25- FOXcast PT: What Can We Do To End Elder Abuse?

One in ten adults over the age of 60 are abused, neglected, or financially exploited. Since we are a private practice working with older adults in 16 states and growing. We want to make sure that we are advocates for our older adults.

Dr. Jimmy McKay, PT, DPT: Welcome to FOXcast physical therapy. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at FOXRehab.org. All right welcome to FOXcast Physical Therapy. I’m your host: physical therapist Dr. Jimmy McKay. On the phone, another colleague at FOX Rehabilitation Jessica Reichel. Jessica welcome to the show.

Dr. Jessica Reichl, PT, DPT: Thank you so much for having me. How are you?

Dr. Jimmy McKay, PT, DPT: I’m doing all right. You know it’s a crazy Monday as we record. I’m sure you had a good day with clients out in the field. And where are you calling from?

Dr. Jessica Reichl, PT, DPT: I am actually calling in from my apartment. I live in Roxboro.

Dr. Jimmy McKay, PT, DPT: Roxboro, where is that?

Dr. Jessica Reichl, PT, DPT: It’s like North West Philadelphia. Do you know Manayunk?

Dr. Jimmy McKay, PT, DPT: Yes I know Manayunk very well. Good area. It’s a fun little town.

Dr. Jessica Reichl, PT, DPT: Yeah it definitely is.

Dr. Jimmy McKay, PT, DPT: We had actually crossed paths on line because of a graphic shared by the NIH-the National Institutes of Health. They put out a graphic that was featuring elder abuse. Signs on how to spot it. Warning signs, different types, and I just thought it be great to bring in the clinician to talk about that particular graphic.

Dr. Jessica Reichl, PT, DPT: Yes definitely.

Dr. Jimmy McKay, PT, DPT: First things first I wanted to make sure the audience was aware of how do we identify, what are the things that you look for when working with clients, and caregivers, and families, and anybody else is going to come in contact with our older adults? How do you start to ID it?

Dr. Jessica Reichl, PT, DPT: One thing like help me ID abuse is just something that doesn’t seem right. Like I got a weird feeling in my stomach. I saw some different things. Like I see in the graphic you know unexplained bruises or scars, someone that kind of appear dirty or dehydrated or underfed. I had a patient who I went and saw on Monday, then I came back on Wednesday and they had the same exact outfit on, the same crumbs on their T-shirt from whatever they ate Monday morning before I was there. And that kind of put my ears up to “there’s something going on here that isn’t quite right.”

Dr. Jimmy McKay, PT, DPT: Yeah. Trust your gut.

Yeah. Another way that kind of helped me identify. I am a new grad so I started with FOX in January. This is my first job out of school, and something that really helps me to know what I was looking at was talking to like my mentor and also my RD my senior RD-actually opening up a conversation with the physician as to what I was seeing really helped me to identify it as well. And it confirmed that I was seeing what I was seeing.

Yeah I like where you started with that which is go with your own gut if it doesn’t seem right to you. But of course, bringing in other people, and I mean a lot of times if something doesn’t seem right and you mentioned to someone else, and they start making that face, they start kind of squinting their eyes, too. That’s when you know you’re on to something and you’re both on the same page that just something isn’t right.

Dr. Jessica Reichl, PT, DPT: Exactly.

Dr. Jimmy McKay, PT, DPT: Elder abuse can come in many shapes and forms and we want to make sure all of them can be identified at least at least we’re on the lookout since we spent a lot of time with our older adults want to make sure that we’re advocating for them and paying attention to these things. What else you got?

Dr. Jessica Reichl, PT, DPT: Yes definitely. Also looking at how our patients interact with their caregivers. I’ve seen some interaction that also kind of perked my ears up, where I was like “I’m not sure if my patient feels safe.” Like they don’t feel comfortable around this person and this is the person giving them 24/7 care. That’s something else that was kind of brought to my attention.

Dr. Jimmy McKay, PT, DPT: Right. Absolutely. Great point. Other signs that the NIH recommends to pay attention to: if the client seems depressed or confused, withdrawn maybe socially, isolated from friends or family. Maybe if you had a good rapport and all of a sudden they were now isolated from you, withdrawing, that’s that’s got to be a red flag too right?

Dr. Jessica Reichl, PT, DPT: Yes, definitely. I had a patient that I actually ended up calling protective services on their caregiver. And while we tried to start therapy back up, it was that caregiver we were trying to schedule with that was actually telling us, “no he doesn’t need therapy anymore. He’s good.” That kind of confirms you know that I was on the right track. Something else is going on here.

Dr. Jimmy McKay, PT, DPT: Absolutely. You mentioned you know dirty clothing, maybe wearing the same outfit multiple times, underfed, dehydrated. Over or under-medicated. Or maybe not receiving the needed care for medical issues that are ongoing, and of course, maybe some obvious signs of bruises, burns, or scars, something superficial like that should be paid attention to as well.

Dr. Jessica Reichl, PT, DPT: Yes, definitely. And something else that was brought to my attention, over or under-medicated. Keeping an eye on whether the patient meds are being stolen. The patient had a prescription for Vicodin for 30 days, but the patients calling the doctor after 15 days for a refill. Well that doesn’t really add up.

That’s a great point. It’s just something to pay attention to-where they are in their course of the medication. And yes, if you could do the math for them, you can see if some of those are being taken from them. Other things that we can pay attention to as physical therapists: bedsores or other preventable conditions which are arising, and another thing that I didn’t think of before I saw this graphic from the NIH, which was recent changes in banking or spending patterns. Sometimes we’re not privy to that information. But sometimes we might be able to see that because many types of elder abuse who’ve got emotional, physical neglect, abandonment, sexual, and of course financial, as I just mentioned. So if you are privy to that information, maybe asking a question or two if something as you mentioned at the top of the show, just doesn’t seem right.

Dr. Jessica Reichl, PT, DPT: Exactly. Always go with your gut. That will never steer you wrong.

Dr. Jimmy McKay, PT, DPT: All right Jessica. So now that we’ve listed to a bunch of ways in how to identify elder abuse that we’re working with clients, what do we do about it? How do we address this? It’s a difficult situation. How did you take it on?

Dr. Jessica Reichl, PT, DPT: I opened up a conversation with both my mentor and my regional director. To kind of say, “hey this is what I’m seeing. I don’t feel good about it.” Trying to bring the attention to someone who may have had experience with this already and kind of going off their ideas as to how to handle it. And they actually suggested that I open up a conversation with the physician. This patient has had a fall. And I was kind of in contact with the physician anyway just because I wanted them to make sure that there wasn’t any fracture or anything like that. So it kind of opened up the conversation of the abuse and the physician was actually really receptive. And he was like, “thank you so much for calling.” So that’s when I really knew I was on the right track and really you know knew that something was up. Something wasn’t right.

Dr. Jimmy McKay, PT, DPT: That’s a great point to bring other people who who know the client already, and if you think it happens to be a caregiver-making sure you go outside that network to make sure the patients taken care of and repercussions don’t come back on them for you bringing that information up to a physician.

Dr. Jessica Reichl, PT, DPT: Yes. And I feel like in my experience, as far as you know taking the step to call protective services. That’s when I will again say, “go with your gut.” If you think something’s not right, it’s better to call and report it, and bring it to the attention of someone who maybe has a better eye for the abuse. I would rather it be in their hands, than I didn’t call, and something happened. Yeah. You know what I mean?

Dr. Jimmy McKay, PT, DPT: 100% agree. I would rather be incorrect in making a report. You know that’s never a great feeling-making an incorrect report-but I would rather err on that side than than keep my mouth quiet in a situation like that.

Dr. Jessica Reichl, PT, DPT: Yes, definitely.

Dr. Jimmy McKay, PT, DPT: Final topic we want to tackle today: what can we do to prevent it? Is there anything we can do beforehand, maybe preventative versus reactive.

Dr. Jessica Reichl, PT, DPT: I think the best way is to get the word out and educate the older population on what different kinds of abuse are. Maybe these people don’t know that they’re experiencing abuse. They might just think oh I’m depressed and they don’t really realize that there’s something that’s causing this depression; and letting them know there is a way out, there is a way to advocate for yourselves in making sure that people can advocate for themselves as well.

I love that. I also love the information that was given out from the NIH. Make sure you just keep an open dialogue with that older adult. And, if they realize and feel comfortable with you that they can communicate with you, that’s a great way to get information earlier than you would if you didn’t have that dialogue.

I agree wholeheartedly.

Information like the graphic we were mentioning from the NIH can be found through the National Institutes of Health, their section of the National Institute on Aging. A statistic we did want to share, is one in ten adults over the age of 60 are abused, neglected, or financially exploited. And since we are a private practice working with older adults in 16 states and growing, we want to make sure that we are advocates for our older adults. Jessica Reichel, I appreciate you taking some time out and sharing some insight into preventing elder abuse with our older adults.

Dr. Jessica Reichl, PT, DPT: Well thank you for having me. Anything to keep our elders safe.

Dr. Jimmy McKay, PT, DPT: So last part of the show Jessica is called your FOXtale. Why did you decide to work with older adults? What about that population really drew you in?

Dr. Jessica Reichl, PT, DPT: Growing up in middle school, high school and in college, I hung out with my grandparents more than people my own age. And this is something I kind of realized after I had one of my clinicals at a skilled -nursing facility. And I kind of assumed that the only way for me to work with herself was working in a skilled-nursing facility. Once I found FOX I instantly fell in love. “You mean I can treat the older population, but in an outpatient setting, and push them to reach their goals rather than just get them save to return home?”

Dr. Jimmy McKay, PT, DPT: Love that. I’m glad you’re here with us advocating and trying to protect our older adult clients. Hey, I appreciate you taking the time out of your busy schedule for giving us some insight.

Dr. Jessica Reichl, PT, DPT: Anything for you, Jimmy. Thanks for having me.

Thanks for listening to FOXcast Physical Therapy a clinically-excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at FOXRehab.Org.