HCHD Takes a TEAM Approach to Elder Abuse and Neglect

The National Center on Elder Abuse estimates 2 million frail older Americans are victims of elder abuse or neglect; the majority of cases go unreported. Neglect - often self-neglect - is the more common, yet there have been no studies to design interventions to address the problem. Dr. Carmel Bitondo Dyer, assistant professor of medicine at Baylor College of Medicine and director of the Harris County Hospital District's Geriatrics Program, recognized the need to address this void.

Under Dr. Dyer's leadership, the Hospital District Geriatrics Program formed a unique collaboration in 1997 with the Texas Department of Protective and Regulatory Services, and Adult Protective Services (APS) Division to form the Texas Elder Abuse and Mistreatment (TEAM) Institute. A representative from the office of the Harris County Attorney is also a member of the Institute. The program focuses on individuals 75 years or older living in Harris County, as well as disabled people from age 60.

The program has been designed as a comprehensive approach to identifying, intervening in and preventing elder abuse and mistreatment. It has three important, and familiar, focuses - clinical care, education and research.

The Harris County Hospital District Geriatric Program provides core clinical care at the Quentin Mease Community Hospital. This includes a full range of services - primary care, rehabilitation, skilled nursing, pharmacy, occupational therapy, social work - to a large number of frail elderly who are at risk for abuse, neglect, or both. Through the TEAM Institute, APS specialists refer clients to the Quentin Mease facility for medical care. This collaboration also allows for enhanced data collection and tracking, important to the research aspect of the program.

Baylor College of Medicine students have the opportunity to accompany APS specialists on regular home visits. The visits provide the students with knowledge about the APS program and services and give them the chance to interact with patients in a nontraditional medical setting.

"As the APS specialists and clients discuss medical problems, students can observe and begin to take part in helping clients agree to needed medical care," Dr. Dyer explains. "These students, then, will form the core of health care providers with solid knowledge of the medical issues surrounding elder abuse and neglect."

Data are being collected on various aspects of the health impact of abuse and neglect in this population. The first, main focus is on assessing all aspects of a patient's social history, medical history, and such areas as the relationship between the patient and the primary caregiver. Other agencies may be involved in this assessment with the goal of identifying the least restrictive intervention, one that maintains patient autonomy and dignity.

According to Dr. Dyer, assessment and consistent team follow-up of geriatric patients has demonstrated improved functional status and quality of life and is a potential intervention for cases of elder abuse and neglect. In addition, the program measures depression scores and functional status, along with quality of life satisfaction scales.

The future of the TEAM Institute is very exciting. The process of establishing the first U.S. inpatient unit for elder abuse, neglect, and exploitation is under way at Harris County Hospital District facilities. In addition, diagnostic tests for use by health care providers are being developed.

"Having these processes in place will help clarify the larger focus on elder abuse and neglect, which lags sadly behind efforts directed at child abuse and neglect," Dr. Dyer adds. "Our elderly patients deserve dignity and good quality of life. We believe the TEAM Institute will contribute to meeting that goal."

Note: Harris County Hospital District Geriatric Program at Quentin Mease Community Hospital is not limited to TEAM Institute patients alone. It provides acute care, a skilled nursing unit, outpatient and multiservice clinics and home visits to all elderly in Harris County.

---

©2006 Texas Medical Center

---

E-Mail: tmc-info@tmc.edu
URL: http://www.tmc.edu/tmcnews/07_01_99/page_08.html