Josh: Hello, everybody.
Josh
Rubenstein
for some more KP candid conversations.
I'm joined right now by Dr.
Anthony ho.
Uh, he is our regional physician lead for K's elder and dependent adults.
Adult abuse prevention program.
Uh, you are working out of our LA medical center.
Uh, Dr.
Ho thank you so much for spending some time to talk about elder abuse.
It is elder abuse awareness month.
And as we go through this interview in this talk, I, I wanna throw out
some statistics, some facts, the people may not know about elder abuse.
First off elder abuse most often takes place in the home.
Where the senior lives and that can be an institutional setting or a
long term, long term care setting.
Um, but I think what people don't understand is it happens at home, which
is something that we saw in the pandemic.
It's something that we see with abuse in general.
Isn't that?
Isn't that correct?
Yes.
Tell me, how would you define, uh, uh, elder
Dr. Hou: abuse, Dr.
Ho uh, first thanks.
Thanks for, uh, uh, uh, giving me this forum, Josh I'm, uh, really,
uh, appreciative, just because it is, uh, you know, really a silent
epidemic, elder abuse, but really what elder abuse is, it's an act or.
Lack of action, uh, in the case of neglect, by a trusted other.
So it could be a neighbor, it could be a family member, it could be a caregiver.
Um, but that lack of action or action results in harm to the older person.
So.
Josh: Why did you pick this as a field?
A, a
Dr. Hou: Uh, you know, I mean, I like any good geriatrician,
probably had a grandparent that they were really close to.
And in my case, you know, my, my grandmother was very close to me and,
uh, you know, just really seeing as she.
Aged, um, just how vulnerable, um, you know, she became in, in some instances,
um, you know, real and, and just sort of just by the virtue of having family
members around and just having like a community around her, uh, you know,
she, she was really able to live.
You know, a good life into, into old age, but realizing as I sort of was
training that that's not the case for a lot of seniors and you know,
a lot of seniors because because of cognition issues or functional issues,
they just don't have that like voice.
Um, you know, and, and that's why, you know, I really grew close to,
you know, the subject as something I wanted to, you know, spread
the word about and investigate.
Um, I had a really great mentor, Dr.
Laura Mosqueda, you know, who, you know, really is a, a world
expert in this field as well, too.
So got really great training from her as well.
Josh: What are some of the signs of, of elder abuse?
Dr. Hou: Uh, you know, elder abuse, just because there's, you
know, uh, several different kinds.
Um, you know, we really.
You know, but they all share some of the same DNA at times.
And you know, what you wanna look for as an, a vulnerable elder.
So we look at risk factors, for example, if someone's cognitively impaired or
emotionally or mentally impaired, that, that, that is a major risk factor.
So those.
Patients may be at higher risk for abuse.
Uh, Dr.
Queda, who I just mentioned, you know, did a, you know, really groundbreaking, um,
you know, a study and analysis that found that 50% of patients with dementia may
experience MIS mistreatment at some point.
So basically if they're cognitively impaired, emotionally, Or mentally
impaired, or if they're functionally impaired, they're at greater risk.
Um, so when we identify a person who may be at greater risk, then
we start looking for red flags and that depends on the kind of abuse.
So if it's neglect, we, you know, naturally I think anyone, you
know, will look for the, the, the.
You know, big, big picture stuff.
Like if they're dehydrated, if they have poor hygiene, but as
clinicians, we sometimes need to look for more subtle things.
For example, if they keep going back to the ER or repeat hospitalizations, or if
they're falling a lot, um, or if the meds tend to be off they're non-compliant or
they're being they're on medications, um, you know who that may be inappropriate.
Um, those kinds of things, you know, point, you point you in the direction
that maybe something is going.
And,
Josh: and we discussed this at the beginning, uh, just before we
started the interview, uh, most common forms and I believe this is
in order, correct me if I'm wrong.
Uh, number one is emotional abuse.
Number two is financial.
Exploitation number three is neglect and number four is
physical or sexual abuse, correct?
Dr. Hou: Yeah.
And those estimates, um, they vary a little bit, depending on the studies
you look at, but for the most part, we sort of see that emotional abuse,
um, you know, mental abuse is, you know, is probably the most common.
And then, you know, between neglect and financial abuse, those are
probably the next most common and then physical and sexual abuse.
But the most important thing is a lot of these are all under report.
So sometimes it's tough to get a gage, but that's about right.
Josh: Tell me this,
what does, and I dunno if you can, but what does an abuser look like?
Who is
an abuser?
Dr. Hou: That's a really great question.
Just because, you know, elders who, um, are abused, who experience mistreatment,
you know, they're oftentimes living with someone who they're dependent on.
So, you know, those abusers, those ones that, you know, uh, you know, may be.
Uh, mistreating these, these seniors, uh, usually they have their own profile.
They may also, they're likely to be dependent on the person,
you know, so there is this sort of codependent relationship.
They also may be having their own challenges.
They may be emotionally distressed.
They may be mentally ill.
Um, they may also be functionally impaired.
And the key thing is a lot of these, um, folks that, you know, unfortunately, You
know, maybe mistreating these seniors, they may not be intentionally doing it.
It's just because of, you know, a lot of factors that they're in this situation.
And it's important to note that, you know, for example, caregiver, stress
and caregiver burden is a big thing that we're trying to attack here at KP.
And you know, a lot of these, uh, trusted others may be.
Put in situations where, where they're so stressed out and, and, you know,
anxious and then really push their limits where the abuse happens.
And that's a matter of, that's something we can help change
over time with education.
Josh: You know, one statistic that really stuck out to me, it's estimated
that more than one in 10 older adults experience some form of abuse.
You know, when we were talking about, uh, child abuse awareness month, one
of the things they said is that if a child abuse says they're being abused,
They're almost always telling the truth.
They're almost never lying.
Is it, are we seeing the same kind of thing with elder abuse as well?
Dr. Hou: Exactly.
And, and then that's the, that's the thing we wanna emphasize for, to our
communities and our providers, you know, listen to older folks because if they
are saying that, you know, whether it's financial abuse, physical abuse, um,
neglect, if they say something, chances are there is something going on, you
know, and we have studies that show that, you know, patients, even patients who.
You know, they did a study on patients with bruising, um, as a, uh, you know,
a result of abuse and even patients who had, you know, dementia and advanced
dementia, um, oftentimes, you know, because of ageism, you know, they may
be poo-pooed in terms of what they're saying, you know, just because they're,
they may not be cognitively intact, but we, they found that, you know, if
someone mentions it, even with advanced dementia, most likely it's happen.
Josh: You you,
you said ageism.
And I think that's really important to, to highlight.
We live in a society that celebrates youth.
Um, but in this society, in, in that's our culture, right, there are other
cultures where the elder is revered.
Um, does that, especially in the business that you're in, um, Do
you feel like we're missing the
boat sometimes on that?
Dr. Hou: I, I, I think so.
And sometimes it's, it's just because, uh, you know, older folks don't
have a voice, you know, they may be in, um, parts of the community.
For example, they may be in an assisted living or in a nursing home.
Um, they, during the pandemic, it's been exacerbated because even if
they're at home, we, they were told to stay, stay inside and not go out.
You know, that's gotten a little bit better as the pandemic has progressed,
but, you know, and, and obviously it was for health reasons, but in reality, they
were getting more and more isolated.
That with more isolation, you know, older folks tend to be
at higher risk for, for abuse.
So to, to answer a question, yeah.
It, it, because of their outta sight, out of mind, oftentimes, you know, we, we, you
know, don't really inquire, you know, we sometimes, you know, Because of, uh, uh,
you know, uh, that they're not really, you know, um, at top of mind, you know, older
folks issues aren't, aren't addressed, um, as strong as they, as they should be.
And the pandemic we found that, you know, you quoted one outta 10, seniors,
you know, are likely experiencing abuse.
We found during the pandemic, it, it was up to five, outta 10, you know, so, wow.
Um, so that that's really sobering.
Josh: And I assume it was very hard to detect that during the, uh,
pandemic, because people weren't coming in for their regular checkups,
you weren't giving that contact,
right?
Dr. Hou: Yeah, exactly.
You know, I mean, oftentimes, you know, seniors were, were being told,
you know, to try to avoid the clinics.
And, and then we really relied on that, you know, telephonic or video
outreach, um, which is hit or miss with, um, patients in terms of how, you
know, a depth they are at technology.
So really, and then, you know, on top of that, you know, during the
pandemic seniors, uh, sometimes.
The only contact they would have, um, outside of their own household
was the doctor and the nurse.
So that, that link was really, really important.
But, you know, during the pandemic, it was all strained.
Josh: How do
you feel, uh, you, you have to have some emotion when you see some
of these vulnerable individuals coming into your practice.
Um, having dealt with abuse, I, I, I assume that you can only put
that tough exterior on for so long,
Dr. Hou: right.
And, and, you know, really you obviously, for our, for physicians, it's really
just really understanding that, uh, If we don't do it, I mean, we're, we
have mandated reporting laws here in California, of course, but you know,
they have done studies, which shows that, you know, doctors aren't really trained
in, um, in, in detecting elder abuse.
Um, they did a survey of medical students who, and residents, and
found that they never got, you know, any lectures on, on this topic.
So, so.
Because it's E emotionally difficult.
Um, you know, human nature is sometimes to just avoid the subject altogether.
So what we're here to, you know, teach, especially during elder abuse awareness
month is, you know, if, if it's not you, it may be MIS you know, um, you know,
cuz no one else is paying attention.
So, um, yeah, it must, it may be difficult, but you know, you really just
have to sort of understand that like, you know, we're oftentimes that, you know,
that only link, you know, to make sure that these folks, you know, are have.
Josh: What can
I do if I suspect someone I know or a loved one is, is
Dr. Hou: dealing with this, uh, great question.
Um, I think, you know, there's two parts of that.
If you are a physician or a nurse, someone in healthcare, um, you know,
actually anyone who's actually responsible for an older person or technically,
uh, you know, mandated reporters.
Um, so any patients over the age of 65, if you suspect.
You, you need to report if it's in the community, um, you know, there's adult
protective services, um, and you, we wanna communicate to them to, to understand that
there is a possible situation happening.
And if the patient lives in a facility, for example, a nursing
home or a custodial facility, a boarding care or assisted living,
we have a long term care ombudsman.
Um, but either way, it's just to make sure that you communicate,
um, to someone, for example, If you contact adult protective services,
just because they're in a facility, they'll go ahead and reach out to them.
Budsman and vice versa.
Um, so, uh, you know, and, and finding that information is, is pretty easy.
If you're within KP, we have a great SharePoint, kp.org/fvp/elder abuse, um,
that that will link you to, um, a way to.
To, uh, get to the proper authorities.
Um, if you're in a facility that, that the signs are posted everywhere.
Um, but it's the national center and elder abuse has a great website too.
So there's a lot of, you know, uh, anti public entities out there
with that information out there.
But the key thing is that idea of like, if it's happening, you
wanna, you know, make sure that you get, get the patient to the right.
Right.
Uh, uh, agency.
Josh: Is is elder blue
is elder abuse.
If it's not physical,
is it illegal?
Dr. Hou: So, uh, you know, great question as well, too.
So, um, in the state of California, we are mandated to report, uh, physical
abuse, uh, uh, financial abuse, sexual abuse, and neglect, um, emotional abuse.
It can be reported, but we're not mandated to, but I would always say that, you
know, I always tell our residents and our fellows this, if someone, if you witness
emotional abuse or mental abuse, chances are there may be something else going on.
So I would always advocate to, to just, you know, again, assess and,
you know, intervene in those cases.
I
assume that when you do an intake and, and you see your patients, um,
you kind of look for the signs, maybe subtly, maybe not necessarily outright
saying, are you being abused, but you're looking for cues and signs.
Josh: Um, is there anything that we can do just regular Joe public, uh, that.
Can
help reduce this?
Dr. Hou: Yes, definitely.
And again, great question.
Especially during the pandemic, I think it became really clear, you know, um,
things that we can do as a society to, to, to help older folks, um, avoid abuse.
Um, and one is social connection.
Um, if we can, as a community, keep elders looped into.
Friends, family, community groups, especially during the
pandemic, since a lot of those options were taken off the table.
Um, I would tell, I would always tell family members who were afar to just
even that phone call, even that like, you know, like, you know, most everybody
has a, has an iPhone or an Android phone.
Now you're just any kind of video application just to have that
face to face is really important.
That social.
Connection now that the pandemic, you know, has moved along a bit more and we're
able to open up a little bit more with vaccinations, that that visit is really
important to keep those elders looped in.
You know, they may have their like immediate household with their
immediate caregiver, but if we can keep them looped into the rest of
the community, that's important.
Um, the other issue is, is physicians and providers, anyone in healthcare,
you know, um, you know, we really are obligated that have that link between
patients, you know, the healthcare and community, but again, If they don't see
us, then it's up to the community, those folks in the community to really keep
their antenna up, you know, for these isolated seniors or these seniors who
are dependent on others to just make sure nothing nefarious is going on.
Josh: Dr.
Anthony ho, thank you so much.
Uh, I truly appreciate this conversation.
It's something that, you know, abuse conversations are really tough for people.
Um, they don't want to think it's happening in anybody that
they know or in their family.
Sometimes it's tough to see, but it's so important the work that KP
is doing, um, and the work that you are doing in particular, again, Dr.
Anthony ho uh, the regional physician lead for our elder and dependent
adult abuse prevention program.
Dr. Hou: Thank you so much.
Great.
Thanks Josh.
Oh,