Training Grant Delivers Elder Abuse Education for Medical Residents and Geriatric Fellows

In 2020, Archstone Foundation awarded a Training grant to the University of Southern California Keck School of Medicine, in collaboration with the Universities of California at Irvine, San Diego and San Francisco, to design, develop, and launch a free Elder Abuse Curriculum for medical residents and geriatric fellows.

This post by guest authors Bonnie Olsen, PhD, Lori Mars, JD, LLM, and Carmen van den Heever, BS, provides an overview of elder mistreatment and outlines the curriculum developed to provide medical residents and fellows with the information and confidence to respond to suspected abuse. The curriculum successfully integrates our focus on promoting teams, enhancing training, and improving technology — our Three Ts of care coordination — and ensures that services are culturally competent, client-centered, comprehensive, collaborative, coordinated, connected and compassionate, our Seven Cs of integrated services.

Elder maltreatment is a significant global public health concern, but more often than not it remains undetected, underreported, and unaddressed.

An estimated 1 in 10 older adults experiences some form of abuse annually. Of the approximately 6 million people in the United States with dementia, half will be abused or neglected. Even more concerning, only 1 in 24 cases of abuse in the community is ever reported to authorities. The stark reality is that millions of older adults live with abuse and never get the help or resources they need to prevent or mitigate harm. And, as the cohort of aging Americans steadily increases — approaching 20 percent of the total population — the prevalence of abuse is predicted to rise.

The situation is dire, but it is not immutable. With appropriate intervention, maltreatment can be averted and addressed.

One area of unrealized potential to identify and respond to abuse has been the health care field. Medical professionals with frequent patient contact are well-positioned to detect elder maltreatment. They are uniquely equipped to identify physical markers of abuse, atypical behavioral changes, and anomalous patient/caregiver interactions that may signal maltreatment. Trusted physicians may also be a conduit for victim disclosure and can provide helpful resources for elders who are socially isolated, reluctant to report abuse, or unaware of supportive resources within their communities.

Yet, despite the opportunities for abuse detection and intervention in clinical encounters, only two percent of maltreatment reports are made by physicians. Many clinicians lack the knowledge and skills to recognize the signs and risk factors of abuse. More still lack awareness of the psychological, social, and cultural barriers that may inhibit victim disclosure. These practice limitations have consequential outcomes for countless elders living with abuse. The impacts of abuse are many, including physical injury, emotional distress, social isolation, financial ruin, homelessness, and death.

Creating Robust, Effective Training to Identify and Respond to Elder Abuse

Though the American Medical Association has recognized the importance of education in elder abuse, there is a paucity of training curricula for medical practitioners. The dearth of dedicated curricula has contributed to the missed opportunities for abuse identification and response by the medical community. Remedying this disparity has been a priority for the Keck School of Medicine at USC, in collaboration with the Universities of California at Irvine, San Diego, and San Francisco, who have designed, developed, and launched the Elder Abuse Curriculum for Medical Residents and Geriatric Fellows.

The curriculum is the culmination of a two-year iterative process to translate the shared expertise of the partnering institutions into an exciting, interactive, and engaging educational experience for medical residents and fellows. Residency and fellowship are ideal junctures to educate emerging doctors in the foundational knowledge of elder maltreatment. As early career physicians acquire skills in hands-on clinical care and are exposed to diverse patients with a multiplicity of concerns across the lifespan, they will treat numerous older people. It is vital that they become adept at detecting mistreatment, addressing abused patients with competence and sensitivity, and understanding reporting requirements.

The curriculum addresses those needs in a series of six online modules:

1. Provider’s role in detection and response
2. Screening and detection
3. Diverse and cognitively compromised populations
4. Intervention and response
5. Summary review
6. Simulated case study and clinical skills development

The first five modules are asynchronous. Modules 1-4 are each 30 minutes in duration. The fifth module is approximately one-hour long, and the sixth is a faculty facilitated module accompanied by a facilitator’s manual. The content is animated with graphics, instructional videos, expert commentary, role play scenarios, ethical dilemmas, and practicum exercises.

Recognizing the critical role of ethnogeriatric care in preventing and responding to elder maltreatment, the project team focused one module on abuse within cognitively impaired, racially and ethnically diverse, unhoused, LGBTQ+, and long-term care resident populations. Other modules address harm reduction strategies to better serve older patients through person-centered, trauma-informed, and culturally responsive care models.

The modules are packaged in three plans, adaptable to residency program availability and need: Complete Curriculum (modules 1-4, 6); Abbreviated Curriculum (modules 5, 6); and Brief Overview Curriculum (module 5). The curriculum is housed on a learning management platform and is easily navigable and readily accessible at no charge through the USC Center for Elder Justice.

Expanding the Curriculum Nationwide

The project collaborators have piloted the curriculum with family medicine, internal medicine, and emergency medicine residents and geriatric fellows within their institutions. Results from a pre-post retrospective survey have overwhelmingly demonstrated efficacy of the training resulting in increased provider knowledge and confidence in abuse detection and response. The curriculum is now available to programs nationwide. As the roll out has unfolded, we have learned that abuse awareness and response resonate beyond the programs originally identified. Team members recently met with a dermatologist from Baylor University to discuss curriculum integration in dermatology residency programs.

Given the early success of the curriculum in replacing systemic inadequacies with practice-based literacy, the next step is to adapt the curriculum to related fields. From medical social workers to civil legal practitioners, education to foster awareness, knowledge, engagement, and response is key to intervening and eradicating abuse. Building provider competency will lead to culture change, helping ensure better lives and outcomes for older adults nationwide.