scholarly journals Abuse of Vulnerable Older Adults by Designated Surrogate Decision Makers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 702-703
Author(s):  
Cory Bolkan ◽  
Pamela Teaster ◽  
Holly Ramsey-Klawsnik ◽  
Kenneth Gerow
Keyword(s):  
Older Adults ◽  
Reliable Data ◽  
Decision Makers ◽  
Community Settings ◽  
Power Of Attorney ◽  
Protective Services ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Vulnerable Adults

Abstract Abuse perpetrated by designated surrogates has become highly visible nationally, yet no reliable data exist on its nature or extent. Because vulnerable older adults needing surrogate decision makers typically rely upon others for care, they may be unable to advocate for themselves and are susceptible to abuse. We prospectively gathered Adult Protective Services (APS) data from six geographically diverse counties on over 400 substantiated cases of abuse by perpetrators (53% non-surrogates; 47% documented or claimed surrogate) of vulnerable adults 65+ living in community settings. Most perpetrators (85%) were designated power of attorney, while approximately 8% were guardians, and 7% were representative payees; most perpetrators were family members. Polyabuse occurred frequently. Almost 25% of cases involved a prior substantiated APS report. This presentation highlights how surrogates perpetuate abuse and outcomes on older adult victims. Our findings inform practice and policy for better prevention, detection, investigation, and intervention in these challenging cases.

scholarly journals PRELIMINARY FINDINGS ON FAMILY PERPETRATORS AS DESIGNATED SURROGATE DECISION MAKERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Cory Bolkan ◽  
Pamela Teaster ◽  
Holly Ramsey-Klawsnik ◽  
Kenneth Gerow
Keyword(s):  
Older Adults ◽  
Decision Makers ◽  
Policy Recommendations ◽  
Community Settings ◽  
Protective Services ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Vulnerable Adults ◽  
Process Level

Abstract Vulnerable older adults needing surrogate decision makers typically rely upon others for care and are unable to advocate for themselves. The issue of EFFE perpetrated by family members designated as surrogates has become highly visible nationally, yet no reliable, empirical documentation exists on the nature or extent of exploitation by surrogate perpetrators. In collaboration with the National Adult Protective Services Association (NAPSA), we prospectively gathered APS data from six geographically diverse counties on 450 substantiated cases of abuse by POAs, representative payees, and guardians of vulnerable adults 65+ living in community settings. This presentation will highlight how family member surrogates perpetuated abuse and the outcomes on elder victims. These findings elucidate person and process-level factors (e.g., characteristics of victims, perpetrators, and their relationships) within the context of the APS system and can inform practice and policy recommendations for better prevention, detection, investigation, and intervention in these challenging cases.

scholarly journals Pathways to and Consequences of Surrogate Decision-Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 702-702
Author(s):  
Pamela Teaster ◽  
Cory Bolkan ◽  
Shawn Meyers
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Elder Abuse ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Protective Services ◽  
Older Americans ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Abstract With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.

scholarly journals Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

Medical Care ◽  
2018 ◽  
Vol 56 (4) ◽  
pp. 337-340 ◽  
Author(s):  
Amber R. Comer ◽  
James E. Slaven ◽  
Annie Montz ◽  
Emily Burke ◽  
Lev Inger ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Communicating with Clinicians: The Experiences of Surrogate Decision-Makers for Hospitalized Older Adults

2012 ◽  
Vol 60 (8) ◽  
pp. 1401-1407 ◽  
Author(s):  
Alexia M. Torke ◽  
Sandra Petronio ◽  
Christianna E. Purnell ◽  
Greg A. Sachs ◽  
Paul R. Helft ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Self-Neglect: One Pathway to Surrogate Decision-Making

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 703-703
Author(s):  
Holly Ramsey-Klawsnik ◽  
Jason Burnett
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Nursing Home ◽  
Mental Capacity ◽  
Early Mortality ◽  
Surrogate Decision Making ◽  
Protective Services ◽  
Adult Protective Services ◽  
Cognitive Limitations ◽  
Surrogate Decision

Abstract Self-neglect, the most frequently reported allegation to Adult Protective Services (APS), involves profoundly harmful behaviors often due to functional or cognitive limitations, health problems, and insufficient resources that result in older adults insufficiently meeting their basic needs. Outcomes include high risk of illness, hospitalization and readmission, hospice and nursing home use, early mortality, and placement under surrogate decision-making authority of either well-intended or opportunistic others. APS staff are charged with assessing self-neglect and intervening to reduce client danger. A nationwide APS survey revealed program policies, procedures, resources, and needs affecting the client welfare. For example, 92% of APS programs have provisions for seeking guardianship for self-neglecting individuals, in 25% of programs staff serve as court-appointed guardians, and a wide variety of tools are used within APS programs to assess clients’ mental capacity. Key study findings, implications, and recommendations will be presented.

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

scholarly journals A Scenario-Based Investigation of Surrogate Decision Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 703-703
Author(s):  
Yuxin Zhao ◽  
Benjamin Katz ◽  
Pamela Teaster
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Financial Management ◽  
Self Efficacy ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Insurance Company ◽  
Surrogate Decision ◽  
Critically Ill Adults ◽  
Amazon's Mechanical Turk

Abstract Surrogate decisions involve complex, challenging choices; surrogate decision-makers make treatment decisions for approximately 40% of hospitalized adults and 70% of older adults, and up to 95% of critically ill adults of any age. The purpose of our study was to understand how people make decisions for others and how surrogate decision making is linked to people’s cognition, self-efficacy, and demographics, especially differences in acute (e.g., health and medical care, financial management, and end of life) versus general scenarios (spending time with family, contacting an insurance company on behalf of a family member). Participants were recruited through Amazon’s Mechanical Turk. We collected data from 290 adult participants aged 18 years or older. On average, people reported a higher level of confidence in general versus acute scenario. The differences of confidence in scenario-based surrogate decision-making links to decision-makers’ cognition, self-efficacy, the experience of decision-making, the experience of caregiving, and demographic factors.

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