New England Journal of Medicine Addresses “Epidemic” of Elder Abuse

http://www.nejm.org/doi/full/10.1056/NEJMra1404688#t=article

Renowned Cornell educators and specialists in geriatric medicine, Mark S, Lachs, M.D., and Karl A. Pillemer, PhD, have an important review essay in the current issue of the New England Journal of Medicine on “Elder Abuse” (linked above).  The authors articulate roles for physicians and health care staff as the first line of help for many older persons who are victims of elder abuse, including the “virtual epidemic” of financial exploitation.  From the introduction:

In the field of long-term care, studies have uncovered high rates of interpersonal violence and aggression toward older adults; in particular, abuse of older residents by other residents in long-term care facilities is now recognized as a problem that is more common than physical abuse by staff. The use of interdisciplinary or interprofessional teams, also referred to as multidisciplinary teams in the context of elder abuse, has emerged as one of the intervention strategies to address the complex and multidimensional needs and problems of victims of elder abuse, and such teams are an important resource for physicians. These new developments suggest an expanded role for physicians in assessing and treating victims of elder abuse and in referring them for further care.

 

In this review, we summarize research and clinical evidence on the extent, assessment, and management of elder abuse, derived from our analysis of high-quality studies and recent systematic studies and reviews of the literature on elder abuse.

One of the perhaps surprising observations in the article is that the “young-old” actually have a higher potential to become victims of abuse than the “old-old,” in part because they are most likely to be living under the control of a spouse or adult child, the most often-identified perpetrators.

Further, the authors advise that “the most important tasks for the physician are to recognize and identify elder abuse, to become familiar with resources for intervention that are available in the local community, and to refer the patient to and coordinate care with those resources.”  The article includes community services and organizations that may provide help to victims.

I was especially interested to see the authors’ thoughts on the importance of interdisciplinary teams, especially given my own law school’s current involvement in creating a Medical Legal Partnership Clinic.  The authors write:

The most promising response to the complex nature of cases of elder abuse has been the development of interprofessional teams. Evidence suggests that interprofessional teams, also referred to as multidisciplinary teams, consisting of physicians, social workers, law-enforcement personnel, attorneys, and other community participants working together in a coordinated fashion, are the best practical approach to assisting victims.

Our thanks to “devoted reader” Professor Dick Kaplan, University of Illinois Law, for providing us with early notice of this important article.