1. Human Rights & Elderly Rights Workshop
Payal Patel, Mercer University PharmD Candidate 2012
Dorris Ottens, University of Georgia PharmD Candidate 2012

2. Human Rights
Fundamental rights to which a person is inherently entitled because she or he is a human being
Cornerstone of public policy
Continuous philosophical debate over what is meant by “right”
Started during the Protestant Reformation and continued to the Bill of Rights and United States Constitution

3. Universal Declaration of Human Rights
Adopted in 1948 by the United Nations General Assembly, secondary to WWII Holocaust atrocities
This document outlines 30 Articles which promote specific freedoms.

4. Highlights of Declaration of Human Rights
All humans are born free and equal
Everyone is entitled to all rights set forth, without distinction of race, colour, sex, language, religion, political opinion, national origin, property, birth, or other status.
Right to life, liberty, and security
No slavery or servitude
Right to recognition as a person

5. Highlights continued…
All people are equal before the law
No arbitrary detention or exile
Freedom of movement, residence, and leave
Right to social security and resources of economic, social, and cultural resources of each State
Right to work, with equal pay for equal work
Right to education and culture

6. Highlights continued…
Right to standard of living adequate for his health and well-being: food, clothing, housing, and medical care and necessary social services
Right to security in the event of unemployment, sickness, disability, widowhood, old age or other circumstances beyond his control

7. Patient Case
60 yo wf
CC: worsening dementia and secondary Parkinsonism
HPI: MVA with head injury 10 yr prior with loss of consciousness.
Diagnosed with normal pressure hydrocephalus
Shunt x 4 years, stable
Rapid decline: aphasia, increased falling and confusion

8. Elderly Prevalence
12.5% of the US population is 65 years of age or older
This group will increase by 5.5% by the year 2020
45 million people over the age of 60 and 3 million over the age of 85
As the number of elderly Americans increase, the number of abuse cases will increase
With the increase in the number of elderly people, there is an increased need to address elderly rights and abuse

9. Prevalence
In US, over 2 million older adults are mistreated every year
3 to 10% elderly are neglected or abused
For every 1 case of elderly abuse, about 5 cases go unreported
Approximately 1.5 million seniors live in nursing homes
30% of the nursing homes have been cited for abuse that can potentially harm the patients

10. Introduction
Most victims are older, frail and vulnerable and depend on others for basic needs
Most seniors do not get the help they need
Elderly people are often subject to discrimination/abuse because they are viewed as being easily taken advantage of

11. Introduction Many governments have support systems for elderly people
Social security
Medicare
Senior citizen discounts
Adult protective services agencies
Receives and investigates reports of abuse/neglect
Provide services to the victims

12. Rights of an elderly person
The rights of an elderly person can be broken down in 3 main categories
Protection: securing the physical, psychological and emotional safety in regards to their vulnerability to mistreatment and abuse
Participation: To create a greater and more active role for the elderly
Image: To define a more positive and less degrading idea of the elderly and their capabilities

13. Elderly Abuse
Definition: Intentional or neglectful acts by a caregiver or any person that can cause harm to an elderly individual
Self-neglect can also be considered mistreatment
Elderly abuse can occur anywhere – in the house, nursing homes, or any other location
Abusers can be spouses, family members, personal acquaintances or opportunistic strangers

14. Risk factors of abuse Older age Lack of access to resources Low income
Elderly women are more vulnerable and more likely to be a victim
Dementia
Social Isolation
Low level of education
Functional impairment
Substance abuse by elder or caregiver

15. Types of Elderly Abuse
Physical abuse: using force to physically injure a vulnerable elder
Emotional abuse: verbal threats, rejection, isolation that can cause a mental distress to an elderly
Sexual abuse: forced or threatened sexual contact on an elderly person
Exploitation: Gaining control over an elderly person’s money or property by misusing authority or fraud

16. Types of Elderly Abuse
Neglect: Failure of a caregiver to provide the needed safety, physical or emotional needs of an elderly person
Abandonment: Abandoning an elderly person by the caregiver
Self-neglect: not being able to understand the consequences of your own action or inaction leading to harm

17. What is self-neglect?
Sometimes elders neglect their own care, which can cause illness or injury. Such behaviors include:
Hoarding
Failure to take medications or refusal to seek medical treatment
Poor hygiene
Not wearing suitable clothing for the weather
Dehydration

18. Warning Signs
Physical abuse: marks, bruises, burns (ex: cigarette burns), blisters
Neglect: malnutrition, lack of medical care, filth
Emotional abuse: depression, unusual behavioral changes, withdrawal from usual activities
Sexual abuse: marks/bruises around breasts or genital area, STDs
Exploitation: unusual bank activities, property loss, altered wills

19. Problems in a nursing home
Low staff-to-patient ratios
Rotating nurses and nursing assistants
Staff not well trained
Facility characteristics
Personality problems of the caregiver

20. Clues for elder abuse in nursing homes
Bruises or skin tears
Multiple fractures due to falls
Unintended weight loss
Poor hygiene
dehydration

21. Preventing abuse in nursing homes
Screening potential employees for history of abuse, neglect or mistreatment
Training all employees
Staffing appropriately
Observing residents for signs of abuse
Investing all types of incidents and reporting results to the proper authorities

22. What can the elderly do to prevent abuse?
Take care of one’s own health
Seek professional help for drug, alcohol and depression concerns
Spouses can attend support groups
Plan for the future with a power of attorney or a living will
Stay active in the community
Stay connected with friends and family
Report any form of mistreatment or abuse

23. What can the elderly do to protect their rights?
Living Will
Directions for a terminally ill patient
Instructions specifying what actions should be taken if the patient is not able to make decisions due to their illness or incapacity
Durable Power of Attorney for Health Care (Health Care Proxy)
Allows the patient to choose a person who can make decisions related to the patient’s healthcare

24. Patient Case Continued…
Husband was given ample prescription samples from the physician’s office
Patient kept deteriorating cognitively and physically
Home health nurses were sent to give care, and reported plenty of medications were at the home, although husband asked for more
Patient missed/cancelled several appointments

25. Case Continued…
At next office visit, a middle-aged woman came as caregiver with the couple
Patient’s symptoms continued to accelerate
Husband picked up samples, and reported he was dating the “caregiver”
PCP concerned about this conflict of interest
Patient’s husband eventually refused home healthcare services

26. Case continued…
Neighbors noticed the “caregiver” was not there during the day, but sometimes at the home for two to three days
Also reportedly saw the husband and caregiver having sex
Neighbors called the police, who then invoked Adult Protection
Husband jailed for spousal abuse x 4 years

27. What can healthcare professionals do?
Healthcare professionals are often the first to notice abuse and neglect and are in a key position to help
Identify signs and symptoms of abuse
Evaluate the validity of the explanations provided for the injuries
Evaluate the cognitive status and health factors
Treat injuries and health problems
Perform screenings for possible abuse

28. What can you do? Do not let abuse go undetected
If you suspect abuse, contact your local adult protective services agency
If you suspect abuse in a nursing home or long term care facility, contact your state specific agency

29. Resources for the Elderly
The National Center on Elder Abuse (NCEA):
Information on elderly rights, resources for families, caregivers, adult protective services, helpful phone numbers to report abuse
Georgia Department of Human Services –Division of Aging Services
Information on disability, elderly programs, senior employment program, adult protective services

30. References
; the Universal Declaration of Human Rights found on the United Nations website. Accessed Feb 2012.
National Center on Elder Abuse website. Accessed Feb 2012.
Georgia Division of Aging Services website. Accessed Feb 2012.
House Ways and Means Committee Prints, Green Book. Accessed Feb 2012.