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January 2, 2006


The Source of Information and Assistance on Elder Abuse

Clearinghouse on Abuse and Neglect of the Elderly (CANE)
Annotated Bibliography:

Dementia: A Supplement to the CANE Annotated Bibliography of October 2000

Cognitively impaired individuals are often dependent upon family members, guardians and health care professionals to interpret and communicate their needs, and in many cases to provide personal care, social support and ongoing supervision. Because individuals suffering from dementia often experience poor judgment and impaired communication skills, they may be more vulnerable to abuse and neglect. In many cases, they may be unable to identify such mistreatment, and unable to report it. In addition, agitation and disruptive behaviors sometimes demonstrated by dementia patients can adversely affect the care that they receive both at home and in institutional settings. Such behaviors can be indicators of pain, depression and illness for those unable to verbalize their needs, and may be misinterpreted. Efforts to address these behaviors may have serious ethical implications for the human rights of these individuals.

The following references address these and other challenges of providing appropriate care to individuals who suffer from dementia that impact upon their quality of life and state of physical and emotional health. It is intended to supplement the references on dementia included in the CANE bibliography entitled "Elder Abuse and Mental Health / Alzheimer's Disease / Dementia" (October 2000).

Most of these reference materials may be obtained through your local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance.

CANE is a service of the National Center on Elder Abuse (NCEA) which is supported by a grant from the Administration on Aging.

(*Like the mysterious staircases at Hogwart's Academy, web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance.)


Bates, J., Boote, J. & Beverley, C.
Psychosocial Interventions for People with a Milder Dementing Illness: a Systematic Review
Journal of Advanced Nursing; Vol. 45 (6), 644-658; 2004.
Literature review
In this literature review, four studies addressing three psychosocial interventions (counseling, reality orientation, and procedural memory stimulation) met the inclusion criteria for evaluation of effectiveness in people with mild and mild to moderate dementia. Mild and mild to moderate dementia was indicated by a score within the range of 15-23 on the Folstein Mini-Mental State Examination (MMSE). All four papers used the controlled trial design wherein one group received the treatment intervention, and the control group did not. Sample sizes were relatively small, ranging from 19 to 28 participants. Although further research is indicated, the results suggest that reality orientation is an effective psychosocial tool for individuals with mild dementia while counseling and procedural memory stimulation do not appear as promising.

Cowan, D. et al.
Nutritional Status of Older People in Long Term Care Settings: Current Status and Future Directions
International Journal of Nursing Studies; Vol. 41 (3), 225-237; 2004.
Journal article (scholarship)
Research indicates that older people, particularly those in long-term care settings, are at increased risk for malnutrition. This article presents an overview of the topic. Causes associated with malnutrition can be classified as either individual or organizational. Individual factors are either physical, due to one's social environment, or a combination of both, and include such causes as ageism, abuse, depression, dementia, pain and isolation. Organizational factors include failure to assist residents with eating, failure to recognize signs of malnutrition, poor staffing, poor staff communication and poor enforcement of regulations. Among the recommendations are the development and evaluation of nutritional assessment instruments designed specifically for the frail and the elderly, and increased education and training for those health care professionals working with this population. Several monitoring tools under development are discussed. (England/U.K)

Miskelly, F.
A Novel System of Electronic Tagging in Patients with Dementia and Wandering
Age and Ageing; Vol. 33 (3), 304-306; 2004.
Journal article (research)
This brief article reports upon the effectiveness of an electronic tagging system to address the potentially dangerous wandering of older individuals with dementia. After a successful pilot study, four residents of a residential care home in the U.K., five hospital patients, and three community based individuals participated by wearing the tagging bracelet. There were no technical difficulties with the equipment, and there were no undetected incidents of wandering. In the residential care home, up to 15 instances of internal wandering occurred daily. Two instances of outside wandering were detected and immediately addressed. Despite its effectiveness, researchers recognize the ethical considerations of using the system.

Reichman, W. & Korn, M.
Comprehensive Management of Behavioral Disturbances in Dementia
January 29 2004
Online continuing education article
This online continuing education article provides an overview of different types of dementia, outlines important behavioral management issues of patients with dementia, and reviews the nonpharmacological and pharmacological interventions available. The "unmet-needs model" is described, which suggests that difficulties in communication may lead to difficulty in detecting the needs of the patient (such as illness or sensory impairment). Other nonpharmacological interventions are caregiver education and increased social contact. Means to decrease behavioral problems in nursing homes and other institutional settings include an assessment of organizational, social, technological issues and the physical setting. The CARE program (Calming Aggressive Reactions in the Elderly) and the NACSP (Nursing Assistant Communication Skill Program) are highlighted as training programs for healthcare personnel. The complex issue of restraint usage is also considered. Pharmacological approaches include the use of neuroleptics such as Haloperidol, Risperidone, Quietiapine, Olanzapine and Clozapine. (Note: This article, along with instructions for continuing education credit for physicians, nurses, pharmacists and other healthcare professionals, is accessible online through Medscape at . A no-fee registration is required.)

U.S. Senate Special Committee on Aging
Crime Without Criminals? Seniors, Dementia and the Aftermath
Washington, D.C.; March 22, 2004
Hearing - Senate
In this U.S. Senate Special Committee on Aging hearing, the following individuals presented testimony on the current inadequacies of treating and managing individuals with dementia within both the health care system and the law enforcement and judicial system: Commander Gary Gotham (family member of a dementia patient), Donna Cohen, Ph.D. (professor and head of the Violence and Injury Prevention Program, Louis de la Parte Mental Health Institute, Florida), Max Rothman (Executive Director of the Center on Aging, Florida International University), and Constantine Lyketsos, M.D. (Professor of Psychiatry and Behavioral Sciences, Johns Hopkins University). Opening statements were made by Senator John Breaux and Senator Larry Craig. (Note: The transcripts from this hearing are accessible online at:

Vitaliano, P., Young, H. & Zhang, J.
Is Caregiving a Risk Factor for Illness?
Current Directions in Psychological Science; Vol. 13 (1), 13-16; 2004.
Journal article (scholarship)
In 1997, it was estimated that informal family caregivers provided $196 billion dollars of long-term care for patients with dementia, therefore, the health of caregivers is a vital concern of not only these individuals and their families but to society as well. This article considers the current research on the impact of caregiving upon caregiver's health. The authors discuss a theoretical model that focuses on the differences between people regarding moderating and mediating factors. The complex interactions of distress, health habits, physiological changes and health risks occurring in a natural living environment contribute to the difficult nature of assessing caregiver health outcomes.


Allen, N.H. et al.
The Effects of Improving Hearing in Dementia
Age and Ageing; Vol. 32 (2), 189-193; 2003.
Journal article (research)
In this study, 31 dementia patients who were identified as having mild hearing impairment were provided with hearing aids and monitored at one month, three months, and six months follow-ups to determine if they had experienced any changes in hearing, cognition, psychiatric symptoms, ADLs, and caregiver burden. While subjects showed a decline in cognitive functioning and no changes in behavioral or psychiatric symptoms or caregiver burden, 42 per cent indicated improvement in global functioning on the Clinical Global Impression of Change (CGI). Hearing aid diaries indicated that 56 per cent of the participants continued to use their hearing aids daily throughout the study, and that those who did so displayed improvements in hearing. (U.K./England)

Freeman, I.
Assuring Safety for People with Dementia in Long-Term Care Facilities: A Focus on Staffing
Ethics, Law, and Aging Review; Vol. 9,107-124; 2003
Journal article (scholarship)
Research into institutional elder abuse and neglect suggests that the most preventable causes of mistreatment are staff shortages and inadequate staff training. This chapter focuses on four aspects of nursing home staffing: hiring practices; sufficient staffing; consistency in staffing; and appropriate training and education in dementia care. A discussion of the limitations of criminal background checks, along with recent state court decisions regarding the constitutionality of these screening practices, is presented. The author maintains that the criminal background check should be seen as only one tool for assessing the appropriateness of care facility employees. One interviewing/training strategy suggested is the use of vignettes to generate problem prevention and problem-solving strategies. A review of federal staffing standards along with staffing requirements implemented in various states is provided, although there are currently no federal guidelines on caring for dementia residents. Nor is there consensus regarding optimal staffing ratios for dementia care in nursing homes, and the guidelines for such care in assisted living facilities is even more vague. Other than the minimum nursing aide training requirement of 75 hours, no specific dementia care training is mandated federally. Staff often feel inadequately prepared and note that training typically ceases once the employee is "on the floor." Research suggests that such training provides risk prevention for both employee injuries and resident abuse and neglect. Included in this discussion is the concept that caregivers should receive training in communications skills to better detect pain and other problems that a cognitively impaired patient may not be able to directly communicate. The article concludes with a recommendation for state and local advocacy for elder abuse prevention as well as for the federal Elder Justice Act.

Ho, B., Friedland, J. Rappolt, S. & Noh, S.
Caregiving for Relatives with Alzheimer's Disease: Feelings of Chinese-Canadian Women
Journal of Aging Studies; Vol. 17 (3), 301-321; 2003.
Journal article (research)
Noting that both the Chinese population and the elderly segment of society in North America are growing, this article explores the impact of culture, caregiver stress and social support upon Chinese-Canadian women caring for relatives with Alzheimer's disease. Twelve women who had emigrated from China were interviewed regarding their experiences as caregivers, within the framework of the model of caregiver stress outlined by Pearlin, Mullan, Semple and Skaff. Secondary stressors, such as role strain and intra-psychic strain, were the main focus of the five open ended questions. Inductive qualitative analysis revealed multiple common themes such as filial obligation, anticipation of the role, differences between Chinese and western attitudes towards caregiving, intergenerational and other family conflicts, work role conflicts, loss of self and "role captivity." One poignant sentiment held by many of these caregivers was that their own children would be unlikely to follow in their footsteps and likewise provide care for themselves. Mediating factors that emerged included positive attitudes as well as the presence of formal and informal supports that were culturally congruent with their values and circumstances. Despite the belief in filial obligation, most of these caregivers intended to institutionalize the care recipient when they could no longer provide adequately for their needs. The authors postulate that the acceptance of this outcome is likely due to the perception that institutionalization is an extension of already utilized formal supports.

National Institute on Aging - National Institutes of Health
2001-2002 Progress Report on Alzheimer's Disease
U.S. Department of Health and Social Services, National Institutes of Health; Washington, D.C.; 2003.
This report highlights the progress made in 2001-2002 in addressing Alzheimer's disease. The publication reports upon research on both risk and prevention factors as well as treatment interventions. (Note: This entire report is available online at, or may be ordered by contacting The Adear Center at (800) 438-4380.)

Schneider, L., Peskind, E., Pfeiffer, E. & Porsteinsson, A.
Choosing Treatment for Alzheimer's Patients and Their Caregivers
December 29 2003
Reprinted with permission from Geriatrics, Vol. 58, S1, 33-18; 2003.
Online continuing education article
Intended for geriatricians, family practise physicians, and internal medicine specialists, this continuing education activity addresses the complexities of treating Alzheimer's disease along with its co-morbid conditions and behavioral, psychiatric and cognitive symptoms. The article is divided into four sections. The first addresses potential noncholinergic treatment strategies, such as the use of Vitamin E to reduce elevated homocysteine levels (risk factors for cardiovascular disease, vasclar dementia, and AD), anti-inflammatories, statins, etc. The second section addresses difficulties of assessment and treatment of depression, while the third section focuses on psychosis and agitation, inculding the use of medications as well as nonpharmacological interventions. The final segment emphasizes the need to include care for the caregiver and family of the patient. (Note: This article, along with instructions for continuing education credit for physicians other healthcare professionals, is accessible online through Medscape at A no-fee registration may be required.)

Stein, R.
Legal System Struggles with Dementia Patients
Washington Post; A01; July 28 2003.
Focusing upon the death of Bess Kleinman, a 90 year old resident of a senior living complex in Florida, this article describes the increasing frequency and complexity of incidents wherein dementia patients become entangled in the criminal justice system. In this case, a 72 year old man, suffering from dementia, suffocated and killed his close friend and neighbor. The article includes opinions of experts in the field of law, aging and Alzheimer's disease regarding the prosecution and disposition of such cases, including domestic violence disturbances. Initiatives from around the country are highlighted. (Note: This article is available online at¬Found=true)

Welsh, S., Hassiotis, A., O'Mahoney, G. & Deahl, M.
Big Brother is Watching You - The Ethical Implications of Electronic Surveillance Measures in the Elderly with Dementia and In Adults with Learning Difficulties
Aging & Mental Health; Vol. 7 (5), 372-375; September 2003.
Journal article (scholarship)
In this article, the authors discuss the ethical considerations of using surveillance technologies, particularly electronic tracking and tagging, in order to monitor the behavior of incapacitated adults. Observing that wandering is often a behavior among community dwelling residents with dementia that precipitates institutionalization, the authors suggest that these technologies could afford such individuals greater freedom. Additionally, the use of these devices among nursing home residents may provide them with a more varied lifestyle and may lead to less agitation and behavioral disturbances. The effect of these technologies upon human rights and civil liberties is considered. (England/U.K.)


Cohen, G.
Alzheimer's Disease - Managing Behavioral Problems in Patients with Progressive Dementia
Geriatrics; Vol. 57 (2), 53-54; February, 2002.
Journal article (scholarship)
This brief article provides advice to physicians managing the care of patients diagnosed with Alzheimer's disease who are demonstrating psychiatric symptoms, such as delusions or increased frustration. Clinical questions are provided as guidelines in addressing the behavioral concerns, along with a list of preferred psychotropic medications. (Note: This article can be accessed online at

Hubbard, G., Cook, A., Tester, S. & Downs, M.
Beyond Words - Older People with Dementia Using and Interpreting Nonverbal Behaviour
Journal of Aging Studies; Vol. 16 (2 ), 155-167; 2002.
Journal article (research)
In light of the frequent communication impairments observed in dementia patients, this qualitative study explores the nonverbal communication of individuals attending a day care center in Central Scotland. Ten dementia clients and six day care staff participated in this ethnographic research that employed the symbolic interactionist perspective. The observations revealed that these clients used nonverbal communication to express their needs to others, to reassure themselves, to engage socially and to communicate humor. These communications demonstrated shared meanings between self and others. This suggests that through nonverbal communication, individuals with dementia can foster interpersonal relationships and maintain a sense of personhood. It also holds implications for caregiving.

Leonnig, C. & Horwitz, S.
Appeal Heard in Case of Elderly Woman
Washington Post; B03; June 26, 2002.
This news article reports on the case regarding the care of Mollie Orshansky, a renowned, retired economist diagnosed with dementia. Prior to a recent medical crisis, the woman had assigned health care power of attorney rights to her niece, and financial decision-making to her sister. A D.C. Superior Court had ordered Ms. Orshansky be removed from the care of her family, indicating that they had not acted quickly enough when her health was declining. The appeals judges were concerned that Ms. Orshansky's wishes were not sufficiently considered in this initial decision. (Note: This article may be accessed online -- along with others regarding guardianship and competency issues -- at

Linzer, N.
An Ethical Dilemma in Home Care
Journal of Gerontological Social Work; Vol. 37 (2), 23-34; 2002.
Journal article (scholarship)
In this discussion, the author uses a case scenario to explore the intracacies of ethical dilemmas in home care. The principles of autonomy, beneficence, dignity and paternalism are considered as they impact upon the social worker's decision to intervene when clients, who appear self-neglecting due to dementia or physical incapacity, refuse services. The decision-making capacity is at the heart of this dilemma.

U.S. Department of Justice Office of Justice Programs Office for Victims of Crime
First Response to Victims of Crime Who Have a Disability
U. S. Dept. of Justice, Office of Justice Programs, Office for Victims of Crime, Washington, D.C.; October, 2002.
Guidebook (online)
This handbook (prepared under grant # 97-VF-GX-0002 for the National Sheriffs' Association) was designed to provide law enforcement officers with basic guidelines for approaching and interacting with victims of crime who have Alzheimer's disease or dementia, mental illness, mental retardation or other developmental disabilities, or who are visually or hearing impaired. Research indicates that individuals with disabilities have a greater risk of criminal victimization. In general, police and other crisis response professionals are asked to consider and challenge their personal biases and to be sensitive to language that infantilizes individuals with disabilities. Specific suggestions for crime victims with dementia include establishing a one-on-one conversation and reducing noise, confusion and distractions. Responders are also reminded to observe for a Safe Return identification bracelet, etc., and to refer support persons to this program. Additionally, responders are instructed to contact the local Alzheimer's Association for emergency shelter if necessary. (Note: This publication is available online at
or may be ordered from the OVC Resource Center, P.O. Box 6000, Rockville, MD 20849-6000, telephone 1-800-627-6872, TTY 1-877-712-9279, or online at


Coyne, A.C.
The Relationship Between Dementia and Elder Abuse
Geriatric Times; Vol.II (4); July/August, 2001.
Online article
In this comprehensive article, the author surveys available research to discuss prominent factors that contribute to a higher prevalence rate of elder abuse among dementia patients. He cites aggressiveness on the part of some patients, a premorbid family history of domestic violence, and a poor understanding of how to manage aggressiveness (by both caregivers and health professionals) as factors that may increase the likelihood of abuse. He also includes discussion of what some health professionals perceive as drawbacks to the mandatory reporting laws. In conclusion, the author notes that laws alone will not protect this vulnerable population and offers recommendations for further action. (Note: This article is available online only at:

Desbiens, N.
How to Help Families Better Assess Patients' Pain
Geriatric Times; Vol. II (3); May/June, 2001.
Online article
This article discusses the role that family can play in assisting institutional staff in assessing and treating pain accurately, particularly among cognitively impaired patients. Addressing the recent JCAHO standards regarding pain management, the authors describe the findings of SUPPORT (the Study to Understand the Prognoses and Preferences for Outcomes and Risks of Treatment) that indicate that families are generally successful in identifying the patient's experience of pain, but not at accurately assessing its magnitude. Interactive education of staff and family, and communication regarding the patient's behavioral changes are essential to improved pain management. (Note: This article is available online only at

Georgia Law Review Association
Symposium: Joint Conference on Legal/Ethical Issues in the Progression of Dementia: Recommendations of the Joint Conference
Georgia Law Review; Vol. 35, 423-447; Winter, 2001.
Law Review article
This paper reports the recommendations generated by the symposium of the Joint Conference on Legal/Ethical Issues in the Progression of Dementia, held at the Center for Continuing Education at the University of Georgia (11/29-12/2/2000). Seventy-five multidisciplinary experts participated in working groups that addressed the following issues encountered in addressing the needs of a dementia client: legal planning, autonomy versus public safety, research consent, treatment choices, end-of-life issues, genetic discrimination by long-term care insurers, legal representation (including ethical considerations when assisting families) and dispute resolution. The conference structure was organized around the case study of an Alzheimer's patient and her family's involvement. The symposium was sponsored by the Borchard Foundation Center on Law and Aging, the Alzheimer's Association, the American Bar Association's Commission on Legal Problems of the Elderly, the National Academy of Elder Law Attorneys and the University of Georgia School of Law. (Note: This article is available electronically through Lexis-Nexis.)

Howell, A.E. & Macaluso, A.L.
Safe Outreach for Seniors (S.O.S.): A Collaborative Training Manual for Health Care and Law Enforcement
Kimball Medical Center - An Affiliate of the Saint Barnabas Health Care System / Geriatric Evaluation and Management Service (G.E.M.S.); Lakewood, NJ; 2001.
This manual describes the Safe Outreach for Seniors Program (S.O.S.) that was formalized in 1998 between law enforcement and the Geriatric Evaluation Program Service (G.E.M.S.) at Kimball Medical Center. The program enlists police officers, often the first professionals to have contact with seniors who are at risk for self-injury or exploitation due to dementia, to make referrals for appropriate health care and social services. The manual provides an overview of dementia and how it may become evident by unsafe behaviors such as erratic driving, poor home conditions, and repeated contacts with police. Actual referral reports are included to exemplify these situations. To order the manual or inquire about the recommended "train the trainer session," contact G.E.M.S. at (732) 886-4797. Cost: 1-10 manuals are $12.00 each; 11-50 manuals are $10.00 each; 50 or more manuals are $8.00 each. Shipping and handling fees are additional and start at $2.50.

Janevic, M.R. & Connell, C.M.
Racial, Ethnic and Cultural Differences in the Dementia Caregiving Experience: Recent Findings
The Gerontologist; Vol. 41(3), 334-347; 2001.
Journal article (literature review)
This article reports on the results of 21studies that compares ethnic, racial and cultural aspects of the caregiving experience. These caregivers were grouped racially and included the following ethnicities: African-Americans, Chinese, Chinese-Americans, Koreans, Korean-Americans, Latinos, Whites and residents of 14 European countries. This research found that among the White respondents, caregivers were more often spouses of the care recipient than among other ethnic groups. White caregivers also reported more depression and viewed caregiving as stressful more often than African-Americans. The research suggests that other minority groups may not have more available support than White caregivers.

Longan, P.E.
Middle-Class Lawyering in the Age of Alzheimer's: the Lawyer's Duties in Representing a Fiduciary
Fordham Law Review; 901-910; December, 2001.
Law Review Article
This article explores the legal intricacies of addressing potential financial abuse by guardians of elderly, incapacitated wards. The Model Rules of Professional Conduct and the Restatement of the Law Governing Lawyers are considered as they relate to the ethical conflicts of maintaining client confidentiality while preventing irresponsible, fraudulent or criminal actions. Both the vulnerability of the ward and the susceptibility of the guardian to commit such acts are discussed. A spectrum of professional options are outlined and include counseling without the right to disclose as the least intrusive, and a duty to discover as the most extreme. Also presented are the more moderate though perhaps more effective interventions of optional and mandatory disclosure. (Note: This article is available electronically through Lexis-Nexis.)

Miller, S., Vermeersch, P., Renbarger, K. et al.
Audio Presence Intervention for Decreasing Agitation in People with Dementia
Geriatric Nursing; Vol. 22 (2), 66-70;    2001.
Journal article (research)
The purpose of this research was to determine if audio presence intervention (API), a modified version of simulated presence therapy (SPT), would decrease the agitated behaviors in dementia patients in long-term care settings and therefore present another non-pharmacological intervention strategy. The process involved the playing of simulated conversation of patients' family on audio cassette when the patient became agitated, and the level of agitation was measured before and after the intervention. Some residents responded positively to this intervention but the authors indicate that the mixed results of this study "...pose more questions than provide answers..." and urge further research into this potential strategy.

Stowell, M.
Review of Selected 2000 California Legislation Health and Welfare Chapter 434: Protecting Those with Alzheimer's Disease and Dementia by Increasing Educational Requirements for RCFE Staff
McGeorge Law Review; Vol. 32, 733-746; Winter, 2001.
Law Review article
This article describes California Health and Welfare Chapter 434 legislation which attempts to protect Alzheimer's and dementia residents of residential care facilities (RCFEs) by requiring specialized training for staff of assisted living facilities that advertise as specializing in dementia care. The law does not require such training for staff of facilities that care for dementia residents but do not advertise dementia caregiving as a specialty area; however, administrators of all RCFEs are required to have specialized training. (Note: This article is available electronically through Lexis-Nexis Academic Universe.)

Venohr, I. et al.
Improving Dementia Care Through Community Linkages: A Multi-Site Demonstration Project
Home Health Care Services Quarterly; Vol. 19 (4), 51-63; 2001.
Journal article (research)
This article describes the Dementia Care Project, which was designed to implement and evaluate a system of care for dementia patients. In particular, the project was meant to strengthen links with community services and to better understand the caregivers' needs. Key elements of the model included a single point of informational contact, provider and caregiver education, case finding, internal linkages and links to community services. The model was implemented at six medical centers over the course of one year. The 337 caregivers surveyed gave an overall 73% satisfaction rating for dementia services, 85% satisfaction rate for information provided, and 80% satisfaction with sensitivity and respect during patient care. Providers also reported improvement in dementia services related to linkages.

Wood, E.
Symposium Article: Dispute Resolution and Dementia: Seeking Solutions
Georgia Law Review; Vol. 35, 785-821; Winter, 2001.
Symposium article
This symposium article explores the use of "alternative dispute resolution" (ADR) with dementia patients while providing an overview of various perspectives in conflict resolution. Examples of common disputes in various settings (from private residence to nursing homes) are used to demonstrate different stages where ADR may be appropriate. The examples present a wide range of issues, from everyday conflicts involving habits and preferences, to key life decisions such as whether or not to insert a feeding tube. Among the many points of discussion are the ways that the mediation process may be enhanced to assist cognitively impaired participants, such as utilizing support persons and surrogates, accommodations, and alternative communication techniques. Ethical considerations, including the inherent "fairness" of the process, confidentiality, and neutrality are also considered. (Note: This article is available electronically through Lexis-Nexis.)

National Center on Elder Abuse
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