SANTA ANA, Calif. — The elderly man in the emergency room was covered with bruises, some purple and others fading to yellow. Despite signs of dementia, he told the same story over and over: His wife’s burly home health aide had beaten him. But the health aide and the wife insisted he had fallen. Now it was up to the members of Orange County’s Elder Abuse Forensic Center to decide which story was true.
A forensic photograph of the bruised body of an elderly victim of abuse.
As the man lay on a gurney, he was interviewed by a team from the center: a geriatrician, a social worker and an investigator from the sheriff’s office. The bruises on the man’s chest, they determined, were the result of being punched. There were bloody outlines of a shoe on the man’s leg. His clear, consistent story, and cognitive tests, persuaded the prosecutor to charge the aide with a felony. At the center here, public health and law enforcement officials are learning to speak the same language and using the same forensic techniques as those popularized on the three C.S.I. television series to diagnose elder abuse and neglect. For decades, the techniques have been the state-of-the-art approach for investigating child abuse and domestic violence. But elder abuse has lagged far behind, suffering from a lack of financing, research and data.
Now change is in the air, and forensic techniques are just one of many new initiatives nationwide to protect the elderly. Geriatricians at the Baylor College of Medicine in Houston, for example, review county autopsy reports looking for suspicious themes. Bank tellers at Wachovia branches nationwide are learning to detect irregular transactions in the accounts of elderly customers. Congress is also expected to consider, before the October recess, the Elder Justice Act of 2006, which would create the first nationwide database on elder abuse, replacing inconsistent or unavailable data. The legislation, which has bipartisan support, also assigns a federal official to coordinate projects and technical assistance and helps replicate programs like Orange County’s.
The most common form is physical neglect, like untended bedsores, dehydration or the reek of urine. A family member who is providing care, most often an adult child, is usually the guilty party. Greed is generally the motive, whether there is a multimillion-dollar inheritance or a monthly Social Security check at stake. All this was well known to the assorted professionals in Orange County, but before the forensic center was established, each had to improvise without easy access to others’ expertise. A social worker might need a public guardian to sort out conflicting claims from adult children over who had power of attorney. The social worker might also need advice from a detective about securing evidence, but calls to colleagues often went unreturned for weeks, and there was likely to be no doctor to consult because few were trained to detect elder abuse.
Some 6,000 cases of elder abuse are reported annually in Orange County. In California, 100,000 reports were filed in 2003, accounting for 20 percent of the 500,000 reports nationwide. But there is widespread agreement among professionals that those numbers may be low. In a 1996 study, only one in 14 cases of physical abuse and neglect were reported and one in 100 of financial exploitation.
-JANE GROSS
Published: September 27, 2006
NY TIMES
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