Physical abuse of the elderly has long been difficult to prove because of older people's propensity to bruise easily and their sometimes-dubious powers of recall, giving perpetrators a handy defense. But thanks to studies by UC Irvine's Program in Geriatrics, that's changing.
The research has identified bruises most likely caused by abuse and established that most seniors, even those with memory disorders, can remember the cause of an intentional injury.
"I'd had enough of this attitude that 'It's not abuse; he's just old, and old people bruise easily or fracture easily,'" says Dr. Laura Mosqueda, director of the nationally renowned geriatrics program. "It's time for us to stop thinking this way."
So Mosqueda and a team of doctors and researchers, supported by grants from the National Institute of Justice, examined every aspect of bruising in adults over 65. The goal was to help law enforcement officers, physicians and social workers identify signs of elder abuse.
Orange County's Social Services Agency receives about 700 reports a month of suspected abuse of seniors. Experts believe that for each incident reported, at least five more go unreported, suggesting these 700 per month are only the tip of the iceberg. And the problem isn't just local:
Nearly 2 million older Americans are abused each year, according to the National Center on Elder Abuse.
"Adult Protective Services would bring cases, but the criminal justice system would be reluctant to pursue them because of the perception that older people bruise too easily," says Aileen Wiglesworth, who led UCI's research and holds a doctorate in gerontology. "No one had really measured this before."
The first bruising study, published in 2005, determined that 90 percent of accidental bruises in the elderly were on extremities rather than the trunk, neck or head and that less than a quarter of older adults with accidental bruises remembered how they had gotten them.
The second study, published last year, found that most seniors with bruises stemming from abuse had at least one 2 inches in diameter or larger. It also concluded that bruises on the face or back and in certain patterns on the arm were likely indicators of abuse.
UCI's research was welcomed by Cherie Hill, a detective in the Anaheim Police Department's family crimes unit who investigates possible elder abuse. "It's completely changed the way I work my cases," she says.
A key finding was on the reliability of an abuse victim's memory, even among those with dementia. "People didn't often remember the source of accidental bruises, but they did with inflicted injuries," Wiglesworth says. "So we advised law enforcement officers to ask them in the right way, and Detective Hill is very skilled at doing that."
Seemingly minor details such as the color of a bruise can become important to an investigation.
"In the past," Hill says, "if someone with a yellow bruise said, 'He beat me up today,' my prosecutor and I would think, 'Well, somebody's lying, because this is a yellow bruise and people don't get yellow bruises the first day.' The case wouldn't go anywhere."
The UCI studies found this conventional wisdom was wrong. "A bruise can be almost any color on the day it appears," Wiglesworth says. "It's a popular myth that you can tell the age of a bruise by its color. We need to get the word out that it isn't true."
The Program in Geriatrics has long worked with law enforcement in Orange County and beyond to identify abuse and pursue offenders. In 2003, the Elder Abuse Forensic Center grew out of UCI's collaboration with the Sheriff's Department, the district attorney's office and Adult Protective Services to improve investigation and prosecution of cases.
"Our responsibility goes beyond treating individuals," Mosqueda says. "We need to use our experience and expertise to find solutions to problems in the community."
—John Murray, University Communications