Re: Question/ Bruising

["dick sobsey" <dick.sobsey@xxxxxxxxxxx>]

As someone who has worked as a nurse investigating injuries to children and
adults, the issues in brusing are not very different.

1. A single bruise is rarely by itself a good indication of abuse, but
patterns of brusing can be very helpful.

2. Bruising issues in elderly adults are not very different than bruising
issues among children. Very few elderly adults fall as frequently as
children in certain age ranges.  Among some children, mostly boys but also
among some girls, there is rarely a day between about age six and 11 that
you can't find some bruise on their body.  They play contact sports, climb
on things that they fall off of, etc. Most of this bruising is minor and
consistent with the stated cause. Often they will not know how they got a
particular bruise. So the mere presence of a bruise is rarely significant,
but other facts about the bruise may be important. Elderly people, do have
falls, but they are less frequent, mor likely ot be traumatic, and more
likely to be noticed (tey will often need help to get up). They may have
medical conditions that predispose to bruising (as some children do) but if
these are severe enough to make a difference, they can typically be clearly
diagnosed and sometimes treated. The vague reference to some obscure
medical condition which may be the source of teh problem can be  sign that
someone is trying to cover a problem.  Also medical conditions don't
typically "cause bruises" though they may predispose to bruising. In one
case that I recall, the individual eventually was taken out of her
caregiving facility and moved to another setting while a diagnosis of the
medical problem was worked out. The diagnostic tests were not revealing but
the move was. As soon as she moved to teh diagnostic facility, the bruising
stopped. The problem was not in her body but in the facility that she left.

2. The location of bruises is significant, especially when considered along
with a stated explanation. For example, a fall on a floor can cause a
bruised knee, elbow, etc. It does not normally cause a bruise that crosses
a shin or forearm, unless they fell against something. Blackeyes are not
normally the result of falls unless the nose or temple has also had a
significant injury, unless they fall against something.

3. Obviously, classic handprint (you can see separate finger marks at least
in the early stage) bruises are a bad sign. When you see this on somone's
face or large parts of their body, its a very bad sign.  Occassionally one
sees grip marks, especially on upper arms especially in elerly people or
people with disabilities. These can be caused when someone is helping
someone to stand from a chair or even helping steady them when they walk.
In some cases, it may be a sign that an individual bruises easily;  in
others, it may be that a caregiver is too rough. This excessive roughness
can be a training issue (someone needs to learn a better technique to help
with transfers) or a staffing issue (somone is trying to move a person by
herself or himself) when two people are required to do it without hurting
the individual. Most of the time, in my experience, however, it is a
bullying and control problem. These can also occur as a result of catching
someone in the midst of a fall.  When someone is in the midst of a
potentially dangerous fall and they are grabbed before they hit bottom, it
often leaves bruises. When one staff member claims this is happing a lot
but others don't encounter the same problem, it may be a coverup, but if it
is a rare occurrence or everyone has the same experience, it is probably
just a legitmate attempt to minimize injury.

4. Bruises have a predictable color change over time. These can help to
identfy the approximate t ime of an injury. This can be useful in
investigations that involve staff who work on various schedules. It can
also be useful when the explanation given doesn't fit with the appearenta
ge of the injury. Finally, it also can be revealing when a person has
bruises of obviously different vintages and an explanaition is given that
he or she "fell down the stairs" or had some other single traumatic event.

5. Perhaps the most revealing information that I encountered came from
explanations of bruises and other injuroes from caregivers, particularly
when an individual was in multiple settings or had multiple caregivers.
Two particular things were worrisome signs. First, repeated bruises with no
explanation from anyone generally was a sign of some kind of abuse.
Occassionally, but very rarely tehre was some kind of medical condition
underlying the problem but if so, it was generally diagnosable and often
treatable. Another rare finding was self-inflicted injury. Second, in
several cases, one particular caregiver explained the injuries while the
others simply noted unexplained injuries. Sometimes the individual
explanations seemed credible, but when the pattern was put together, one
had to ask why does this individual always seem to hurt himself or herself
in the presence of caregiver X and not the others.

6. In short, bruises can be useful in recognizing abuse, when considered
carefully. The size, location, timing, patterns, explanations, and
exculpatory statements should be carefully noted. Of course, bruises are
only one source of information and need to be considered along with all
other information.

dick sobsey


>My name is Erin Westphal and I am the Program Coordinator for the Vulnerable
>Adults Specialist Team at the University of California, Irvine. We are a
>multidisciplinary team that looks at cases of elder abuse. We have recently
>been looking into bruising and the elderly and what that means in terms of
>abuse and whether or not identifying bruises can aid in the prosecution of
>the abuser.
>
>That being said, there is little information on bruising and the elderly. I
>have started looking for some stats on bruising and children and whether
>bruises can be used to help determine and prosecute abuse. It was suggested
>to me that I address my question to the list serve,from Anne at Cornell,  to
>see if anyone has some information in this area. Any help is greatly
>appreciated.
>
>Thank you
>
>Erin C Westphal MSG
>Program Coordinator
>Vulnerable Adults Specialist Team
>University of California, Irvine
>101 The City Dr
>Pavilion III
>Orange, CA 92686
>714 456 5735
>eeldred@xxxxxxx


Dick Sobsey, Director
JP Das Developmental Disabilities Centre
University of Alberta
6-123 Education North
Edmonton, Alberta T6G 2G5  Canada
phone: (780) 492-3755
fax: (780) 492-1318
dick.sobsey@xxxxxxxxxxx