lori Mars (19:50):

So they can contact the the national consumer voice for quality long-term care. They can contact their local agency through that organization. There's also a website called Elder Care Locator, which is fantastic and it provides access to all kinds of resources, not just reporting resources like APS and the Ombudsman, but also it provides access to local legal aid and other supportive services like area agencies on aging aging and other agencies that could be helpful for older adults. So that would be a terrific resource and it's on our website also. So if someone wants to access our website or give us a call on our helpline, we'd be happy to make those referrals.

Larry (20:46):

And your website is what?

Lori Mars (20:52):

Nca.Acl.Gov.

Larry (20:55):

Okay, good. And would you repeat your phone number again?

Lori Mars (21:01):

The, and again, I just wanna make sure that people understand it's a helpline, it's not a hotline. We don't take direct reports of abuse, but we can make referrals and recommendations and provide information. And that number is 8 5 5 503 5 3 7.

Larry (21:21):

What else should we know? What did we miss? Anything?

Lori Mars (21:25):

We could talk about the signs of abuse that people might observe. There are physical signs, there are emotional and psychological signs and financial signs, and it's also important to differentiate these, each of these signs that I'm gonna talk about with other causal factors because, for example, for physical abuse, malnutrition and dehydration may be a sign of abuse, but it could also be a sign of a medical condition or maybe depression or, or some other causal sore. So it's important to differentiate those. But like I said, malnutrition and dehydration bruising and, and pressure ulcers, those can potentially be signs of abuse. In fact, the director of the National Center on Elder Abuse, Dr. Laura Moda, I mentioned earlier, she's a geriatrician. And a number of years ago, she conducted a series of of research studies to differentiate accidental from intentional abuse.

Lori Mars (22:31):

And the studies revealed that accidental abuse, I mean, accidental bruising will more likely occur on the arms or on the legs. Intentional harm will be more often observed as larger bruises on the face, on the chest in the genital area. There may be patterns of bruising. I mean, there may be like a pattern of like a hand print on someone for abuse. So it's important to understand those kinds of factors and, and those kinds of signs that if you see those signs and may alert you to think that it's potentially there could potentially be abuse. But there are other physical signs like unusual weight loss, or it could be a missing glasses or a wheelchair or a walker, things like that. There are signs of emotional abuse and this isn't an exhaustive or an exclusive list, but it could be someone who is withdraws from society or someone who has anxiety or depression or loses sleep.

Lori Mars (23:39):

And especially with emotional abuse, we all, I think, express and experience whether it's abuse or, or other types of occurrences differently. So each people may express these signs in different ways. So if you look at the individual and you see that the patterns of behavior that you're observing now are different then the patterns that you've observed in the past, that may be an indicator that something else is going on, that there potentially may be abuse that's present. And again, there's, you know, a wide variety of things that would qualify as examples under this category, but just some of those that I've mentioned before for financial abuse unpaid bills could be an indicator and expenditure of funds that's atypical or uncharacteristic of a prior course of behavior. A new will or new signatures on dispositive documents that are atypical or uncharacteristic, those could be signs of abuse as well.

Lori Mars (24:45):

And the other thing that we didn't talk about is the impact of abuse. So as you can well imagine, and your listeners can well imagine, the impact of abuse can be quite severe. And it often depends on the type of abuse, but it abuse can result in, in physical harm, in mental health consequences like anxiety and depression. Abuse can also result in a higher mortality rate. Those people who have been ex who have experienced abuse have a three times higher mortality rate than those who have not experienced abuse, which is quite significant. Other indicators could be like, again, like withdrawal, it could be certainly financial abuse, billions of dollars a year or lost in in incidents of abuse. There could be a functional decline. Poverty, homelessness and increased disability.

Larry (25:44):

W we've talked on this podcast with a journalist named Diane Diamond who's coming out with a book in the fall on senior guardianship. And, and that's a form of abuse as well.

Lori Mars (26:03):

Guardian guardianship is a very complicated issue. It can be a mechanism for abuse, but sometimes guardianship may be appropriate. It's always considered a remedy of last resort, so it's extremely important to consider all other least restrictive alternatives to guardianship. In fact, we have some literature on our website, about least restrictive alternatives to guardianship, which may be of interest to your, to your listeners and viewers, but yeah, but it's, it's a very complicated issue and it's, like I said, it is a remedy of last resort.

Larry (26:48):

It becomes a problem, I assume, when an older adult is not able to be responsible for their own financial, medical solutions to their problems.

Lori Mars (27:04):

It's, it's an issue that relates to capacity. I'm not an expert in capacity. We do have experts in capacity at the Keck School of Medicine. But we, it's always important to remember to for adults to have to exercise self-determination and to express their preferences and values whenever possible. And again, I would go back to the least restrictive alternatives that are available. So, and each situation is unique and different and has to be a judge based upon the, the circumstances and the context of that particular situation. I would also say that guardianship can be plenary which means all embracing, but there are also opportunities for limited guardianships and restricted guardianships. So if all less restrictive alternatives have been exhausted then there are other opportunities. I will tell you that at the Keck School of Medicine, we have a vibrant and terrific research department.

Lori Mars (28:14):

And one research study that we did work on was to develop a tool for judges across the country to assess the risk of abuse in guardianship cases which can be used before guardianship guardianships are ordered and even after they've been ordered. But the tool that we developed and I was part of that study as well, Dr. Bonnie Olsen led that study. It was funded by the Department of Justice. The tool that was developed provides within it options for less restrictive alternatives and helps judges understand that there are a number of other remedies and to at least vet and to question and things that they should do before issuing a, a final order or even an order for limited guardianship or conservatorship, depending on the state. Different terms are used by different states.

Larry (29:13):

What I've learned from this discussion, and I thank you for it, is that the problems involved with elder abuse are more complex than most of us think they are. We, we tend to believe that elder abuse is someone striking an older person, but the complexity involved is really encompassing a lot of different aspects.

Lori Mars (29:55):

That's true. It is, it's very complex, multifactorial, and I didn't mention one response to elder abuse, which I would like to because it is an evidence-based practice and it's called the multidisciplinary team. And these come into play when after abuse typically has occurred. But multidisciplinary teams are growing across the country and their convenings of experts across disciplines who like adult protective services, ombudsman, police, civil attorneys, public guardians, victims, advocates and they come together to address these complicated cases of abuse to provide case review and recommendations. And they're extremely helpful in analyzing and, and helping older adults come to resolutions that are hopefully person-centered and, and trauma-informed and culturally appropriate and, and fit the need

Larry (30:56):

Worry. Thank you so much for being on specifically for seniors and for this critical information you shared. As I mentioned at the beginning of the podcast, I hope that this will be shared with friends and relatives who may have an older adult in their circle of friends who may be in jeopardy. Thank you. Thank you so much for coming on.

Lori Mars (31:23):

Thank you. Thank you so much, Larry, for giving us this opportunity. And one thing I would add is that I think that this information is important not just for older adults, but for everyone because the response to elder abuse, to ending elder abuse is a collective communal response. And it's really for all of us at every age to intervene and to get involved in, in this cause and concern.

Larry (31:50):

Thank you again, Laurie.

Speaker 4 (31:53):

Thank you so much.

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