Mark Lachs says an epidemic of thefts and fraud targeting the elderly - by lawyers, financial advisers, family members, and others - is fast becoming a national crisis.
He should know.
Lachs, a geriatrician and social scientist at Weill Cornell Medical College in New York, is a leading expert on the financial and physical abuse of America's aging population. He and a few other social scientists have begun to provide the first credible scientific reports on the extent of fraud and other financial exploitation aimed at the elderly.
Their work suggests that millions are victimized every year. But only a fraction of the incidents ever comes to the attention of authorities.
"There are millions and millions of people who are affected, and it is enormous in its scope; you go to a dinner, and everyone has a . . . story," Lachs says. "If this were a disease, we would probably say it is an epidemic."
Lachs, who did undergraduate work and a medical residency at the University of Pennsylvania, is a clinical practitioner in New York. He is also known internationally for his elegantly designed and penetrating epidemiological studies. His groundbreaking 1998 work on mortality rates of elderly victims of financial and physical mistreatment showed that victims die at a rate three times faster than those who have not been abused.
Lachs and his colleagues drew attention again in March with a study, based in part on a phone survey of 4,000 people over age 60 in which 4.2 percent of respondents said they had been the victims of financial fraud or exploitation in the preceding year.
The implications are sobering. Projected on a national stage, the results suggest that at least 2.5 million people over 60 are victimized by family members, financial advisers, scammers, and others. Even Lachs' tally was likely an undercount because elderly people suffering from severe mental decline, a group at high risk for being preyed upon, were not polled.
The resources lost in those schemes will not be passed down to heirs or donated to charities. Nor can the assets pay for nursing-home care. Elderly victims who lose their savings often turn to Medicaid, the government health-care program.
Just as troubling is Lachs' corollary finding: Only a tiny percentage of fraud cases ever come to the attention of authorities.
When Lachs and his colleagues compared the results of the phone survey with reports to law enforcement and social-service agencies, they concluded only one in 44 cases of abuse is reported.
"I have no doubt," Lachs said, "that financial fraud is by far the most common form of abuse of the elderly."
For years, the primary source of data on the physical abuse and financial exploitation of the elderly came from the National Center on Elder Abuse, which since the late 1980s has culled information from reports by Adult Protective Services.
But data sets differed from one state to another, and not all states participated. Moreover, the data were collected for program management and funding requests, not scientific inquiry.
Only in the last few years have social scientists and physicians such as Lachs begun to understand how much abuse is inflicted on the elderly.
The problem is getting worse. The Government Accountability Office says reports of fraud and other bad treatment are burgeoning as the aging of America's population accelerates.
In 2008, University of Chicago researchers interviewed 3,000 people between the ages of 57 and 85 asking whether they had been subjected to physical or financial mistreatment in the preceding year; 3.5 percent said that a caregiver, relative, or financial adviser had improperly taken their money. (Again, the research excluded those suffering from dementia and other mental decline.)
Similar findings emerged from a Justice Department study conducted by Ron Acierno, a professor of psychiatry and behavioral sciences at the Medical University of South Carolina. In a random phone survey of 6,000 people over 60, one in 20 reported suffering financial mistreatment at the hands of relatives in the preceding year.
"The majority of the research . . . has tended to obscure the issue of elder abuse rather than enlighten," Karl Pillemer, a professor of human development at Cornell University and one of the first social scientists to quantify abuse of the elderly, said of past studies. Lachs "was one of the few physicians who would go to visit protective services. He combined his training as a physician and in public health and epidemiology, which really makes him a unique figure."
The day his grandfather died of kidney cancer 41 years ago, 10-year-old Mark Lachs wept inconsolably.
Other boys may have idolized race-car drivers or athletes, but Lachs' hero growing up was his feisty grandfather. Harold Fenster filled an emotional gap that opened wide when Lachs' parents split, and young Mark went to live with his mother.
Fenster taught his grandson how to body surf, ride a bike, and throw a baseball. Witty, athletic, and fun-loving, the prominent trial lawyer radiated authority.
"He was a tough guy physically, and he was a tough guy intellectually, and he loved me," Lachs said.
In the increasingly pivotal specialty of geriatric medicine, it is common for practitioners like Lachs to have had an elderly person play a central and often inspirational role in their lives. Lachs' fascination with unwrapping the riddle of elder mistreatment began serendipitously, while he was studying for a master's in public health at Yale Medical School.
He had gone to Yale to study the intersection of public health and social programs under Alvan Feinstein, an early proponent of clinical epidemiology. Feinstein, a Philadelphia native, urged disease researchers to focus more on information gleaned from patients and less on lab work and public health records.
Lachs spent days in Feinstein's classroom and nights working as an emergency room physician at Yale New Haven Hospital. A pivotal moment occurred when he oversaw the treatment of an elderly woman who arrived covered with cigarette burns, an obvious abuse victim.
"It was horrifying and so unfathomable to me that someone could be physically treated like that," Lachs said.
He wanted to know how extensive such mistreatment was and whether physicians could do something to stop it.
An early role model was Colorado physician C. Henry Kempe, who had done the nation's first serious epidemiological study of child abuse.
In the early 1960s, Kempe noticed that children were arriving at Colorado hospitals with horrible injuries that could not be explained by normal activity. He concluded that many had been severely beaten by their parents.
Some parents and caretakers went beyond simply beating children to administering overdoses of drugs or exposing the child to natural gas or other toxic substances. His 1962 study coined the term "battered child syndrome" and became a classic. It not only helped to identify and quantify the problem, but also prescribed protocols for physicians to intervene and protect injured children.
To Lachs and other researchers, the child abuse Kempe described paralleled in important ways the harm inflicted on many elderly, not only through physical abuse but also financial exploitation. The victims were defenseless, and the crimes were hidden and evinced an unspeakable depravity.
When Feinstein learned of Lachs' interest in elder abuse, he urged him to contact the local Adult Protective Services. Soon, Lachs was accompanying APS investigators on visits. What he saw troubled him.
The isolated and impoverished elderly he visited were living in conditions that promoted not only their physical abuse and financial exploitation, but eventually their very physical ruin.
He realized that "there could be . . . an environment so enshrouding, so negative that you don't need to be physically abused to suffer its ill effects."
From those weekly visits emerged the concept for Lachs' first important epidemiological study.
He hit upon the idea of correlating emergency room visits by elderly patients with abuse reports to the APS. A fundamental research issue was how to determine whether the visit was the result of abuse or some routine medical problem. He chose indicators such as accusations of abuse, or fractures and lacerations, that could not be explained and that might signal mistreatment. They were then evaluated by two physicians working independently of one another.
More than a third of the elderly emergency room patients who had also reported abuse, he found, were likely there for injuries or other consequences of abuse, such as depression. Yet attending physicians treated only the physical symptoms.
The emergency room visits, in other words, were missed opportunities to tackle a larger problem.
The study led Lachs to design yet another project, this one aimed at nailing down survival rates for elderly abuse victims.
In 1998, Lachs, Pillemer, and others published findings in the Journal of the American Medical Association. Theirs was the first longitudinal study on the subject, meaning it followed subjects over time, in this case for 13 years.
To this day, their work remains the only epidemiological research quantifying the effect of financial exploitation, neglect, and physical abuse on elderly survival rates. Adjusting the results for chronic diseases, race, income, marital status, and the quality and strength of social networks, the key finding was that abused members of the study group died at three times the rates of those who had not been mistreated.
In the dry and technical language epidemiologists favor, the group reported that "the need for adult protective service generally and elder mistreatment specifically were independent predictors of early death."
The study offered no medical explanation for why abuse victims might die sooner than others; it was not designed to do so. But Lachs finds the answers self-evident.
Apart from the chance that abuse victims might succumb to the effects of their injuries, he sees many nuanced linkages between exploitation, abuse, and failing health.
Even if the injuries are minor, they can create a climate in which the patient might be less likely to perform tasks of daily living, such as taking key medications.
In cases of financial fraud, a patient might become deeply depressed over having to live without sufficient financial resources, the accumulation of a lifetime.
"The mind-body connection is very, very strong," Lachs said. "You don't have to be a doctor or a scientist to know that when you have good social networks that you are more connected with the world and you feel better."
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