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Clearinghouse on Abuse and Neglect of the Elderly (CANE)

Annotated Bibliography
The Health Care System: Addressing Elder Mistreatment
July 2003


The health care system plays an important role in the well being of all individuals, but particularly in the lives of older individuals. Not only are health care professionals responsible for assessing and treating physical problems, they are in an ideal position to identify elders who are being abused, neglected or self-neglected. Unfortunately, too often ageism-even on the part of health care providers-delays or prevents effective treatments and interventions for elders.

The following bibliography highlights recent publications that address the role of physicians, nurses, emergency room professionals, dentists and others in preventing and addressing elder mistreatment. In addition, there are a number of articles that demonstrate how ageism may impact the delivery of health care services for seniors.

To Order Articles from the Annotated Bibliography:

Unless otherwise indicated, these reference materials may be obtained through CANE.

The digits following the hyphen in the file numbers indicate the total number of photocopied pages. For example, if the file number is A78-11, then this
article (number A78-11) is 11 pages in length. Articles of interest will be forwarded to you at a cost of $.20 per page. Order from:

University of Delaware
Clearinghouse on Abuse and Neglect of the Elderly/CANE
Department of Consumer Studies
211 Alison Hall West
Newark, DE 19716

PLEASE NOTE THAT A CHECK MADE OUT TO CANE-UD MUST ACCOMPANY YOUR ORDER. For more information on ordering materials, contact CANE at (302) 831-3525, or at [email protected] . To find other resources on the topic of domestic or intimate partner violence, or to research other aspects of elder abuse and neglect, visit the CANE Web site at http://db.rdms.udel.edu:8080/CANE



Annotated Bibliography:

  1. P5200-7
    Simon, S. & Gurwitz, J.
    Drug Therapy in the Elderly: Improving Quality and Access
    Clinical Pharmacology & Therapeutics; Vol. 73 (5) 387-393; May 2003

    This article addresses the use of inappropriate drugs, the inappropriate use of drugs, and the underutilization of potentially beneficial medications in the elderly. While there has been a decline in the use of inappropriate medications, there are approximately 1,900,000 adverse drug events among Medicare enrollees annually, 180,000 of which are life-threatening or fatal. These events, many preventable, typically occur as a result of how the drug is administered (drug interactions, inaccurate dosage, etc.) Underutilization of medication in the following conditions has been observed in treatment of the elderly: asthma, cardiovascular disease, hypertension, dyslipidemia, stroke prevention, osteoporosis prevention, pain management and depression. The exclusion of older patients in clinical trials regarding medication forces physicians either to under prescribe certain medications, or to prescribe without adequate evidence of efficacy and safety. One significant barrier to underutilization of appropriate medications is the lack of prescription coverage for many seniors. Computerized Physician Order Entry (CPOE) systems are described as one possible means of enhancing coordination of prescription management throughout various aspects of health care that would improve the quality of pharmaceutical use.


  2. P5263-00
    U.S. Senate Special Committee on Aging
    Ageism in the Health Care System: Short Shrifting Seniors?
    Washington, D.C.; May 19 2003

    This online resource presents the testimony before the U.S. Senate Special Committee on Aging of a number of senior patients and family members who experienced ageism in the health care system. In their respective remarks, Dr. Marks (Director of the National Center for Chronic Disease Prevention and Health Promotion) indicates the need for preventative screening and immunization among older patients, and the need for continued coordination between the aging and health networks, and Dr. Robert Butler (Mount Sinai Hospital) addresses the under-representation of geriatric patients in clinical trials. (Note: Testimony from this hearing is available online at http://aging.senate.gov/index.cfm?Fuseaction=Hearings.Detail&HearingID=20)


  3. P5225-8
    Bassett, S. & Smyer, T.
    Health Screening Practices in Rural Long-Term Care Facilities
    Journal of Gerontological Nursing; Vol. 29 (4) 42-49; April 2003

    This study assessed the health screening practices in 41 long term care facilities in a rural Midwestern state. Breast self examinations, clinical breast examinations, mammography, manual prostate examinations and prostate-specific antigen testing are assessment tools specifically recommended in the American Cancer Society (ACS) screening guidelines. Although 87 per cent of the Directors of Nursing of the nursing homes participating in the research were aware of the ACS guidelines, only 23 per cent of the facilities implemented the guidelines. Less that 13 per cent had written policies for screening. Nurses are encouraged to promote health screening practices among older patients including nursing home residents.


  4. P5173-5
    Grief, C.
    Patterns of ED Use and Perceptions of the Elderly Regarding Their Emergency Care: A Synthesis of Recent Research
    Journal of Emergency Nursing; Vol. 29 (2) 122-126; April 2003

    This article provides a literature review of research on elderly patients' perception of emergency treatment. Ten studies (1986-1999) were identified and systematically evaluated using the Nursing Practice Research Analysis Tool. Overall, the elderly experienced increased length of stays, more diagnostic tests, higher rates of recidivism and less satisfaction. It is unclear if the lower rates of satisfaction (resolution of presenting problem) are related to ageism on the part of emergency health care professionals, or due to health and social complications related to the aging process. Geriatric education emergency room (ER) professionals and studies focusing on interactions between elderly patients and ER staff are recommended.


  5. P5164-7
    Scheetz, L.
    Effectiveness of Prehospital Trauma Triage Guidelines for the Identification of Major Trauma in Elderly Motor Vehicle Crash Victims
    Journal of Emergency Nursing; Vol. 29 (2) 109-115; April 2003

    Motor vehicle accidents (MVA) are the most common cause of trauma in older persons prior to age 75. However, studies have indicated that older MVA victims are the most undertriaged group when being assessed for transfer either to a trauma center or a non-trauma hospital. This retrospective study examined the outcome of over 2000 MVA victims (New Jersey) who died subsequent to discharge from the hospital. Those patients 65 and older were compared to patients 25 through 64 years of age. Undertriage was 8 per cent for young and middle-aged men, 12 per cent for young and middle-aged women, 15 per cent for older women and 18 per cent for older men. The researchers indicate that age should be a factor considered during prehospital triage.


  6. P5258-24
    Thunder, J.
    Quiet Killings in Medical Facilities: Detection & Prevention
    Issues in Law & Medicine; Vol.18; Spring 2003

    This article is intended to prompt a discussion of the phenomenon of "quiet killings," those deaths occurring in hospitals, nursing homes, and other health care settings, which are categorized as either due to negligence or medical error rather than intentional acts and, therefore, are not viewed as criminal in nature. The author presents numerous cases where patients and residents were intentionally murdered, many with lethal injections, that were investigated and prosecuted, but he also describes examples that imply these acts may go undetected more often than the public realizes. Motivations for such killings appear quite varied, ranging from sexual gratification to overcoming issues of inadequacies. The victims are often too impaired to communicate. Defenses that are commonly used are examined and include mercy killing, patient's consent, medical error, administration of pain medication. Prosecution may become even more complicated when ageist beliefs enter into the equation. Ten suggestions are outlined to enhance prevention and detection of quiet killings, and include improved background checks, surveillance cameras, the establishment of Elder Death Review Teams (fatality review teams) and an increase in forensic autopsies.


  7. P5250-7
    Dyer, C. & Fisher, J.
    The Hidden Health Menace of Elder Abuse. Physicians Can Help Patients Surmount Intimate Partner Violence.
    Postgraduate Medicine; Vol. 113 (4) 21-24, 30; April 2003

    National estimates suggest that up to one half of all elder abuse cases involve domestic violence. This overview focuses on the role that physicians can play in the detection of intimate partner violence amongst elderly patients. Shame, fear, economic vulnerability, cultural differences, and an underestimation of the problem on the part of health care professionals contribute to the invisibility of the problem. Identifying the nature of the abuse (caregiver stress versus a power and control issue) is a vital step that influences clinical direction. Assessment of competency and dangerousness, along with safety planning, should be continuously addressed in the management plan. Documentation and reporting are also discussed. A practical guideline for screening and intervention and a comparison of appropriate intervention/documentation and incomplete intervention/documentation is included.


  8. P5249-7
    Carney, M., Kahan, F. & Paris, B.
    Elder Abuse: Is Every Bruise a Sign of Abuse?
    Mount Sinai Journal of Medicine; Vol. 70 (2) 69-74; March 2003

    This article presents a case study that illuminates the roles that physicians and other health care professionals can play in the prevention, detection and management of elder abuse and neglect. The author presents a summary of the patient's history over a two-year period. The medical team suspects that the 84 year old woman is being neglected and physically abused by her adult son, who is disabled, unemployed and financially dependent upon his mother. Following a home visit by the social worker, Adult Protective Services are notified. Office, family, and home visits, multidisciplinary assessments and referral for supportive services are among the interventions documented and discussed as part of the treatment plan for this complex case.


  9. P5232-7
    Landesman, A.
    Mahler's Developmental Theory - Training the Nurse to Treat Older Adults with Borderline Personality Disorder
    Journal of Gerontological Nursing; Vol. 29 (2) 22-28; February 2003

    According to one researcher, adults with Borderline Personality Disorder (BPD) are at greater risk of morbidity and mortality secondary to neglect, increased risk of self-destructive behavior including drug abuse, and premature institutionalization. After presenting an overview of Mahler's developmental theory of BPD, the authors present a case study of an older nursing home resident who exhibits the characteristics of the disorder including interpersonal conflicts with staff and other residents that arise from demanding, abusive and splitting behaviors. The need for nurses, CNAs, physicians and other health care professionals to be aware of the dynamics of this mental health issue and to provide a unified and consistent care plan is essential for the resident's benefit and to diminish caregiver stress.


  10. P5135-2
    Thobaben, M. & Duncan, R.
    Domestic Elder Abuse by Health Care Providers
    Home Health Care Management & Practice; Vol. 15 (2) 168-169; February 2003

    This brief article uses a case study to illuminate the home health care provider about the possibility of domestic elder abuse. Care providers are encouraged to monitor the patient globally during all home visits and to be aware of their agencies policies regarding suspicions of elder abuse, neglect or exploitation.


  11. P5195-7
    Goodroad, B.
    HIV and AIDS in People Older Than 50 A Continuing Concern
    Journal of Gerontological Nursing; Vol. 29 (4) 18-24; 2003

    According to the Centers for Disease Control (CDC), there are over 75,000 Americans aged 50 and over who have been diagnosed with AIDS, representing approximately 11 per cent of those in the U.S. diagnosed. While AIDS cases are decreasing nationally, the rate in this segment of the population remains stable, with unprotected heterosexual contact representing the highest risk group. Women and minorities are at increasing risk. Ageist myths regarding older people as non-sexual, non-injection-drug using contribute to the invisibility of the problem, as even health care professionals are less likely to suspect a diagnosis of AIDS or HIV. One recommendation for gerontological nurses is the need for comprehensive screening of all patients that includes a thorough sexual and substance abuse history.


  12. P5179-346
    Mittelman, M., Epstein, C. & Pierzchala, A.
    Counseling the Alzheimer's Caregiver: A Resource for Health Care Professionals
    AMA Press, Chicago, Illinois; 2003

    Intended for counselors and other health care professionals working with families of Alzheimer's disease (AD) patients, this book provides recommendations based upon the Spouse Caregiver Intervention Study at the New York University School of Medicine's Alzheimer's Disease Center. The topics covered include essential information regarding AD and the assessment of the caregiving context. The counseling protocol of the NYU Center is outlined and presented along with counseling strategies and techniques, such as the use of "ad hoc" counseling, family counseling and preparation for and referral to support groups. One chapter is devoted to exploring issues related to decisions of residential placement, and the final chapter addresses death and bereavement. Each chapter concludes with a checklist of practical counseling guidelines. The use of case vignettes throughout the book illustrates concepts discussed. (Note: This book is not available through CANE. To order, contact the AMA Press online at www.AMAPress.com or telephone 800 621-8335. Price: $42.95.)


  13. P5137-7
    Kahan, F. & Paris, B.
    Why Elder Abuse Continues to Elude the Health Care System
    Mount Sinai Journal of Medicine; Vol. 70 (1) 62-p68; 2003

    The Mount Sinai Hospital Elder Abuse Program was created in 1998. The purpose was to identify elderly patients in the hospital who had experienced elder abuse or neglect, to assist them in attaining compensation, and to provide counseling, support, advocacy and referral. A case study is presented to illustrate the difficulties in providing services. Over a two-year period, 182 cases were identified and assessed, with approximately half of those referred patients having a diagnosis of memory impairment. This article presents information regarding the population served through this model program, and addresses the obstacles found in the health care setting. Interdisciplinary/multidisciplinary team work is pivotal, along with the continued education of health care professionals regarding the symptoms of elder mistreatment.


  14. P5105-7
    Peake, M. et al.
    Ageism in the Management of Lung Cancer
    Age and Ageing; Vol. 32 p171-p177; 2003

    In this study, data was gathered concerning the diagnosis and treatment of 1,652 lung cancer patients in the U.K. between 1997 -1998. The results indicate that there are age-related differences regarding the management and survival of non-small cell lung cancer (NSCLC) patients. Although age alone does not appear a significant prognostic factor in NCSLC, and elderly patients' response rates to chemotherapy are comparable to younger patients, older patients appear under treated. This research suggests that ageism in treatment may account for higher mortality rates of NSCLC in the U.K. as compared to the U.S. and most of Europe.


  15. P5104-11
    Teel, C. & Carson, P.
    Family Experiences in the Journey Through Dementia Diagnosis and Care
    Journal of Family Nursing; Vol. 9 (1) 38-58; 2003

    Early detection of Alzheimer's disease (AD) increases the likelihood of early pharmaceutical and social interventions, which typically improves the quality of life for both the patient and his or her caregiver and may slow the disease's progression. In this study, 14 family caregivers of Alzheimer's patients were asked to describe their experiences of seeking an accurate diagnosis and appropriate treatment. The participants responded to flyers distributed through local chapters of the Alzheimer's Association in Kansas. Semi-structured interviews were conducted and transcribed. Constant comparison analysis was used during the data collection and analysis, and identified themes were presented for follow-up at the peer debriefing. For many caregivers, the diagnosis process went on for several years and involved multiple visits to various health care professionals, including primary care physicians, neurologists and psychiatrists. Physical, emotional and financial stressors and health care providers with limited knowledge regarding AD were the key barriers to effective treatment identified. The role of nurses in family care settings is discussed.


  16. P5227-9
    Rogan, F. & Wyllie, A.
    Engaging Undergraduate Nursing Students in the Care of Elderly Residents in Australian Nursing Homes
    Nurse Education in Practice; Vol. 3 (2) 95-103; 2003

    This paper explores the response to an education program designed to foster enhanced attitudes towards caring for the aged. The program, implemented at the University of Technology in Sydney, Australia, combined ongoing clinical experiences with classroom education. For six weeks, student nurses spent one day a week at the same nursing home caring for the same resident. Following the six weeks, the student continued with four day training at the same institution. Following the training, 112 students completed a survey regarding their experiences and 18 of these respondents participated in focus groups. Results indicate that students developed a person-centered approach towards the elderly through continuity of care. Thirty-seven per cent of the 112 reported being highly interested in working with the elderly, 23.3 per cent were moderately interested, 33 per cent had low interest, 1.7 per cent had no interest and one student had less interest following this course. Authors recommend that this approach be further developed as a means to combat ageism among students and thus address a potential crisis in the health care system as the population continues to age.


  17. P5217-8
    Shugarman, L., Fries, B., Wolf, R. & Morris, J.
    Identifying Older People at Risk of Abuse During Routine Screening Practices
    Journal of the American Geriatrics Society (JAGS); Vol. 51 24-31; 2003

    This study explored the links between various characteristics of older, community-dwelling individuals and the potential for elder abuse. Research was based upon data from 701 application interviews from the Michigan Home and Community Based Services (HCBS) waiver program and the Care Management program (November 1996 - October 1997). Five measures of elder abuse and neglect were used to identify those potentially victimized, and characteristics were analyzed to determine if an association was suggested. Thirty-three of the 701 demonstrated at least one of the signs of potential abuse. Short-term memory, psychiatric illness, alcohol abuse, and four measures of poor social functioning and impaired support were associated with the potential for mistreatment. While this index had a high degree of sensitivity for identifying potential abuse, it did not appear to have a high degree of specificity. The researchers suggest health care professionals combine these indicators with key questions from the Minimum Data Set for Home Care (MDS-HC) for screening and care planning.


  18. P5147-3
    Chaffin, J. & Richter, P.
    Making Prevention of Abuse and Neglect through Dental Awareness Green
    Military Medicine; Vol. 167 (11) 920-922; November 2002

    Noting that the military community prevalence rates of family violence are commensurate with those of the civilian community, and that reports indicate that up to 94 per cent of family violence injuries effect the head and neck, the U.S. Army Dental Command developed a program to increase awareness of this societal problem. The Prevent Abuse and Neglect through Dental Awareness (P.A.N.D.A.), initially developed by Delta Dental of Missouri, was adapted by the military to promote awareness of family violence and to enhance the dental professional's ability to identify symptoms of abuse and neglect. The six components of the protocol are outlined: assessment of the patients' physical appearance, behavioral assessment, a thorough patient history, (including separate histories of sponsor and patient in the event of trauma), an oral examination, documentation (including photographs, if indicated) and consultation and reporting of any suspected abuse to the designated personnel.


  19. A68-12
    Todd, C.
    Practitioners Must Consider Roles as Investigators, Reporters
    ED Legal Letter; Vol. 13 (5) 49-60; May 2002

    This is a comprehensive overview of the roles that emergency physicians and health care professionals play when treating victims of abuse (or suspected abuse). Specifics include the handling of forensic evidence (including chain of custody) in order to preserve its value in future investigation and prosecution, and documentation, including the recording of victims' statements. The article concludes with discussion of mandatory reporting in cases of child abuse, elder abuse and other violent crimes.


  20. N4778-62
    U.S. General Accounting Office, Aronovitz, L.
    Nursing Homes: More Can be Done to Protect Residents from Abuse, along with prepared remarks by Ms. Aronovitz - Hearing before the U.S. Senate Special Committee on Aging
    Washington, D.C.; March 4, 2002

    This U.S. General Accounting Office (GAO) report regarding institutional abuse was presented by Leslie Aronovitz, director of the Health Care - Program Administration and Integrity Issues, at the U.S. Senate hearing entitled Safeguarding our Seniors: Protecting the Elderly from Physical and Sexual Abuse in Nursing Homes, March 4, 2002. In her introduction, the director describes the process involved in this report that was designed to address the following: (1) to determine whether allegations of abuse were reported in a timely manner; (2) to assess the extent to which abusers are held criminally accountable; (3) to evaluate whether present preventative measures are sufficient to safeguard residents. The report was limited to physical and sexual abuse and based upon data from three states with relatively large nursing home populations: Illinois, Pennsylvania and Georgia. Interviews with officials at the Centers for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration or HCFA) and law enforcement representatives were also conducted. Three major factors contribute to the hidden nature of institutional abuse: definitional inconsistencies; powerful deterrents for victims, families and witnesses to report abuse; and the fact that incidents handled appropriately by the facilities do not result in violations or citations, and therefore remain uncounted. The following are among the findings identified: late reporting of allegations, thus compromising the investigation, difficulty in finding appropriate telephone listings in directories to facilitate reporting, discrepancies in referring to law enforcement for prosecution, delays in investigation and reporting, and insufficient policies regarding background checks for all employees. Recommendations to address these deficiencies are discussed. (Note: This report is available online at http://www.canhr.org/pdfs/d02312.pdf


  21. P5033-7
    Beverly, C., for the U.S. Senate Special Committee on Aging
    Testimony of Claudia J. Beverly, PhD., RN, FAAN, for the U.S. Senate Special Committee on Aging hearing - Patients in Peril: Critical Shortages in Geriatric Care
    February 27, 2002

    This is the testimony of Claudia J. Beverly at the U.S. Senate Special Committee on Aging hearing held on February 27, 2002, entitled Patients in Peril: Critical Shortages in Geriatric Care. In her address, she focuses on the shortage of geriatric nurses and other health care professionals, and the need for the development of interdisciplinary team health care provision. In particular, she discusses the impact of nursing shortages upon geriatric care in nursing homes, hospitals as well as at home. She also discusses several aspects of the Nurse Reinvestment Act.


  22. A26-11
    Rich, B.
    Moral Conundrums in the Courtroom: Reflections on a Decade in the Culture of Pain (The Caduceus in Court)
    Cambridge Quarterly of Healthcare Ethics; Vol. 11 (2) 180-190; Spring 2002

    In light of research that most seriously and/or terminally ill patients suffer unnecessary pain, this article reviews the legal and ethical considerations of pain management. The lawsuits of Henry James (NC, 1991) and Bergman v. Chin and the Eden Medical Center (CA, 2001) are presented as examples of the disparity between the prioritization of pain management by patients and their families and health care professionals. The author suggests that legal remedies, rather than clinical guidelines, will have a greater impact upon changing physicians' practices.


  23. N4844-79
    Wood, E.
    Termination and Closure of Poor Quality Nursing Homes: What Are the Options?
    The AARP Public Policy Institute, publication #2002-05; Washington, D.C.; March 2002

    This AARP Public Policy Institute Issue Paper utilizes case studies from seven out of thirty-three nursing facilities involuntarily terminated from Medicare/Medicaid participation and closed between 1996 - 2000. In addition to termination, the study looks at alternative remedies for poor quality care, including the value of assigning temporary management and receivership. It also identifies least harmful models of closure and resident transfer. Among the proposed recommendations: enhancement of public accessibility to accurate (and current) information regarding quality and compliance issues; the study of the effectiveness of current intermediate sanctions such as monetary penalties and correction plans; and the development of best practice protocols addressing residential issues of termination and transfer, under the leadership of the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration or HFCA). To obtain this publication, contact: AARP, 601 E Street, Washington, D.C. 20049.


  24. P5041-25
    Eremia, A.
    When Self-Regulation, Market Forces, and Private Legal Actions Fail: Appropriate Government Regulation and Oversight is Necessary to Ensure Minimum Standards of Quality in Long-Term Health Care
    Annuals of Health Law; Vol. 11; 2002

    As quoted from the introduction: "...This paper examines why market forces, self-regulation, and private litigation, individually and collectively, have generally not been successful paradigms for ensuring quality health care. This paper also explores the federal government's role in promoting quality, deterring substandard care and overseeing the healthcare industry...Finally, some of the government regulatory inadequacies are examined..." The Health Care Quality Improvement Act (HCQIA, 1986) and the recent use of the False Claims Act in redressing nursing home abuse are among points of discussion. (Note: This article is available electronically through Lexis-Nexis subscription services.)


  25. N4912-8
    Brandl, B. & Horan, D.
    Domestic Violence in Later Life: An Overview for Health Care Providers
    Women & Health; Vol. 35 No. 2/3 41-54; 2002

    Co-published simultaneously in Domestic Violence and Health Care: Policies and Prevention; Reyes, C., Rudman, W. & Hewitt, R., eds; Haworth Press; p41-54, 2002.
    This overview was prepared to assist health care professionals in detecting domestic violence in older women. Universal screening of all female patients over age 60 and those with disabilities is encouraged and combines a review of medical indicators as well as interviews regarding lifestyle and family history of conflict and violence. The authors discuss issues of competency, documentation (written and photographic), confidentiality, safety planning, referral and reporting, and support. In particular, the authors caution against the prescribing of anti-depressant medication without a thorough abuse assessment, blaming the victim, recommending family or marital counseling without treatment for the batterer, colluding with the abuser, and minimizing the dangerousness for the victim or health care professional when help is offered.


  26. N4986-7
    Richardson, B., Kitchen, G. & Livingston, G.
    The Effect of Education on Knowledge and Management of Elder Abuse: A Randomized Controlled Trial
    Age and Ageing; Vol. 31 335-341; 2002

    This study compares the effectiveness of educational experience versus reading educational materials in improving the identification and management of elder abuse. A group of 31 health care staff attended a course addressing elder abuse and a second group of 33 staff received reading materials. Key results indicate that while educational seminars appear more effective, "multidisciplinary education needs to be targeted according to baseline knowledge as those who knew more learned less." (U.K.)


  27. N4595-24
    Fink, A., Tsai, M., Hays, R. et al.
    Comparing the Alcohol-Related Problems Survey (ARPS) to Traditional Alcohol Screening Measures in Elderly Outpatients
    Archives of Gerontology and Geriatrics; Vol. 34 55-78; 2002

    In this study, 574 elderly patients at the UCLA Medical Center and Sansum-Santa Barbara Medical Foundation Clinics participated in a comparison of the newly developed Alcohol-Related Problems Survey (including an embedded version of the AUDIT) with two other well validated screening tools, the SMAST and the CAGE. The ARPS, which assesses the respondents' medical conditions and medication usage as well as patterns of alcohol usage, identified the respondents who scored positively on the other scoring tools. It also identified "hazardous" and "harmful" drinkers, due to the interaction of lower levels of alcohol consumption with medical conditions and medications that were not identified by the other tests. The implication is that this tool could be effective n the health care setting as a means to identify elderly patients at risk for alcohol related problems who were previously unidentified. The ARPS survey is included. (Available electronically through Elsevier subscription service.)


  28. P5118-9
    Kapp, M.
    Health Care Rationing Affecting Older Persons: Rejected in Principle but Implemented in Fact
    Journal of Aging & Social Policy; Vol. 14 (2) 27-42; 2002

    Although rationing of health care based upon chronological age has been rejected in theory in the U.S., the author of this article examines four "...forms of de facto health care rationing that carry real but largely hidden ramifications for older persons: third-party payer behaviors, physician practice patterns, the spread of evidence-based clinical practice parameters or guidelines in medicine, and the shift toward greater consumer choice in selecting health plans..." Faced with increases in out of pocket expenditures such as premiums or uncovered prescriptions, some older Americans ration health services for themselves. Physicians may make decisions regarding diagnostic and treatment recommendations based upon patient age, and aggressive care is limited for the oldest hospital patients and nursing home residents. Recommendations are offered, and include the guarantee of access to "accurate, comprehensive, timely information about the health care options financially and logistically available to, and medically appropriate for" all individuals, including older consumers.


  29. P5183-7
    Sugar, J., Anstee, J., Desrochers, S. & Jambor, E.
    Gender Biases in Gerontological Education: The Status of Older Women
    Gerontology & Geriatrics; Vol. 22 (4) 43-55; 2002

    As age increases, women represent an increasingly higher proportion of the population. This research was undertaken to explore how and to what extent the field of gerontology addresses the health issues of aging women. Twenty-five teaching textbooks (including introductory gerontology texts, handbooks and encyclopedias) and all articles published in "The Gerontologist, " and the four separate journals of the "Journal of Gerontology" ("Biological Sciences," "Medical Sciences," "Psychological Sciences," and "Social Sciences") during the past five years were reviewed for inclusion of content regarding aging women's health issues. Of the 286 chapters in the handbooks only one was dedicated to aging women's health issues; of the 727 topics in encyclopedias covered only six addressed aging women's health issues; of the 159 chapters in the textbooks, only two chapters addressed aging women's health issues. A total of 90 articles of the 1,207 total articles in the gerontology journals focused on older women's health concerns, with more emphasis found in the biological and medical science journals. Additionally, the authors found that only 60 per cent of gerontological studies published during the five year period analyzed gender variations in research data.


  30. N4838-366
    Committee on the Training Needs of Health Professionals to Respond to Family Violence - Board on Children, Youth, and Families, Institute of Medicine; Cohn, F., Salmon, M. & Stobo, J., eds.
    Confronting Chronic Neglect: The Education of Health Professionals on Family Violence
    National Academy Press, Washington, D.C.; 2002

    This book, the third report of the National Academies focusing on the issue of family violence, addresses deficits in educational curricula for health professionals. The three objectives of this research were: (1) to assess the training needs among various health care disciplines; (2) assess the available curricula for detecting and addressing family violence; (3) to identify current efforts, coalitions and initiatives to enhance the competencies of health care providers regarding this issue. Among the recommendations made is the establishment of national education and research centers addressing family violence, leadership from professional health organizations in the form of competency standards, and federal support for the evaluation of training efforts. Appendices include accreditation requirements, policy statements of health professional organizations, state by state mandatory reporting laws for family violence, existing mandatory educational requirements, existing curricula on family violence, and summaries of evaluative studies of training efforts. Note: (This book is not available through CANE but is currently available online at www.nap.edu or can be ordered directly from: National Academy Press, 2101 Constitution Ave., N.W., Lockbox 285, Washington, DC 20055, telephone 1-800-624-6242. Price: $39.95)

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