Elder Scare

By Andy Faught | Photo by Max S. Gerber

Four years out of USC Medical School, Laura (Frankl) Mosqueda '81 was serving a geriatric fellowship at Rancho Los Amigos National Rehabilitation Center in Downey when an elderly patient displayed an ugly bruise on her arm. The injury spoke to an equally ugly reality: The trauma was caused by the victim's daughter, who struck her mother with a phone.

Although Mosqueda filed a report with adult protective services, the outcome wasn't what she expected. "Nothing happened," she says. "I was shocked and angry, and I decided to figure out what was going on."

What she discovered was systemic inertia. It was a defining moment for Mosqueda, who today is one of the nation's loudest voices to speak out against elder abuse and in favor of protections and responses for its victims. 

In 2003, she co-founded the Elder Abuse Forensic Center, a first-of-its-kind effort that provides unprecedented collaboration among legal, medical, social services, and law enforcement professionals. The center, which Mosqueda directs, works to prevent abuse by creating greater awareness in those sectors, while also attempting to identify more effective ways to prosecute abuse. The center has spawned as many as 20 similar efforts around the country. 

Unlike child abuse, which is a hot-button topic among policymakers and the public alike, elder abuse—which can be intentional or unintentional and can result in physical injury, pillaged bank accounts, and death—hasn't registered the same urgency. Caretaker inattention also has been blamed for maladies that include pressure sores, dehydration, and starvation.

The signs often are easily ignored, and the problem is no less prevalent in countries around the globe, says Mosqueda, chair and professor of family medicine and geriatrics at the USC Keck School of Medicine. Mosqueda moved the forensic center to the university in 2014 after running it for 11 years at UC Irvine.

In the United States, one in 10 adults older than 60 is the victim of abuse, according to the National Center on Elder Abuse, of which Mosqueda is co-director. But an estimated 93 percent of such cases go unreported. "I've heard this over and over again: that old people are supposed to die. It's often missed that something bad even happened," she says. "We've had examples in which a funeral home calls the coroner and says, 'You guys better take a look at this.'"

Slowly, the conversation is gaining resonance. On July 13, Mosqueda attended the White House Conference on Aging, at which elder abuse was the subject of a lively session moderated by Kathy Greenlee, ­assistant secretary for aging at the U.S. Department of Health and Human Services. (The department funds the National Center on Elder Abuse and the National Indigenous Elder Justice Initiative, and ­administers the Older Americans Act's Title VII Elder Rights programs.) "What we need most to grow old is to be safe and healthy and whole," Greenlee told the gathering.

Dialogue is being propelled in a dramatic way by baby boomers. Every day, nearly 10,000 Americans turn 65, a trend that will continue for the next 19 years, according to the Pew Research Center. Senior citizens older than 85 form the fastest-growing segment of society, with half of them suffering from Alzheimer's disease or some other form of dementia, Mosqueda says. 

The stories of abuse carry similar overtones. In one scenario, a patient with Parkinson's disease who struggles to walk or find balance once on their feet is shoved by a caregiver. "A shove that might just be annoying to you or me could end up causing a hip fracture or even death in someone like that," Mosqueda says. "It's abusive, even if it's born of frustration. Sometimes it's a really horrific act by a sociopath, and sometimes it's an overwhelmed caregiver. That's part of what makes it so difficult to study and understand.

"The justice system is confused in trying to understand it, but frankly, if it paid attention to the really blatant cases and did a good job of that, we would be light years ahead of where we are now." 

In April 2011, the center at UC Irvine received the U.S. Department of Justice's national Award for Professional Innovation in Victim Services. Center co-founder Kerry Burnight, a professor in geriatric medicine and gerontology at UC Irvine, calls Mosqueda "the most respected voice in elder abuse in the nation."

"She's in the trenches every day working and advocating for elders and their families," says Burnight, who runs Ageless Alliance, a grassroots organization working to end abuse. "She has unlimited and dogged energy for the cause, because she cares deeply about every human."

Mosqueda has testified in a number of elder abuse criminal trials, and she points to district attorney efforts in San Diego and Seattle, where she says the problem is getting proper attention. She recently participated in a Department of Justice video series that seeks to train prosecutors how to deal with elder abuse. 

She's also pushing for doctors to do a better job at recognizing the problem. "If we don't understand the dynamics and the context of elder abuse, then we can't really get toward prevention and early detection," Mosqueda says. "I have a lot of hope around prevention. It's really changed the way I practice medicine."

Prevention means asking more questions of the elderly and their family members, she says. "It used to be that one of my patients would come in and say that their grandson was moving in with them. I'd say, 'Oh, that's really nice.' Now I stay neutral, and I say, 'What do you think about that?'" Mosqueda says. "Now what I'll hear is, 'I think it's great,' or 'I'm kind of worried because he just got out of jail.' That's my opportunity to work toward prevention. I have no doubt that we've prevented abusive situations that way."

She advises her patients to protect their finances and make their healthcare wishes clear early on, before health problems surface. "When you combine Dr. Mosqueda's ability to craft a message and her passion for the content of it, it's compelling, and I think that's what makes her so effective," says Bonnie Olsen, a USC professor of clinical family medicine who works with Mosqueda on forensic center business. "She's been able to get the message across that if a doctor isn't asking questions or doesn't have elder abuse on their radar, then they're not really doing their job."

 As a biology major at Occidental, Mosqueda honed her critical thinking skills through "active dialogue" with faculty such as mathematics professor Ben Freedman. "There are a lot of ethical dilemmas in understanding some of the philosophical considerations of elder abuse, so having that background from Oxy is helpful," she says. "My Oxy experience helped prepare me to understand not just the science, but the politics, sociology, literature, and all of those other things that make us more well-rounded human beings."

Many victims of elder abuse don't report harmful behavior because they fear being moved to a nursing home and losing their independence. There's also the stigma attached to their experience. "They just can't believe that somebody they trusted did this to them. There's such a sense of shock and disbelief, and who wants to prosecute their daughter?" Mosqueda says. "They end up feeling embarrassed, ashamed, and incompetent." 

It's a mindset that Mosqueda is working to change. "It's not OK to hit an old person," she says.