Federal effort tackles abuse of elderly

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A federal report calls for additional efforts to reduce abuse against the nation’s oldest citizens.
A federal report calls for additional efforts to reduce abuse against the nation’s oldest citizens.

Elder abuse is inflicted upon many of the more than 2 million Americans in long-term care settings, and more oversight is needed, according to a government report published Wednesday. 

“The Elder Justice Roadmap” defines elder abuse as any “physical, sexual and psychological abuse, as well as neglect, abandonment and financial exploitation.”

Most adverse events in nursing homes are largely due to inadequate treatment, care and staffing — leading to a 22% increase in unnecessary hospitalizations and costing Medicare $2.8 billion, the report stated.  

To form a plan on how to combat elder abuse in long-term care facilities, as well as in all senior residential settings, 750 practitioners and leading experts were asked to complete the following sentence: “To understand, prevent, identify or respond to elder abuse, neglect, or exploitation, we need…” 

The following top five priorities were identified: 

  1. Increase public awareness of elder abuse
  2. Conduct further research on mental health and cognitive capacity issues 
  3. Provide better training and support for caregivers
  4. Quantify costs of elder abuse
  5. Invest more resources in services

In addition to these priorities, the government initiative calls for stronger monitoring of services, policies and oversight through survey, licensing agencies and the development of law enforcement and prosecution units that specialize in elder abuse.

“The Roadmap Project is an important milestone for elder justice,” said Associate U.S. Attorney General Tony West. 

“Elder abuse is a problem that has gone on too long, but the Roadmap Report released today can change this trajectory by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multifaceted dimensions of elder abuse and financial exploitation,” he explained. “While we have taken some important steps in the right direction, we must do more to prevent elder abuse from occurring in the first place and face it head on when it occurs.”

The initiative was funded by the U.S. Department of Justice with support from the Department of Health and Human Services. In further support of the initiative's mission, the DOJ created an interactive, online curriculum for attorneys and the HHS developed a voluntary national adult protective services data system, DOJ announced.

Garden therapy

Individuals with advanced dementia had better behavior after viewing a Japanese garden in their senior living center, researchers have found. 

Seiko Goto, MA, Ph.D, and fellow researchers from Rutgers University conducted the study to compare responses to two sensory environments in a nursing home: a multisensory Snoezelen room and a temporary Japanese garden. 

The researchers measured residents' stress levels according to behavior and heart-rate changes while viewing a sensory environment for 15 minutes twice a week. Participants who viewed the garden had more positive behavioral changes while those who viewed the Snoezelen room showed more negative results. 

Pulse rates were significantly lower in the Japanese garden than in residential rooms, but there was little to no change between being in the residential room and the Snoezelen room.  

Residents also started showing negative behavior when the Japanese garden room was changed to include plants and furniture installed with no design.

Results from a previous study conducted by Goto and a different research team from Rutgers University supported these findings. Of the three landscaped places — an herb garden, a simple landscape with a single tree and a Japanese garden — structured gardens evoked greater responses in measurements of heart rate, sympathetic functions and mood. 

Findings from the most recent study were published in the Journal of Alzheimer's Disease.

Questioned surgeries

About one-third of knee replacement surgeries in the U.S. were classified as “inappropriate,” which is higher than expected, Virginia researchers assert in a new study. 

The data support the need for “consensus development of criteria for patient selection” among U.S. practitioners who treat candidates for knee replacement surgery, the researchers said.

Daniel L. Riddle, Ph.D., and his colleagues from the Virginia Commonwealth University in Richmond, conducted the study using data from 205 people who had undergone total knee arthroplasty surgeries. 

Each individual was enrolled in the Osteoarthritis Initiative, a prospective 5-year study sponsored by the National Health Institute. 

The researchers then used an appropriateness classification system to classify each surgery as “appropriate,” “inconclusive” or “inappropriate.” 

They also used pain, physical function, knee motion, laxity, age and radiographic measurements. The average age of a person in the data set was 67 years and 60% were women. 

Results showed that about 44% of the surgeries were appropriate, about 22% were inconclusive and about 34% were inappropriate. Based on previous evidence and research, the hypothesized prevalence rate for inappropriate classifications was 20%.

The Agency for Healthcare Research and Quality reports more than 600,000 knee replacements are performed in the U.S. each year. 

The AHRQ estimates an 85% increase in knee replacement surgeries by 2030.

Full findings appear in Arthritis and Rheumatology.


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