Research

The faculty members of the UCI School of Medicine Program in Geriatrics are nationally known for their research in the field of elder abuse and neglect. The Center of Excellence will provide a valuable and much-needed bridge, between direct service and academics. We aspire to stimulate new ideas, identify needed areas of inquiry, bring together researchers from across California and beyond and serve as a mechanism for feeding research findings back to the field. The bridge between direct service and academics will cause work in both sectors to be more effective in serving the victims of elder abuse and neglect.

• Geriatric Bruising Study
• Pressure Ulcer Study
• Caregiving Study
• Systems Analysis
• Elder Mistreatment Survey
• National Institute of Justice Journal (off-site link)
  • Aug 2008 document on discussion of Models of Elder Abuse
  • Nov 2006 article on ongoing Forensic Markers research projects
• Research Staff

For a printable (PDF) document of research articles and other publications on elder abuse by Center of Excellence faculty and staff, click here. 

ONGOING RESEARCH IN ELDER ABUSE

Accidentally Acquired Bruises in Older Adults

The objective of this study, funded by the National Institute of Justice, was to summarize the occurrence, progression, and resolution of accidentally acquired bruises in a sample of adults aged 65 and older, and compare these findings with characteristics of bruises acquired through elder physical abuse.

The systematic documentation of accidentally occurring bruises in older adults could provide a foundation for comparison when considering suspicious bruising in older adults. Between April 2002 and August 2003, a convenience sample of 101 seniors was examined daily at home (up to 6 weeks) to document the occurrence, progression and resolution of accidental bruises that occurred during the observation period.

• Nearly 90% of the bruises were on the extremities
• There were no bruises on the neck, ears, genitalia, buttocks, or soles of the feet
• Subjects were more likely to know the cause of the bruise if the bruise was on the trunk
• Contrary to the common perception that yellow coloration indicates an older bruise, 16 bruises were predominately yellow within the first 24 hours of onset
• Those people on medications known to impact coagulation pathways and those with compromised function were more likely to have multiple bruises

Mosqueda L, Burnight K, Liao S: The Lifecycle of Bruises in Older Adults. Journal of American Geriatrics Society, 2005; 53(8):1339-1343.

http://www3.interscience.wiley.com/journal/118681332/abstract

Full article (PDF)

 

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2.  Pressure Ulcer Study

Background: Pressure ulcers may occur under circumstances ranging from excellent care to severe neglect. At present we are guided by a combination of common sense, anecdotal evidence, and clinical experience to determine when a pressure ulcer is a forensic marker of neglect. Scientific evidence is needed to better understand when they are truly markers of neglect. In order to understand this, we must first understand the characteristics of an ulcer that occurs under circumstances of good care.

Study Hypotheses: 1) Long-term care residents may develop advanced stage pressure ulcers despite good care. 2) These pressure ulcers will be noticed prior to becoming a stage 3 or 4. 3) These ulcers share some common characteristics that have forensic value.

Study Questions:

• What are the characteristics of advanced pressure ulcers in the setting of good care?
• Do advanced stage pressure ulcers develop in the setting of best care practices?
• Can an advanced ulcer present without a prior recognition of a lower grade ulcer?

Setting: Best-practice, Long-term care facilities throughout the United States.

Inclusion Criteria

1)      Resident of a long-term care facility, age 65 or over

2)      Presence of 1 or more pressure ulcers stage 3 or greater that developed at the facility

3)      Recipient of good individual care

Methods: Best-practice long-term care facilities are identified through federal databases.  The high quality of their care is confirmed through site review. After an eligible resident is identified and consent obtained, a research RN documents all characteristics of the advanced pressure ulcers using a standard instrument.  Digital photos are taken of the ulcers.  Pertinent information regarding the resident’s care will be abstracted by the research RN. The initial stage of the ulcer and the time the skin was last intact will then be recorded.

A panel of elder abuse experts will review the medical information and rate the quality of care the resident has received on a 1 to 5 point Likert scale with 5 being the best care possible. Only those residents who are judged to have received a 4 or 5 will be included in the study.

Analysis: Descriptive analysis will be performed to examine pressure ulcer characteristics that occur in a setting of good care including documenting and analyzing the number, severity, and location of the ulcers. We will also specifically determine if an advanced stage ulcer can develop without a prior documentation of a lower grade ulcer.

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3. Caregiving Study Caring for those with Dementia

This consortium project, funded by the California Department of Health Services brought together resources from UCI’s Program in Geriatrics and Institute for Brain Aging and Dementia as well as the Alzheimer’s Association of Orange County (AAOC). The goal was to better understand the factors that affect the quality of caregiving for people with dementia. The study participants were people with dementia still living at home and their caregivers. The researchers assessed characteristics of the caregiver (e.g., health), the patient (e.g., level of dementia), and their environment (e.g., use of outside resources) to see which of these were associated with mistreatment. The focus was on physical and psychological mistreatment as well as neglect. An multidisciplinary LEAD panel (Longitudinal, Experts, All Data) panel assessed presence of mistreatment based on a priori definitions of physical and psychological elder abuse and neglect by a caregiver.

The findings indicate high prevalence of mistreatment of people with dementia (47%) and identified some patterns and characteristics that can alert others to the possibility that mistreatment is occurring.

• Click here for a printable slide-based handout (PDF) highlighting the specific findings.
• A one-page summary of findings (MS Word) is also available.
• Listen to a 6-minute podcast about the study and findings: Caregivers, People with Dementia, and Elder Abuse (audio mp3)

Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, Fitzgerald W. Screening for abuse and neglect of people with dementia.Journal of the American Geriatrics Society. 2010 Mar;58(3)493-500.

4. Systems Analysis & Implementation Improving the quality of Elder Abuse Data in California

The ultimate goal of this project, funded by the Archstone Foundation, is to improve the quality of state-wide data on elder abuse in California.

The best data available on mistreatment of older adults in California are reported by Adult Protective Services (APS) agencies, and yet there is evidence of inconsistency in these data from county to county. The researchers talked to 54 of 58 APS county offices in California by phone, conducted a number of site visits and collected data in an online survey.  The results of this study are informing a statewide committee to address improving the quality of APS data collection.  Some of the more generalizable findings are being prepared for publication.  

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5. Elder Mistreatment Survey Development Validation

Photo-collage courtesy of Ombudsman, Inc. of Alameda County

 

The projected rapid increase in the population of older Americans over the next 30 years raises the concern that the problem of elder mistreatment will grow at least as much and as fast. Although it is clear that the problem of elder mistreatment is already large – the best estimate is that one to two million older Americans are victims of mistreatment annually - most events are never reported. The personal costs are profound: not only do victims suffer from their injuries and losses, they are likely to die at an earlier age than elders who are not victims of mistreatment.

There is very little understanding of the issues that surround elder mistreatment, for example risk or preventive factors, medical markers, consequences and clinical courses, healthcare and other costs, successful interventions and, methods for studying each of these issues. Current approaches to detecting abuse for research purposes are either invalid and unreliable or cumbersome, and difficult to apply on a broad scale, making population studies infeasible. There is a desperate need for a standardized measurement approach that can be generalized across groups.

This project was funded by the National Institute on Aging to develop and test a self-reported, survey-based measure that can be broadly applied to generate population estimates of abuse and move elder mistreatment research forward. The survey is designed to predicts elder mistreatment in samples of Mexican American and Non-Hispanic white community-dwelling elders, including the cognitively-impaired. The results of this study are being prepared for publication.

ONGOING STUDIES

Coroners’ Investigations of Suspicious Elder Deaths

For this study, funded by the National Institutes of Justice, researchers are gathering information from county coroner’s offices throughout California. The purpose of the study is to collect and analyze data associated with elder deaths as well as to gain understanding of processes the county offices in California use to support the decision to assume jurisdiction or not for a reported death of an older adult.

The Challenge of Providing Care to People with Multiple Sclerosis

Researchers at UC-Irvine are working to understand the relationships between a person with multiple sclerosis and their caregiver.    The goals are (1) to refine, validate, and field-test a self-report measure for detecting abuse and neglect among people with MS, and (2) to use this validated measure to conduct a nationwide survey of people with advanced MS and their primary caregivers.

National Institute of Justice August 2008 summary of Elder Abuse Workshop: Laying the Foundation for Theoretical Model Development in Elder Mistreatment (off-site link)

http://www.ojp.usdoj.gov/nij/topics/crime/elder-abuse/workshop-2008/day2-2.htm 

National Institute of Justice Journal November 2006 article on ongoing Forensic Markers research projects (off-site link)

http://www.ojp.usdoj.gov/nij/journals/255/elder_abuse.html

"Elder abuse in the United States" by Catherine C. McNamee with Mary B. Murphy (off-site link)

http://www.ojp.usdoj.gov/nij/journals/255/elder_abuse.html 

RESEARCH STAFF

Raciela B. Austin, RN Research Nurse UCI School of Medicine, Geriatrics Raciela B. Austin, RN obtained her nursing degree from Mount St. Mary’s College in Los Angeles. She also holds a Bachelor of Science degree in Biology. Ms. Austin has five years experience working as a geriatric nurse in an adult day care setting, a geriatric-psychiatric nurse in an in-patient hospital setting (UCLA-Neuropsychiatric Institute/Hospital) and as a home health nurse to patients with complex medical conditions.