Dr. Eileena Chui Consultant Psychiatrist Queen Mary Hospital

Transcription

1 Elder abuse from a clinical perspective Dr. Eileena Chui Consultant Psychiatrist Queen Mary Hospital 1

2 is "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. (elderabuse.org.uk ) Elder abuse refers to the commission or omission of any act that endangers the welfare or safety of an elder (elders are defined as persons aged 60 or above). (Procedural Guidelines for Handling Elder Abuse Cases, SWD) (Revised August 2006) Elder abuse 2

3 Rate of elder abuse : 7.6% (New York State) Peterson % (USA) Laumann % (USA) Acierno 2010 Reasonable estimation of elder abuse is 10% (Mark 2015, New England Journal of Medicine) Prevalence 3

4 Physical Abuse Psychological Abuse Neglect Financial Abuse Abandonment Sexual Abuse (Procedural Guidelines for Handling Elder Abuse Cases, SWD) Forms of Elder Abuse 4

5 The American Medical Association recommends that doctors routinely ask geriatric patients about abuse, even if signs are absent. Alert the risk factors Keep questions direct and simple Interview the case and caregiver together and separately Accurate and objective documentation Health Care professionals should 5

6 Taking money or property p Forging an older person's signature Getting an older person to sign a deed, will, or power of attorney through deception, coercion, or undue influence Using the older person's property or possessions without permission Promising lifelong care in exchange for money or property and not following through on the promise Confidence crimes ("cons") are the use of deception to gain victims' confidence Scams are fraudulent or deceptive acts Fraud is the use of deception, trickery, false pretence, or dishonest acts or statements for financial gain Telemarketing scams. Perpetrators call victims and use deception, scare tactics, or exaggerated claims to get them to send money. They may also make charges against victims' credit cards without authorization Financial Abuse 6

7 L is a 69 years old, single lady, currently residing in a C&A Home (Sub-vented) Has been ill since 32 years old (1980) Diagnosis is Schizophrenia Last admission to Hospital in 2009 The case 7

8 Persistent Persecutory Delusions: Believed that her father instructed a doctor to inject dye to her body and she became mentally ill (30 years ago) Believed that elder brother injured her finger by sound waves Believed that elder brothers tried to control her by computer and Buddhist s power and they controlled the dentist to remove her teeth. Presentation 8

9 Escaped to London in 6/2009 and back to Hong Kong in 10/2009 and relatives lost contact with her Went to AED by herself and complained of right hand pain and toothache. th h Admitted d to Kowloon Hospital then. (10/2009) Assessed to have persistent psychotic symptoms and poor drug adherence and tendency to neglect herself and default treatment Family members worried about her getting lost again when her mental condition became worse and request discharged her from Kowloon hospital to a private elderly home in the Western district i t (KK, operated by N) in 11/2009. Transferred to the Western Psychiatric Centre (WPC) for follow up since

10 Mental Illness: Onset in 1980 Refused to see doctor and left HK to USA afterwards Admitted to psychiatric unit in USA in 1986 Three attempts of suicide in USA and Germany (1980s) Arson in Canada in 1995 under psychotic influence, returned to HK afterwards Past Psychiatric History 10

11 Born in Hong Kong 5 siblings (4 th ), good relationship with Eldest brother but not so with 3 rd elder brother Master degree in Music in USA Music teacher since 1974 Single, no intimate relationship Catholic No family history of mental illness Background 11

12 Medication supervision was not satisfactory at the elderly home L used to return home at weekend e but she appeared ed poor in personal hygiene (not bathing for days) and even not put on clothes properly when leaving home (not wear underwear, trousers etc.) Persistent psychotic symptoms including paranoid delusion and muttering was noted expressing wish to hire a lawyer to revoke the diagnosis of mental illness and she said that she spent $1,000,000 on hiring a private psychiatrist and a lawyer The progress 12

13 Once?employed a solicitor to handle the accommodation issue when she requested to leave KK Elderly Home (hostel) in 2010 Had been assessed by Occupational Therapist in 2010 and found to have lacking the independent living skills and advised not to be discharged from the elderly home But then.. When she s 65 years old in She no longer expressed her wish to be discharged from the elderly home (hostel) in Sep 2013 (she should be moved to another hostel of the same group run by N without knowledge of relatives and health care professionals.) 13

14 Elder brother wrote a letter to case doctor and handed it to the Staff of WPC on 26 Nov Elder brother mentioned that L had recently transferred HKD 230, to the operator N L signed on the contract which she believed she would be allowed to live forever including ALL expenses incurred until she die. (she mentioned to her elder brother that she was firmly told by N) 26 Nov

15 N wrote to elder brother to inform him about L had sign a contract: *N claimed: L used to lend money to a male resident M and L said that M would marry her and she would continue to lend money to M *N claimed that she discussed with L and L agreed to donate money to the hostel for renovation and L could live in the hostel and the hostel would give pocket money to L The letter 15

16 L s elder brother claimed this letter was written by N 16

17 N also gave a copy of the contract between N and L to L s elder brother. (only p2-p4) p N told elder brother that L had been coerced into lending money to at least 1 inmate of N s hostel. This letter and a copy of the contract from elder brother had been filed and forward to the Case doctor for instruction. 17

18 1. L did not come to receive the depot injection on 27 Nov 2013 and Nursing staff contacted her by phone the same day to remind her to come in two days time 2. A fax received on 27 Nov 2013 at 10:43am from?l (she should have no fax machine) and she did not come on or before 29 Nov 2013 for injection. ****The Nursing staff hand-in the file to their supervisor on 29 Nov 2013 because they had no idea what to do Case doctor on leave. ID: xxxxxxx The alarm 18

19 A referral was made to MSW for suspected financial abuse MSW contacted elder brother and elder brother told MSW that he lost contact with L as she was not living in the same hostel as discharged from Kowloon hospital in recent one year. He could not contact L until the operator contacted him. Involvement of the Medical Social Worker 19

20 L was seen (with staff H of N s hostel and MSW C) by me L mentioned that she did not like her elder brother as he did not allow her to go out She did not want people to cheat her money and she gave all her money (US$20000) to N She had been cheated by a resident (an Indian named M) She mentioned that N would give her a new hostel where she would be named. (staff H said that the residents were told to address her as the Director) A Medical consultation ti arranged on 2 Dec

21 L mentioned that she had not seen such contract before (p2-p3) L mentioned that she had an agreement with N that she would be the Director of the Hostel L mentioned that she gave HK$230,000 to purchase the shares of the hostel to become the Director L mentioned that she went to the Bank of Communication and she gave the transaction advice to N afterwards L said that she went to a solicitor s office likely in Central and she had been seen by a solicitor named Chu???? The Contract t p.2-4 was shown to L and staff H 21

22 We only have p.2-p.4 No signature of the Solicitor??? L could only understand this page N The title: Director L s signature the contract 22

23 She was not aware of this clause five years She could not tell what are these terms She said that she had not seen this page of the contract before we showed this to her on 2 Dec

24 She had not seen this page before and she did not understand any of the point on this page 24

25 L mentioned that she wanted to live in hostel A of N s group but she was bought to hostel B instead and then she was asked to leave hostel B afterwards. MSW arranged an emergency placement (an elderly home which elder brother and family s friend found in TKW for her) and she was bought to that home with her consent right after the consultation. The management 25

26 We initiated the application for Emergency Guardianship Order to protect L Case doctor interviewed ie ed L on 11 Dec 2013 and she mentioned some other reasons (as a contribution for the society) for the transfer of the HK$230,000 to N and she wanted to get back the money now. L was assessed to be a mentally incapacitated person that an Emergency Guardianship Order was recommended d in order to protect and promote the interests of welfare of subject. 26

27 EGO hearing in Feb 2014 and L had been received into Guardianship. The MSW negotiated with N to get back the money but not successful. L enjoyed living in the elderly home in TKW and she was transferred to attend follow up at the out-patient clinic of Kowloon Hospital. L obtained a place at a (sub-vented) C&A Home in Oct 2016 and she received psychiatric follow up by the KCH out-reaching team 27

28 Health care professionals : suspecting elder abuse 1. refer the case to social worker 2. consider the safety issue of the case (arrange placements) keep the case away from the abuser 3. Assessment and Management collaboration with other disciplines (Multidisciplinary approach) Intervention tips 28

29 Thank you. 29