Approccio preventivo e terapeutico - SALA URANIA 1 ABUSO E NEGLIGENZA NELL'ANZIANO: UN PROBLEMA CONTEMPORANEO Venerdì 2 Dicembre 2016 16:35 ...
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Venerdì 2 Dicembre 2016
SALA URANIA 1
16:35 - 17:30 Simposio
ABUSO E NEGLIGENZA NELL’ANZIANO:
UN PROBLEMA CONTEMPORANEO
Approccio preventivo e terapeutico
Graziamaria Corbi, MD, PhD
Dip. Medicina e Scienze della Salute
Università degli studi del Molise
Numero soggetti over 60
The EU in the world 2013 — a statistical portrait
European Commission. The 2015 Ageing Report
Percentuale di donne per età (World 2007)
Pablo Picasso (1903)
La vita
Indice di vecchiaia al 1° gennaio 2015 nei paesi EU (%)
Eurostat 2016
Life expectancy at birth, 2012 Healthy life expectancy at birth, 2012
Life expectancy at birth, plotted against equivalent of healthy
years of life lost since birth, males and females
Gerontologist, 2016;56:S2, S178–S193 doi:10.1093/geront/gnw034
ISTAT 2015
Indice di stato psicologico per sesso e classe d’età - Anni 2000,
2005 e 2013 (punteggi medi)
ISTAT 2015
Prevalence of frailty in older persons
Ageing Research Reviews 2013;12:719– 736Venn diagram displaying extent of overlap of frailty with
ADL disability and comorbidity (≥2 diseases).
n=196
Disability: ≥ 1 ADL Comorbility
(n=67) 21.5% (n=2131)
(n=79)
5.7% 46.2%
(n=21) (n=170)
26.6%
(n=98)
Frailty
The Gerontological Society of America
Fried et al J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.Victims' characteristics
Frazão et al J Forensic Leg Med. 2014;28:19-24Risk factors for elder abuse and strength of evidence
World report on ageing and health 20151900 to 1940, and 1960 to 1980, U.S. Bureau of the Census, 1983; 1950, U.S. Bureau of the
Census, 1953; 1990, U.S. Bureau of the Census, 1992; 2000, U.S. Census Bureau, 2001; 2010,
U.S. Census Bureau, 2011; 2020 to 2050, U.S. Census Bureau, 2012a; 1900 to 2010, decennial
census; 2020 to 2050, 2012 National Population Projections, Middle series.Swiss Med Wkly. 2016;146:w14273
Elder Abuse as a Risk Factor for Hospitalization in Older
Persons
JAMA Intern Med. 2013;173(10):911-917. doi:10.1001/jamainternmed.2013.238DISTRIBUTION OF SCIENTIFIC ARTICLES IN SOME
DATABASES ON THE TOPIC OF THE (A) ELDERLY IN
RESPECT TO (B) CHILD ABUSE
Corbi et al. Intern Emerg Med 2015;10:297–303PUBLIC INFORMATION CAMPAIGNS TO PREVENT
ELDER ABUSE IMPLEMENTED, BY COUNTRY/AREA,
2012
Global status report on violence prevention 2014COUNTRIES WITH LAWS TO PREVENT VIOLENCE
Global status report on violence prevention 2014COUNTRIES WITH IDENTIFICATION, REFERRAL AND
SUPPORT SERVICES AVAILABLE, BY TYPE OF
SERVICE
Global status report on violence prevention 2014Global status report on violence prevention 2014
Global status report on violence prevention 2014
Global status report on violence prevention 2014
1- 30 APRILE 2015 Ospedale A Cardarelli - Campobasso Policlinico – Università A. Moro - Bari
Conoscenza del fenomeno di abuso sugli anziani
300
Care assistants Physicians Nurses
250
200
150
%
100
50
0
VERO FALSO Non so VERO FALSO Non so VERO FALSO Non so VERO FALSO Non so
pochi anziani abuso=violazione esistono procedure se segnalo rapporto
subiscono abusi diritti umani standard x segnalare con pz rovinato
Corbi et al.Capacità nel riconoscere segni e sintomi di abuso
250
Care assistants Physicians Nurses
200
150
%
100
50
0
VERO
VERO
VERO
VERO
VERO
VERO
VERO
VERO
FALSO
FALSO
FALSO
FALSO
FALSO
FALSO
FALSO
FALSO
Non so
Non so
Non so
Non so
Non so
Non so
Non so
Non so
ematomi ustioni piaghe neglect ecchimosi graffi malnutrizione lesioni
multiple
Corbi et al. submittedDovere di segnalare un abuso ed a chi
250
Care assistants Physicians Nurses
200
150
%
100
50
0
Non so
VERO
FALSO
Non so
Polizia/Carabinieri
Familiari
Direttore UO/Azienda
Autorità giudiziaria
Dovere di segnalare A chi segnalo
Corbi et al.
submitted%
10
15
20
25
30
35
40
45
0
5
Mancanza chiare definizioni
Mancanza chiare
definizioni+non voglio
coinvolgimenti
Mancanza chiare
definizioni+non conosco
leggi
vittime negano
maltrattamenti
N° sospetto abuso
Care assistants
Non ho certezza su come
segnalare
Non certezza su come
Motivi di omessa segnalazione
segnalare+Non chiara
definizione di abuso+non
Physicians
conosco leggi
Non conosco leggi in materia
Nurses
Corbi et al. submittedDisponibilità a segnalare dopo formazione
300
Care assistants Physicians Nurses
250
200
%
150
100
50
0
Si No Non so
Segnalo dopo formazione
Corbi et al. submittedTYPOLOGY OF SCREENING TOOLS
1. Direct questioning or self-reports
Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST)
Vulnerability to Abuse Screening Scale (VASS)
Self-Disclosure Tool
Elder Abuse Suspicion Index (EASI)
Caregiver Abuse Screen (CASE)
2. Inspecting for signs of abuse
Elder Assessment Instrument (EAI)
Signs of Abuse Inventory
3. Evaluating risk of abuse
Bass and Neal
Indicators of Abuse (IOA)
Expanded IOA (E-IOA)
Coehn M et al, 2007; 2011Hwalek-Sengstock Elder Abuse Screening Test
(H-S/EAST)
A score of 3 suggested as a cut-off score for risk of abuse was
not determined based on a statistical method.
Its final score is composed of signs of abuse and of risk factors,
all receiving the same unweighted scoring.Vulnerability to Abuse Screening Scale – VASS
the H-S/EAST with 2 additional questionsElder Abuse Suspicion Index (EASI)
Validated* for asking by
family practitioners of
cognitively intact seniors
seen in ambulatory
settings.
5 questions and 1 observation by doctor
*Yaffe MJ, Wolfson C, Lithwick M, Weiss D. J Elder Abuse and Neglect 2008; 20(3).8 items to identify potentially abusive caregivers In caregivers whether or not abuse is suspected. The more YES responses, the more likely the presence of ABUSE
Elder Assessment Instrument (EAI)
41-item divided in 7
categories
A comprehensive approach
for screening in all clinical
settings but mostly at
HIGHLY SENSITIVE AND LESS SPECIFIC
Emergency Dept
The major strengths its rapid assessment capacity (12-15 min)
There is no “score”
sensitizes to screening for elder mistreatment.
A patient should be referred
to social services if
Limitations no scoring system
1) there is any positive weak specificity.
evidence without clinical
explanation,
2) there is a subjective
complaint by the older adult
of elder mistreatment, or
3) the clinician deems there is
evidence of abuse, neglect,
exploitation, or abandonment.
Fulmer et al, 1984Indicators of Abuse (IOA)
Più alto è il punteggio totale (0-108), >la probabilità che si stia
verificando un abuso.
≥16 probabile presenza di abuso
≤4 probabile assenza di abuso
Ogni indicatore preso singolarmente non è indicativo di abuso.Brief Abuse Screen for the Elderly (BASE)
5 items to assess
likelihood of abuse
by caregiverNecessita
or di training formativo (5 h) del personale x
elder interpretarloNone of the instruments has been validated adequately in diverse clinical settings; most have been evaluated only in emergency room settings
The Mount Sinai Hospital Elder Abuse Program
BMJ Open 2016;6:e009690.
Grazie per l’attenzione
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