News and Commentary Archive

Explore recent scientific discoveries and news as well as CLBB events, commentary, and press.

Mission

The speed of technology in neuroscience as it impacts ethical and just decisions in the legal system needs to be understood by lawyers, judges, public policy makers, and the general public. The Massachusetts General Hospital Center for Law, Brain, and Behavior is an academic and professional resource for the education, research, and understanding of neuroscience and the law. Read more

Elder Abuse

This comprehensive review article published by The New England Journal of Medicine highlights the scope and management of elder abuse, drawing from research and clinical evidence. Perhaps most strikingly, they estimate that the prevalence of elder abuse (physical, psychological, verbal, and sexual abuse, financial exploitation, and neglect) is around 10%.

By Mark S. Lachs and Karl A. Pillemer | The New England Journal of Medicine | November 12, 2015

Although it has probably existed since antiquity, elder abuse was first described in the medical literature in the 1970s.1 Many initial attempts to define the clinical spectrum of the phenomenon and to formulate effective intervention strategies were limited by their anecdotal nature or were epidemiologically flawed. The past decade, however, has seen improvements in the quality of research on elder abuse that should be of interest to clinicians who care for older adults and their families. Financial exploitation of older adults, which was explored only minimally in the initial studies, has recently been identified as a virtual epidemic and as a problem that may be detected or suspected by an alert physician.

In the field of long-term care, studies have uncovered high rates of interpersonal violence and aggression toward older adults; in particular, abuse of older residents by other residents in long-term care facilities is now recognized as a problem that is more common than physical abuse by staff.2,3 The use of interdisciplinary or interprofessional teams, also referred to as multidisciplinary teams in the context of elder abuse, has emerged as one of the intervention strategies to address the complex and multidimensional needs and problems of victims of elder abuse, and such teams are an important resource for physicians.4,5 These new developments suggest an expanded role for physicians in assessing and treating victims of elder abuse and in referring them for further care.

In this review, we summarize research and clinical evidence on the extent, assessment, and management of elder abuse, derived from our analysis of high-quality studies and recent systematic studies and reviews of the literature on elder abuse.6-10

DEFINITIONS AND ESTIMATES OF PREVALENCE

Debates about how to define elder abuse and which types of behavior to include in the definition greatly inhibited progress during the early period of research on this topic. Initial formulations were overly broad and included types of behavior that are not typically part of definitions of domestic abuse, such as crime by strangers, age discrimination, and failure to care for oneself (referred to as “self-neglect”). Over the past decade, however, consensus has arisen about the inclusion of five major types of elder abuse11-13: physical abuse, or acts carried out with the intention to cause physical pain or injury; psychological or verbal abuse, defined as acts carried out with the aim of causing emotional pain or injury; sexual abuse, defined as nonconsensual sexual contact of any kind; financial exploitation, involving the misappropriation of an older person’s money or property; and neglect, or the failure of a designated caregiver to meet the needs of a dependent older person (Table 1).

When these types of abuse have been considered together, epidemiologic surveys have shown generally similar prevalences of elder abuse over a period of 12 months, as indicated by three high-quality epidemiologic studies of community-dwelling older people (60 years of age or older). In a survey of more than 4000 older people in New York State, the rate of elder abuse was found to be 7.6%16,17; in a national survey by Laumann et al., the rate was 9%,12 and in a national telephone survey by Acierno et al.,18 the rate was 10%. It is likely that these figures are underestimates; the reliance on self-reported information from persons who are able to participate in a survey excludes patients with dementia, and studies have shown that dementia places older persons at greater risk for mistreatment.19 When the available evidence is taken into consideration, an estimated overall prevalence of elder abuse of approximately 10% appears reasonable. Thus, a busy physician caring for older adults will encounter a victim of such abuse on a frequent basis, regardless of whether the physician recognizes the abuse.

Continue reading the full journal article here.

In Alzheimer’s Cases, Financial Ruin and Abuse Are Always Lurking

By Paul Sullivan | January 30, 2015 | The New York Times “Your Money” “Wealth Matters”

Midway through the film “Still Alice,” which tracks the growing grip of Alzheimer’s on a 50-something Columbia University professor, that professor, played by Julianne Moore, stands at a lectern to address an Alzheimer’s conference. She is holding a yellow highlighter and a copy of her speech.

She proceeds to talk about her struggles with the disease and how she never knows what will vanish from her memory and when. It’s a lucid, affecting talk, and the viewer would be hard pressed to know anything was wrong with her, if not for the highlighter. She uses it to track her every word so she doesn’t read the same sentence over and over again.

For anyone who has ever watched a family member disappear into Alzheimer’s, Ms. Moore’s performance is gripping, particularly as her tricks to stall her decline inevitably fail and the later stages of the disease consume her. Yet the movie is also a great vessel to explore many of the financial issues that families need to address when someone is diagnosed with Alzheimer’s or any other disease that causes cognitive impairment.

Continue reading »

Stopping the Financial Abuse of Seniors

According to the AARP, about 60 percent of adult protective services (APS) cases of financial abuse nationwide involved an adult child of the elderly person.

This longform resource, created in 2011 by the American Bank Association’s Bank Compliance magazine, addresses the vital role banks play in the regulation of elder abuse, and how the law bears on bank–elder interactions.

Read “Stopping the Financial Abuse of Seniors” here.