March 4, 2008

Brown University ’s Center for Gerontology & Health Care Research has received a $209,000 grant from the National Institute on Aging to get a better handle on how much elder abuse exists in Rhode Island .

Much elder abuse never gets reported so researchers don’t expect to come up with definitive statistics on the extent of the problem. But Wendy Verhoek-Oftedahl, a professor of community health at Brown’s School of Medicine and the principal investigator for the project, said she believes that there is much more documented elder abuse in Rhode Island than anyone previously has reported.

She said she hopes her group’s research spurs more people in the community to report the abuse, neglect and exploitation of the elderly.

The grant money will be used to collect and link data from sources that already collect evidence of elder abuse — the state Department of Elderly Affairs; the attorney general’s office; hospital emergency and discharge rooms; nursing homes, police departments; the state’s domestic violence database; records from the Rhode Island medical examiner’s office; the Health Department’s forensic laboratory; and Butler Hospital, the Providence psychiatric facility where many elderly patients who have mental health problems get treatment.

From the various sources, the researchers want to create a comprehensive database at the Rhode Island Department of Health that would document each case of elder abuse reported during 2006 and 2007. Verhoek-Oftedahl said she expected the work to be completed by June of next year.

The work that Verhoek-Oftedahl and her five-member team is doing could serve as a model for other states, she said, and is especially important because of Rhode Island’s high concentration of elderly residents. Rhode Island ranks fourth in the country for residents aged 75 and older. Studies show that people over 75 are the most likely victims of abuse and that almost all elder abuse (89.3 percent) takes places in domestic settings. Elders suffering from dementia are often targets.

Currently, the state Department of Elderly Affairs is the main centralized reporting source for elder abuse statistics. It investigates complaints, provides assistance to victims and refers cases called into its hot line to the police for prosecution, if, upon investigation by social workers, there is evidence of physical or financial abuse.

The DEA says it receives 800 to 900 complaints of abuse each year and verifies about 80 percent of them, according to Corinne Calise Russo, the DEA director. But the statistics do not provide a true picture of the extent of reported elder abuse in Rhode Island because not all complaints of abuse are reported to the DEA’s hot line. Sometimes doctors and the police do not report cases of abuse they encounter to the DEA, according to Verhoek-Oftedahl and Dr. Robert Kohn, the director of the Brown medical school geriatric psychiatry training program, who is working with her on the project.

As a preliminary step in applying for the grant, Verhoek-Oftedahl and one of her former students, Emily Garber, did a study which found that only 36.3 percent of the elder domestic violence arrests made by Rhode Island police departments from 2001-2004 were reported to the Department of Elderly Affairs for investigation. The study showed that while the police were reporting all of the arrests they made to the state Supreme Court’s Domestic Violence Training and Monitoring Unit, as required, social workers at the DEA who provide assistance to such victims were unaware of many of these cases.

Kohn said the study showed that while some departments did report all of the arrests they made for domestic violence against elders to the DEA, some of the biggest ones did not.

One of the things Kohn says he’ll do with the grant money is to see whether workers in hospital settings are doing a better job of reporting the abuse they encounter. He will review five years of mental health records at Butler to see whether psychiatrists and social workers there are reporting suspected elder abuse noted in their reports. Medical records at other acute care hospitals will also be reviewed, along with records from the medical examiner’s office which does autopsies.

One of the goals of the project is also to try to detect some previously unrecognized cases of elder abuse so the investigators can come up with an estimate of how many cases of elder abuse go unreported. Verhoek-Oftedahl also said that “we want to look at demographics of the victims, the characteristics of perpetrators. We know elder abuse is very widely underreported.”

Verhoek-Oftedahl says that the data linkage the project envisions will provide “unduplicated counts of victims of physical, sexual and psychological abuse as well as victims of neglect and financial exploitation. Elders residing in both community and institutional settings will be included.”

Once all of this information is collected and stored electronically in a central databank, “we will finally have a clearer picture of the extent of elder mistreatment in the population and have the information essential to develop and target more effective public health interventions,” Verhoek-Oftedahl said. “We may not be using the best interventions possible right now and may need to modify existing interventions.”