_____________________________________________________________ The California Dental Practice Act
there are at least five (and perhaps up to 14) unreported inci- dents [11]. Studies have shown that dental professionals are reluctant to report elder or dependent abuse/neglect and that they have a low index of suspicion of this category of abuse [13]. The national frequency of elder abuse is estimated at up to 10%, with some research indicating that the number may be as high as 1 in 6 [14]. The overwhelming majority of abuse and neglect occurs in domestic, rather than institutional (e.g., residential care) settings, largely due to the shift in care in the 20th century from state institutions to the home (particularly for younger disabled individuals) [12; 14]. However, with an increasing aging population and longer life expectancies, it is projected that by 2030 there will be a 50% increase in the number of older adults who require nursing home care [14]. Women are the victims of elder abuse two-thirds of the time. Elder and dependent adults are also at risk for poor oral health due to caretaker neglect. In fact, neglect is one of the most common causes of elder injury reporting [14]. These popula- tions are also at a high risk for self-neglect, accounting for more than 500,000 additional reported cases in the United States per year. A 2010 study revealed that 40% of individuals 65 years of age or older suffer from some form of neglect [15]. Elder and Dependent Adult Abuse Laws Laws pertaining to mandatory elder and dependent adult abuse reporting are found in the California Welfare and Institutions Code Sections 15600 to 15632 [16]. Section 15600. (a) The Legislature recognizes that elders and dependent adults may be subjected to abuse, neglect, or abandonment and that this state has a responsibility to protect these persons. (i) Therefore, it is the intent of the Legislature in enacting this chapter to provide that adult protective services agencies, local long-term care ombudsman programs, and local law enforce- ment agencies shall receive referrals or complaints from public or private agencies, from any mandated reporter submitting reports pursuant to Section 15630, or from any other source having reasonable cause to know that the welfare of an elder or dependent adult is endangered, and shall take any actions considered necessary to protect the elder or dependent adult and correct the situation and ensure the individual’s safety. Section 15630. (a) Any person who has assumed full or inter- mittent responsibility for the care or custody of an elder or dependent adult, whether or not he or she receives compensa- tion, including administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder or dependent adults, or any elder or dependent adult care custodian, health practitioner, clergy member, or employee of a county adult protective services agency or a local law enforcement agency, is a mandated reporter.
(b) (1) Any mandated reporter who, in his or her professional capacity, or within the scope of his or her employment, has observed or has knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse, or neglect, or is told by an elder or dependent adult that he or she has experienced behavior, including an act or omission, constituting physical abuse, abandonment, abduction, isolation, financial abuse, or neglect, or reasonably suspects that abuse, shall report the known or suspected instance of abuse by telephone or through a confi- dential Internet reporting tool, as authorized by Section 15658, immediately or as soon as practicably possible. If reported by telephone, a written report shall be sent, or an Internet report shall be made through the confidential Internet reporting tool established in Section 15658, within two working days. INTIMATE PARTNER VIOLENCE Intimate partner violence is defined as violence directed at a “spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship” [7]. According to a 2016 to 2017 survey by the Centers for Disease Control and Prevention, severe physical violence by an intimate partner (including acts such as being hit with something hard, being kicked or beaten, or being burned on purpose) has been expe- rienced by an estimated 32.5% of women and 24.6% of men during their lifetimes [17]. Dental professionals should be vigilant in recognizing signs of abuse among adolescent and adult patients. Up to 50% of abusive injuries occur to the head (particularly areas covered with hair) and neck, and facial injuries occur in 94% of inti- mate partner violence cases and are similar to those already discussed [7; 18]. Again, dental visits may be a patient’s only contact with healthcare professionals, making identification of abuse an important part of dental visits [7]. A history of intimidation, fear, isolation, and dependency is often present in victims of abuse, so it is especially important to determine the origin of orofacial or craniofacial injuries through the use of nonjudgmental questions. The Stanford School of Medicine recommends the following lines of indirect questioning for most age groups [31]: • How are things going at home? • What about stress levels? How are things going at work? At home? • How do you feel about the relationships in your life? • How does your partner treat you? • Are you having any problems with your partner?
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