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Nursing home residents commonly abused by neighbors


By Heather Lindsey for the Cornell Chronicle:

pillemer lachs

Pillemer and Lachs

Twenty percent of people living in nursing homes are abused by other residents, according to a study by researchers in the College of Human Ecology and Weill Cornell Medicine.

“We were very surprised by the prevalence of aggression,” said senior author Karl Pillemer, the Hazel E. Reed Professor in the College of Human Ecology’s Department of Human Development and professor of gerontology in medicine at Weill Cornell Medicine, who published the findings June 13 in the Annals of Internal Medicine. “We thought it would be common, but we did not anticipate that 1 in 5 people would be involved in a resident-to-resident incident.”

In addition to the physical injuries that can result from these abusive incidents, “the emotional toll that can result from being victimized incessantly can be overwhelming,” said lead author Dr. Mark Lachs, co-chief of the Division of Geriatrics and Palliative Medicine and the Irene F. and I. Roy Psaty Distinguished Professor of Clinical Medicine at Weill Cornell Medicine.

The Cornell researchers and colleagues at the Research Division of Hebrew Home at Riverdale evaluated 2,011 residents in 10 nursing home facilities during a one-month period. Of those individuals, 407, or 20.2 percent, had experienced a least one resident-to-resident incident of mistreatment.

Nine percent of victims experienced verbal abuse. Five percent encountered physical abuse, and less than 1 percent sexual abuse. Another 5 percent suffered “other” types of abuse, such as invasion of privacy and menacing gestures.

The most common types of verbal aggression were screaming at another resident and using foul language. Physical aggression most often included hitting and pushing. Going into another resident’s room without permission and taking or touching another person’s property were common examples of invasion of privacy.

A major risk factor for aggression was cognitive impairment, said Pillemer, who is also director of the Bronfenbrenner Center for Translational Research at Cornell. “You have people who would otherwise not be violent but who have serious aggressive episodes,” he said.

People who were younger and more physically active, meaning they were able to wander into other residents’ rooms, were more likely to be involved in an abusive incident, he said.

Crowding in common spaces such as hallways and lounges also increased risk. Conflict occurred more frequently in the winter months, presumably when patients had limited space to interact indoors, and in nursing homes with lower staffing levels, said Lachs, who is also professor of medicine at Weill Cornell Medicine.

The first steps toward addressing the problem are improving staff awareness and developing clear protocols for dealing with aggression among residents, Pillemer said. Individualized care is also important. Some people who are at greater risk of becoming aggressors may need more supervision than others.

One obstacle to addressing this form of aggression is that regulatory agencies and media have traditionally focused on physical abuse of residents by staff.

“This certainly occurs, and we should have zero tolerance for it,” Lachs said. “But this study suggests that one is much more likely to experience physical or verbal harm from another resident than from a staff member.”

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New Book: “Emotion, Aging, and Health”


aging emotions book coverAlthough older adults face significant health challenges, they tend to have better emotion regulation skills than younger or middle-age adults. Why is this so? And how might we use this knowledge to promote better health and well-being in adulthood and later life?

The newest book in the Bronfenbrenner Series on the Ecology of Human Development, Emotion, Aging, and Health (American Psychological Association), explores the reciprocal relations between aging and emotion, as well as applications for promoting mental and physical health across the lifespan. The authors discuss the neural and cognitive mechanisms behind age-related shifts in affective experience and processing.

In addition to presenting emotion regulation strategies for offsetting age-related declines in mental and physical functioning, the book examines the role of culture and motivation in shaping emotional experience across the lifespan, as well as the factors defining boundary conditions between human illness and human flourishing in old age.

By highlighting these major advances in interdisciplinary research, the authors suggest promising avenues for intervention.

The work presented in Emotion, Aging, and Health, edited by Anthony Ong and Corinna Loeckenhoff, is drawn from presentations made at the Fourth Biennial Urie Bronfenbrenner Conference.

ong loeckenhoff

Anthony Ong and Corinna Loeckenoff at the 2013 Biennial Urie Bronfenbrenner Conference.

The book's chapter co-authors include the co-editors and conference organizers Corinna Loeckenhoff and Anthony Ong along with Emily D. Bastarache, Julia K. Boehm, George A. Bonanno, Charles L. Burton, Susan T. Charles, Carmen Écija Gallardo, Frank J. Infurna, Derek M. Isaacowitz, Laura D. Kubzansky, Kate A. Leger, Kimberly M. Livingstone, Gloria Luong, Bruna Martins, Mara Mather, Daniel K. Mroczek, Michaela Riediger, Tamara Sims, Jeanne L. Tsai, Emily J. Urban, Heather L. Urry, Lilian Velasco, Alex J. Zautra, and Eva K. Zautra. The foreword is written by BCTR director Karl Pillemer.

The book is the fourth in the APA's Bronfenbrenner Series on the Ecology of Human Development, each volume in which results from research presented at a Biennial Urie Bronfenbrenner Conference. The first three books in the series are:

chaos book coverChaos and Its Influence on Children's Development: An Ecological Perspective, edited by Gary Evans and Theodore Wach

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Research for the Public Good: Applying Methods of Translational Research to Improve Human Health and Well-being, edited by Elaine Wethington and Rachel Dunifon

neuroscience book coverThe Neuroscience of Risky Decision Making, edited by Valerie Reyna, and Vivian Zayas

Video from the Fourth Biennial Urie Bronfenbrenner Conference

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Coordinated team action best addresses elder abuse


news-pillemer2-inpostThe Cornell Chronicle reports on a recent publication, co-authored by BCTR director Karl Pillemer, outlining the likely traits of victims and perpetrators of elder abuse and the best approach to addressing the problem. The findings from the review of current research suggests that a team approach is most effective:

As many as one out of 10 people age 60 and older will experience some kind of abuse, most often in the form of financial exploitation, says a new Cornell study. Prevalence rates were previously thought to be 4 percent to 6 percent.

“It’s not that the rate of elder abuse has gone up. It’s that with improved research, we now know definitively that this is a very serious public health problem,” said Karl Pillemer, the Hazel E. Reed Professor in the Department of Human Development and a professor of gerontology in medicine at Weill Cornell Medicine.

“Elder Abuse,” appearing Nov. 11 in The New England Journal of Medicine, pulls together research from 46 studies from around the world. Pillemer is co-author with Mark Lachs, professor of medicine and co-chief of the Division of Geriatric and Palliative Medicine at Weill Cornell Medicine.

A profile of those likely to be abused also has emerged, the authors say. At greatest risk are women and elders with physical or cognitive impairments, low incomes or dementia. Those who live with others, such as a spouse or adult children, are also at higher risk; people who live alone are much less likely to be abused because there is simply less opportunity for abuse. On the other side of the coin, perpetrators tend to have mental illness and abuse substances.

“So you can get a picture of an older woman, who is beginning to experience an impairment, lives with a relative (who is likely to be the abuser) and otherwise is socially isolated, and may have some form of dementia. The perpetrator has their own problems. That is what elder abuse looks like,” Pillemer said.

The abuse can take many forms: physical, sexual, psychological or verbal mistreatment, as well as financial exploitation and neglect. The study found that in nursing homes, there are high rates of violence and aggression toward older adults. In particular, residents abusing other residents is more common than staff mistreating residents.

The findings also suggest that doctors play a crucial role in recognizing abuse and intervening, said Lachs. “A physician may be the only person who ever gets the chance to detect elder abuse, because these people can become so socially isolated with just the abuser that often no one else sees them,” he said. And given the prevalence of the problem, a doctor who is seeing 20 patients per day could see several potential victims of elder abuse per week, he added.

Simply removing the victim from their situation rarely works. Some older people, if they have no other choice, would prefer to rely on an abusive caregiver who is also providing care than have to move out of their home or into a nursing home, Pillemer said. “These cases are often unbelievably difficult to resolve. It’s hard for an agency to resist the temptation to move the person into the nursing home. Usually that’s not what the older person wants, and often it’s not the most appropriate place for them.”

Instead, doctors can be most helpful by spearheading a multidisciplinary team of nurses, social workers, hospitals, police, district attorneys and lawyers to help victims get the services they need. One of the paper’s strongest recommendations is for each city to create this type of team. “It’s a simple intervention, but it turns out to really work wonders,” Pillemer said. “The expression ‘It takes a village’ is true for the prevention of elder abuse.”

Experts recommend team approach to thwart elder abuse - Cornell Chronicle
Nursing home residents abusing one another and scammers ripping off the elderly, new study finds - Daily News

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Networking event on pain in later life sparks new connections


TRIPLL co-director Elaine Wethington speaking with Information Sciences grad student Alex Adams (l) and Communications associate professor Jeff Niederdeppe (r)

TRIPLL co-director Elaine Wethington speaking with Information Sciences grad student Alex Adams (l) and Communications associate professor Jeff Niederdeppe (r)

On October 21st the Translational Research Institute on Pain in Later Life (TRIPLL) hosted a networking event for over 30 invited researchers at the Statler Hotel on Cornell campus.  TRIPLL, an NIH-funded Edward R. Roybal Center, fosters multidisciplinary collaborations among researchers from Weill Cornell Medical College, faculty at Cornell’s Ithaca Campus, Cornell Tech, and the Bronfenbrenner Center for Translational Research (BCTR), with the goal of understanding and treating pain in older adults.

An introduction by TRIPLL director Cary Reid (Weill Cornell Medical College) noted key challenges in the field. “Up to half of all older adults live with chronic pain,” Reid said, “but diagnostic and treatment approaches have yet to catch up to this reality.” To address this concern, Reid highlighted a range of resources offered by TRIPLL to engage new researchers in the field, including pilot funding, webinars, feedback on project proposals, matchmaking with potential collaborators, and access to participant populations.

“Promising new approaches to treat pain may come from wide variety of fields,” said TRIPLL co-director and interim BCTR director Elaine Wethington. She continued, “for this event we reached out to researchers in social, behavioral, economic, environmental, biological, communication, and information sciences. Basic scientists can sometimes feel daunted when trying to extend their work to clinical settings and patient populations. TRIPLL provides the guidance and resources to help secure study participants.”

Current and past TRIPLL pilot investigators spoke about the support TRIPLL gave them, helping them secure local and federal support for their research.

(0) Comments.  |   Tags: aging    Cary Reid    Cornell Tech    Elaine Wethington    TRIPLL    Weill Cornell   

The midlife crisis myth


Elaine Wethington

Elaine Wethington

Do a significant number of people experience stress about aging in midlife, leading to sudden life changes and sports car purchases? They do not, according to a new study. A recent post on psychologytoday.com explains that there is no evidence that people experience greater stress or more major life changes in midlife as opposed to other ages. BCTR acting director Elaine Wethington is referenced in the post, further clarifying another factor that may lead to belief in the myth of the midlife crisis:

Cornell University sociologist Elaine Wethington talks about the midlife crisis as a case of “expected stress.” You think everyone will have a midlife crisis so you feel you have to fit into the mold. If you don't, you think there's something wrong with you.

Worried about a midlife crisis? Don't. There's no such thing. - Psychology Today

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Pillemer in the NY Times on blooming in later life


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Karl Pillemer

A recent New York Times article dispels the myth that a person's best creative, professional, or even physical accomplishments are necessarily confined to the younger years. Many are finding success and satisfaction in their 60s and later, perhaps due to experience gained and an openness to try new things in the later stages of life.

BCTR director Karl Pillemer, a gerontologist whose Legacy Project gathers wisdom from elders, is quoted in the article:

We absolutely have to revamp this idea of a linear pattern of accomplishment that ends when you’re 50 or 60. There are simply too many examples of people who bloom late, and it’s the most extraordinary time of their life...There was this feeling of somehow ‘getting it right’ at 50 or 60 or older.

Finding success, well past the age of wunderkind - New York Times

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New book: “Thirty Lessons for Loving” by Karl Pillemer

Tags: aging,   book,   Karl Pillemer,   marriage,   media mention,   publication,   video,  

news-pillemer-lessonsloving-inpost30 Lessons for Loving: Advice from the Wisest Americans on Love, Relationships, and Marriage uses data and stories from the most detailed survey of long-married people ever conducted to show the way to lifelong, fulfilling relationships. Author and incoming BCTR director Karl Pillemer presents this sage advice from the oldest and wisest Americans on everything from finding a partner, to deciding to commit, to growing old together. The new book, out in January, follows the success of Pillemer’s 30 Lessons for Living, which offered life advice across various areas (work, family, money,etc.). Pillemer is also Hazel E. Reed Professor in the Department of Human Development and Professor of Gerontology in Medicine at the Weill Cornell Medical College.

In an article in Cornell Alumni Magazine, Pillemer explains why advice from this group is so important and can be so helpful to younger generations,

They're looking back from the finish line; it's no longer a mystery how things are going to turn out. These are people who've been through just about everything that keeps young people awake at night, and they're still doing okay. They're living examples that a lot of what we worry about is actually resolvable—that with resilience, drive, and flexibility, you can still be happy, even though bad things sometimes happen to you.

The book is already garnering media attention, including an interview on CBS This Morning (video below). Pillemer will give a book talk on 30 Lessons for Loving on Wednesday, February 25th at 4:00pm in Room 160 Mann Library, Cornell campus.

The book trailer:

Pillemer on CBS This Morning

Secrets to a successful marriage from 700 retirees - CBS This Morning
Heart to heart - Cornell Alumni Magazine
It's never to late for love, according to gerontology research - Cornell Chronicle
Inside Cornell: Karl Pillemer's "30 Lessons for Loving" - CornellCast
The love advice that shocked expert Karl Pillemer - Huffington Post
Romantic advice from highly experienced practitioners - Sarasota Herald Tribune
Hundreds of retirees share secrets to a happy marriage - USA Today
Forget 'gray divorce': Here's how to make love last - The Wall Street Journal

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TRIPLL’s National Institute on Aging funding renewed

Tags: aging,   Karl Pillemer,   media mention,   pain,   TRIPLL,  

The BCTR's Translational Research Institute for Pain in Later Life (TRIPLL) has received a five-year, $1.95 million renewal grant from the National Institute on Aging. In this next phase, TRIPLL adds a focus on behavior change science, applying insights from psychology, sociology, economics, and communications to develop optimal pain management techniques. TRIPLL investigators also plan to explore how new communication tools, including social media and smartphones, can be harnessed to manage pain.

TRIPLL co-director Karl Pillemer notes,

In spite of how widespread chronic pain is among older adults, there are relatively few tested interventions to help people reduce their pain. Our new focus is exciting because we hope to translate findings into more effective interventions by deepening our understanding of human behavior and decision-making.

TRIPLL, based in New York City, is one of 12 national Edward R. Roybal Centers for Translational Research on Aging. TRIPLL unites social and psychological scientists at Cornell’s Ithaca campus, Weill Cornell Medical College researchers, and community-based health care partners.

Funding renewed for aging and pain research center - Cornell Chronicle

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Talks at Twelve: Karl Pillemer, Sunday, September 15, 2019

portrait of Karl Pillemer View Media

Talks at Twelve: Karl Pillemer

Resident-to-Resident Elder Mistreatment in Nursing Homes:  Findings from the First Prevalence Study
Thursday, October 23, 2014

Karl Pillemer
Human Development, Cornell University

Tags: abuse,   aging,   Karl Pillemer,   video,  

Resident-to-Resident Elder Mistreatment in Nursing Homes:  Findings from the First Prevalence Study
Thursday, October 23, 2014

Karl Pillemer
Human Development, Cornell University

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Talks at Twelve: Karl Pillemer, Thursday, October 23, 2014

 
portrait of Karl Pillemer

Resident-to-Resident Elder Mistreatment in Nursing Homes: Findings from the First Prevalence Study
Karl Pillemer, Human Development, Cornell University

Thursday, October 23, 2014
12:00PM-1:00PM
Beebe Hall, 2nd floor conference room



This talk is open to all. Lunch will be served. Metered parking is available in the Plantations lot across the road from Beebe Hall.

Over the past two decades, a growing body of research has addressed abuse experienced by older persons in long-term care facilities. This literature has focused primarily on mistreatment of residents by staff; but preliminary research and clinical experience suggest that residents are at much greater risk of aggression from other facility residents. In his talk, Karl Pillemer will report findings from the first large-scale study of Resident-to-Resident Elder Mistreatment (R-REM), which identified incidents of R-REM in 10 long-term care facilities (1903 residents) over a 2-4 week observation period. Using multiple methods, the study provides the prevalence rate of overall R-REM and specific subtypes: physical, verbal, sexual and others, as well as main correlates of R-REM.

Karl Pillemer, Ph.D., a sociologist and gerontologist, is the Hazel E. Reed Professor of Human Development in the College of Human Ecology and a Professor of Gerontology in Medicine at Weill Cornell Medical College. He has a career-long interest in issues related to elder abuse and neglect, including conducting the first prevalence studies of elder mistreatment in the community and in nursing homes. He also has a program of research on the quality of care in nursing homes, examining how staff characteristics and environmental factors affect the delivery of care and resident outcomes. Dr. Pillemer has developed and evaluated a number of intervention programs aimed at improving care provided by staff, and is the co-principal investigator of an NIH-funded study of resident-to-resident elder mistreatment in nursing homes.

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