VA Asked to Take Lead Role in Preventing Mistreatment

By Brenda L. Mooney

SEATTLE—The VHA should take a lead role in combatting elder abuse, which affects at least 10% of older adults in the United States, according to a recent medical journal article.

The report in the Journal of the American Geriatrics Society suggested that mistreatment of veterans could be even more common, because the population has many of the factors considered high risk for elder abuse. Specifically, the article noted, VHA patients have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment and social isolation than the general population.1

“Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors,” emphasized study authors from the VA Puget Sound Health Care System and the University of Washington, both in Seattle. As a result, they suggested, the VA healthcare system should be at the forefront of resolving the problem.

Veterans at the Spanish Peak Veterans Community Living Center in Walsenburg, CO. A new study is urging VA to help combat elderly abuse, which is much more likely to happen at home than in community facilities such as this. Photo from facility’s website

“As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults,” the article noted. “The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served.”

To that end, the authors outlined a rationale for developing a research agenda for elder abuse at the VHA.

“As the healthcare system is specifically dedicated to meeting the needs of those who served our country, the VHA has often been at the forefront of developing innovative, integrated care programs. Nowhere has this been more evident than in their pioneering research on geriatric syndromes and models of clinical care for veterans in later life,” the authors emphasized. “From the development of long-term care programs within the Department of Veterans Affairs (VA) in 1964 to the advent of Geriatric Research, Education, and Clinical Centers (GRECCs) in the early 1970s to pioneering comprehensive home-based primary care (HBPC) programs and more recently the Medical Foster Home, the VA has always been a leader in using research and education to improve the care of vulnerable older adults.”

The article defined elder abuse as “harm of an older adult by another person or entity that occurs in any setting, in a relationship in which there is an expectation of trust or when an older person is targeted based on age or disability.” The umbrella term includes physical abuse, sexual abuse, psychological abuse, neglect, and financial exploitation, according to the report, with many victims experiencing multiple types at once, according to the report.

Dementia Exacerbates Problem

Past research has shown higher rates among older people with dementia and those living in skilled nursing facility residents. Adverse outcomes go beyond the immediate effects, with depression and higher mortality rates being common. Older victims of mistreatment also have higher rates of emergency department visits, hospitalization and nursing home placement.

A study about a decade ago examined the prevalence, types and intervention outcomes of elder abuse/neglect among a veteran population. Researchers from the Department of Social Welfare at the UCLA School of Public Policy and Social Research revised medical records of 575 veterans who had received services from the VA’s Geriatric Outpatient Clinic in Los Angeles during a three-year period.2

An elder abuse report was found for 31 veterans, making up 5.4% of the total. Results indicate that prevalence of elder abuse/neglect was higher among veterans who were older and those of Caucasian and African American races. In addition, eight of the victims suffered from more than one type of elder abuse including, self-neglect, with financial abuse and self-neglect being the most commonly reported types overall.

The study also found that family members were perpetrators in most of the cases, although three-quarters of financial abuse cases involved nonrelatives. Of the victims, nearly half had dementia and eight were clinical depressed.

Moving victims from their unsafe home into a nursing home or board and care facility was the most common intervention, followed by conservatorship arrangement, authors of the 2006 study noted. Patients with dementia were most likely to require some living arrangement adjustment, with abused veterans who remained at home receiving conservatorship, outside supportive services or a combination of both.

At that time, the authors wrote, “This study calls for more comprehensive and systematic research on elder abuse/neglect at multi-settings in order to generate useful information for prevention and detection of, and effective intervention in elder abuse and neglect in the veteran population.”

That’s even more important now, according to the recent article. The authors noted that most elder abuse cases in the United States—possibly as few as 1 in 24—are identified, adding, “Although challenging to quantify, abuse of older adults is estimated to cost many billions of dollars in direct medical costs each year.”

The VA could be the answer, the researchers emphasized.

 “As we learn more and more about the complexities of this phenomenon, an institution like the VA that has a national scope and can partner with other federal agencies such as the Department of Justice, is uniquely positioned to be an effective leader,” explained lead author Lena Makaroun, MD, of the VA Puget Sound Health Care System and the University of Washington. “Our paper may be used as a starting point for leaders within the VA interested in pursuing this work and also suggests opportunities for private-public partnerships, inter-departmental partnerships and state-federal level partnerships as ways forward.”

Makaroun added that VA has “the opportunity to lead by spearheading a research agenda on studying abuse, neglect, and exploitation among older veterans that is outlined in our paper,” adding that the benefits will go beyond the VHA’s patient population.

“Progress made by this research will not only help veterans, but as we’ve seen in many instances before this, advances developed within the VA have the potential to greatly impact the care of older adults nationally. While adults are living longer in this country, we also want them to live better, and part of having a good quality of life in older age, as at any age, is ensuring safety, adequate care and justice,” she said.

1.    Makaroun LK, Taylor L, Rosen T. Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known. J Am Geriatr Soc.2017 Nov 10. doi: 10.1111/jgs.15170. [Epub ahead of print] PubMed PMID: 29124741.2.    Moon A, Lawson K, Carpiac M, Spaziano E. Elder abuse and neglect among veterans in Greater Los Angeles: prevalence, types, and intervention outcomes. J Gerontol Soc Work. 2006;46(3-4):187-204. PubMed PMID: 16803784.