ElderAbusePocket UCI
ElderAbusePocket UCI
Pocket Reference
A Medical/Legal Resource
for California Judicial Officers
2012
Copyright © 2012 by the Judicial Council of California ACKNOWLEDGMENTS
and Laura Mosqueda, MD Raciela Austin, RN
All rights reserved. Ron Chez, MD
Except as permitted under the Copyright Act of 1976, Tanya Gurvich, PharmD, CGP
no part of this publication may be reproduced in any Bonnie Olsen, PhD
form or by any means, electronic, online, or mechanical, Steven Tam, MD
including the use of information storage and retrieval Solomon Liao, MD
systems, without permission in writing from the Our very special thanks to the Hon. Joyce M.
copyright owners. Permission is granted to nonprofit Cram, Superior Court of California, County
institutions to reproduce and distribute for educational of Contra Costa, Hon. Kim R. Hubbard
purposes all or part of the work if the copies are and Hon. Lon F. Hurwitz, Superior Court
distributed at or below cost and if the Judicial Council of
of California, County of Orange, and Mr.
California, Administrative Office of the Courts and Laura
Steven W. Siefert, legal research attorney,
Mosqueda, MD are credited.
Superior Court of California, County of
This publication was made possible by a grant from the Orange, for the invaluable expertise they
Archstone Foundation. The opinions and views expressed in provided in reviewing this publication, and to
this document do not necessarily represent the views of the the Hon. Shawna Schwarz, Superior Court of
Archstone Foundation or the Judicial Council of California/ California, County of Santa Clara.
Administrative Office of the Courts. The information
contained in this work is not intended to replace the advice Thank you to the judicial officers who
of a physician or other medical professional. participated in pre-development focus groups
for this publication:
For additional copies of this publication, please call the Hon. Nancy L. Davis, Superior Court of
Administrative Office of the Courts Center for Families, California, County of San Francisco
Children & the Courts at 415-865-8024, or write: Hon. Loretta M. Giorgi, Superior Court
Judicial Council of California of California, County of San Francisco
Administrative Office of the Courts Hon. W. Michael Hayes, Superior Court
Center for Families, Children & the Courts of California, County of Orange
455 Golden Gate Avenue, San Francisco, CA 94102-3688 Hon. Donna L. Hitchens (ret.), Superior Court
www.courts.ca.gov of California, County of San Francisco
Hon. Kim R. Hubbard, Superior Court
This reference guide is also available
on the California Courts website: of California, County of Orange
www.courts.ca.gov/programs-collabjustice.htm Hon. Lon F. Hurwitz, Superior Court of
California, County of Orange
CONTRIBUTORS Hon. Sue M. Kaplan, Superior Court of
Lisa M. Gibbs, MD California, County of San Francisco
Laura Mosqueda, MD Hon. Ronald P. Kreber, Superior Court
Elaine A. Chen, MS of California, County of Orange
Mary S. Twomey, MSW Hon. Newton J. Lam, Superior Court
Bradley Williams, PharmD, CGP of California, County of San Francisco
Eve Hershcopf, AOC Associate Attorney Hon. Caryl A. Lee, Superior Court of California,
Donna Strobel, AOC Education Specialist County of Orange
Hon. Cynthia Ming-Mei Lee, Superior Court
REFERENCES of California, County of San Francisco
Finberg, Jeanne, “Financial Abuse of the Elderly in
Hon. Michael J. Naughton, Superior Court
California,” Loyola of Los Angeles Law Review,
of California, County of Orange
Vol. 36, pp. 667-691 (2003).
Hon. Nancy A. Pollard, Superior Court
“Effective Court Practice for Abused Elders: A Report of California, County of Orange
to the Archstone Foundation,” Judicial Council of Hon. Thomas H. Schulte, Superior Court
California, Administrative Office of the Courts (2008). of California, County of Orange
Our appreciation for the use of the “Handling Elder Hon. Mary Fingal Schulte, Superior Court
Abuse Issues” curriculum and participant materials, of California, County of Orange
a component of the Administrative Office of the Hon. Marjorie A. Slabach (ret.), Superior Court
Court’s Primary Assignment Orientation and Criminal of California, County of San Francisco
Assignment Courses for Judicial Officers Hon. Mary E. Wiss, Superior Court of
June 15-17, 2011, Hon. Sandra L. Margulies, Associate California, County of San Francisco
Justice, Court of Appeal, First District, Division One, Hon. Garrett L. Wong, Superior Court
Faculty Team Leader. of California, County of San Francisco
TABLE of CONTENTS
Introduction4
LEGAL INFORMATION
III. Conservatorships 32
A. Probate Conservatorship 32
B. Lanterman-Petris-Short Act Conservatorship 34
1
IV. Legal Resources Related to Elder Abuse 36
A. National Resources 36
B. California Resources 37
MEDICAL INFORMATION
VI. Common Terms Used in Elder Health Care and Elder Abuse 51
2
APPENDICES
3
INTRODUCTION
The concept for this “Pocket Reference” was born out of the idea that it would
be helpful for judicial officers who see elders in their courts to have easy
access to relevant medical and legal information regarding elder abuse. Judges
interact with older adults who participate in court as parties, jurors, witnesses,
victims, conservatees, and defendants. Abuse may be a factor affecting an elder
who is appearing in any of these roles. Judicial officers will need to be aware of
elder abuse whether concerns about abuse are brought before the court directly
or arise indirectly.
Note: The focus of this Pocket Reference is elder abuse. Although the Elder
Abuse and Dependent Adult Civil Protection Act also addresses protections
for dependent adults, the specialized information pertaining to dependent
adults is beyond the scope of this guide and therefore is not included.
4 Introduction
Legal
Information
5
6
I. ELDER ABUSE and the COURTS
ELDER CALIFORNIANS
• California currently has more than 4.2 million people age 65 and
older, 11.4% of the state’s population and the largest number of
elders of any state in the country.
• The number of Californians ages 65 and older is increasing; elders
who are more than 80 years old represent the fastest-growing
segment of the population.
• In 2020, when the population of Californians age 65 and older
increases to more than 6.1 million (15% of the total population),
nearly one million of those elders will be at least 85 years old.
• By 2040, there will be nearly 9.7 million California elders 65 years
old and older (20% of the population).
• Approximately 13% of people age 65 and older, and nearly half of
people 85 and older, have Alzheimer’s disease.
SOURCE: California Department of Finance, Interim Population
Projections for California and Its Counties 2010-2050, May 2012.
www.dof.ca.gov/research/demographic/reports/projections/interim/view.php
As our state’s population ages, more elders will appear in court. Medical and
psychological issues will be a factor in many cases since increased life expectancy
carries an increased likelihood of living with chronic disease, Alzheimer’s, and
other health problems associated with old age. Some of these court cases will also
involve elements of physical, mental, and financial abuse of elders.
Elder abuse is a somewhat hidden problem in society and in the justice system and
may be an underlying factor in a variety of court cases involving older persons.
In California:
• The Department of Justice estimates that 1 in 20 elders is a victim of
neglect or physical, psychological, or financial abuse.
• Most abuse occurs in elders’ homes or other domestic settings.
• Adult Protective Services (APS) agencies received more than 110,000
reports of elder and dependent adult abuse in 2006-07.
• For every reported case of elder abuse, it is estimated that five cases are
never reported.
1) ABUSIVE ACTIONS
Elder abuse:
• encompasses a range of conduct by an alleged abuser;
• results in the mistreatment or exploitation of an older adult;
• causes harm or creates a serious risk of harm.
The Elder Abuse and Dependent Adult Civil Protection Act (EADACPA),
(Welfare & Institutions Code §§15600-15675), California’s statutory scheme
protecting elder and dependent adults from abuse by caretakers and others,
defines abuse of an elder or dependent adult to mean the following (Welfare &
Institutions Code §15610.07):
(a) (b)
• Physical abuse The deprivation by
• Neglect a care custodian of
• Financial abuse goods or services
• Abandonment and/or that are necessary to
• Isolation avoid physical harm
• Abduction, or or mental suffering.
• Other treatment with resulting physical
harm or pain or mental suffering.
2) SELF-NEGLECT
Self-neglect is an elder’s inability to provide for his or her basic needs for food,
clothing, shelter, and medical care, or to manage his or her financial affairs.
3) FINANCIAL ABUSE
Elder financial abuse can take many forms and may be committed by
family members, caregivers, or other people known to the elder, or may
be perpetrated by strangers. The impact of financial exploitation can be as
profound as physical abuse. Elders are rarely able to rebuild their financial
assets or recoup their losses. The result can be reduced independence and
security for the elder, increased dependence on family, and greater reliance on
public assistance and social welfare programs.
Victim
• Dependent on the abuser;
• Physical or mental frailty;
–– Nearly two-thirds of elders whose abuse was reported to Adult
Protective Services were affected by major medical issues.
–– More than half of abused elders had some degree of cognitive
impairment, most commonly dementia.
• Socially isolated;
• Verbally or physically aggressive;
• History of substance abuse or mental health issues;
• Hesitant to use the social services system.
Abuser
• Relationship with the victim (42% of alleged abusers were intimate
partners, adult children or other family members; 16% were caregivers);
• Dependent on the victim;
• Younger (approximately two-thirds of abusers were under age 60);
• Suffering from a disturbed psychological state;
• Resentful of providing care;
• History of substance abuse or mental health issues;
• History of generational abuse (domestic violence, child abuse);
• Previous history of elder abuse in a caregiving context.
SOURCE: National Center on Elder Abuse (2006), Abuse of Adults Aged 60+:
2004 Survey of Adult Protective Services.
One theory of elder abuse has identified “caregiver stress” as the basis for abuse.
While it is true that the responsibilities of being a caretaker can be overwhelming,
especially for families with few resources, more recent research does not support
“caregiver stress” as the primary cause of abuse in most cases. Even in those cases
Elders who are abused are similar to victims of domestic violence or child abuse
in that they are often reluctant to tell anyone about the abuse because they:
• do not want to see themselves as victims and are in denial;
• are ashamed;
• believe the abuse is their fault;
• do not want to get the abuser in trouble.
The victim’s:
• dependence on the abuser for care and companionship;
• dementia or other mental health issues;
• frailty or lack of mobility;
• fear of reprisal, abandonment, or loss of independence
(placement in a nursing home);
• fear of involvement with the legal system;
• not knowing where to turn for help;
• having responsibilities as the caregiver for the abuser.
If the abuser is the elder’s own child there may be particularly
complicated dynamics which lead the elder to minimize the abuse.
These include:
• parents’ inclination to protect their child rather than consider their
own personal safety;
• feelings of guilt, shame or embarrassment because the elder
attributes the abuse to poor child raising;
• desire to maintain contact with children and grandchildren;
• fear that the child will become homeless if the elder reports the abuse;
• the abuser’s manipulation of the elder’s emotions, including parental love.
Legislative Intent:
“to provide that adult protective services agencies, local long-term care
ombudsman programs, and local law enforcement agencies shall receive
referrals or complaints from…source(s) 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.”
The Adult Protective Services program (Welfare & Institutions Code §§15750-
15766) requires each county welfare department to establish and support a
system of protective services to elderly and dependent adults who may be
subjected to neglect, abuse, or exploitation, or who are unable to protect their
own interests. Each county is also required to maintain a specialized entity
with lead responsibility for the operation of the adult protective services
program (Welfare & Institutions Code §§15751, 15752).
SERVICES PROVIDED BY
ADULT PROTECTIVE SERVICES AGENCIES
Receipt of APS services is voluntary; adults who are offered APS services must
consent to receive them. Mandated reporters of elder abuse, however, are
authorized to provide information to APS or other agencies investigating elder
abuse, and may cooperate in the investigation without prior consent of the
victim (Welfare & Institutions Code §15630).
See:
• Report of Suspected Dependent Adult/Elder Abuse, California
Department of Social Services Form SOC341: www.dss.cahwnet.gov/
cdssweb/entres/forms/English/SOC341.pdf.
• Report of Suspected Dependent Adult/Elder Financial Abuse, California
Department of Social Services Form SOC342: www.dss.cahwnet.gov/
cdssweb/entres/forms/English/soc342.pdf.
The Ombudsman must have the elder’s permission to report the abuse unless
the Ombudsman personally witnessed abuse of the elder or unless there is a
violation of the Penal Code (Welfare & Institutions Code §15636). Mandated
reporters, however, are authorized to provide information to the Ombudsman,
Adult Protective Services or other agencies investigating elder abuse, and may
cooperate in the investigation without prior consent of the victim (Welfare &
Institutions Code §15630).
Judicial officers and staff throughout the court system may encounter
elderly victims of abuse whether at the hands of a family member, a friend
or neighbor, a caregiver in a home or institutional setting, or a stranger who
takes advantage of the elder’s trust. Elder victims of abuse may appear before
the court as defendants, plaintiffs, witnesses, jurors, petitioners, respondents,
conservatees and/or victims.
1) CASE TYPES
Elder abuse cases can enter the court in the form of:
• criminal cases;
• family law cases;
• cases regarding health care decisions for incapacitated persons;
• civil harassment;
• domestic violence;
• lawsuits against facilities;
• proceedings following a report to Adult Protective Services;
• probate & Lanterman-Petris-Short (LPS) conservatorships (many
conservatorships are established in response to abuse);
• mental health commitment;
• civil fraud and conversion;
• personal injury;
• traffic;
• unlawful detainer (for example, an elder trying to evict an adult child who
is not paying rent, is stealing from the elder, or has a drug problem);
While some types of cases are initiated to address elder abuse directly, many
cases are not, and these cases require judicial officers and court staff to recognize
different forms of abuse or symptoms of abuse, and to be sensitive to elders’ needs
in navigating court processes. See section V-A, Assessing for Abuse, page 41.
WHAT IS CAPACITY
Elder litigants can have dementia or other capacity issues that require the court
to ascertain whether they are competent to:
• care for themselves;
• take various types of actions that have legal ramifications;
• participate in litigation.
Note: Judicial officers should inquire into all medications the elder or
dependent adult may be taking, including prescription, over-the-counter, and
the medications of others (usually done to save money), all physical conditions
and any recent surgeries under general anesthesia as any or all of these may
temporarily affect capacity by causing “faux” dementia.
The court may also be required to decide whether there is a need for
a conservatorship. Capacity is obviously a central issue in probate
conservatorships. Probate Code §810 includes a rebuttable presumption that
all persons have capacity to make decisions. Section 811 requires each judicial
determination that a person lacks legal capacity to perform a specific act to
be based on evidence of a deficit that significantly impairs the person’s ability to
understand and appreciate the consequences of his or her actions with regard to
the type of act or decision in question.
3) UNDUE INFLUENCE
“Undue influence” is the misuse of one’s role and power to exploit the trust,
dependency, or fear of another to deceptively gain control over that person’s
decision-making. California defines undue influence by statute in Civil
Code §1575:
• In the use, by one in whom a confidence is reposed by another, or who
holds a real or apparent authority over him/her, of such confidence or
authority for the purpose of obtaining an unfair advantage over him/her;
• In taking an unfair advantage of another’s weakness of mind; or
• In taking a grossly oppressive and unfair advantage of another’s necessities
or distress.
Note: In California, a wide range of laws directly address various forms of elder
abuse; other laws can be relevant in cases in which actual or suspected elder
abuse is an issue. Appendix A, page 71, contains a list of many of these laws.
Judicial officers have a range of options for responding to elder abuse cases,
including several designed to make court processes more accessible for elders.
Courts may:
• Offer direct calendaring of elder abuse matters;
• Limit unnecessary continuances;
• Use flexibility in scheduling to address the elder’s need for rest, medication
and meals;
• Take more frequent breaks;
• Provide case setting priority for elder abuse cases; (A party over age 70 has
the right to petition for case setting priority which the court must grant if
the party has a substantial interest in the action and the health of the party
necessitates a preference to prevent prejudicing the elder’s interest in the
litigation. Code of Civil Procedure §36(a).)
• Improve physical accessibility to the courtroom;
• Permit/provide support persons (see next page).
Courts also have alternative methods for obtaining and preserving testimony
of an elder victim or witness. These include:
• depositions;
• telephonic hearings;
• substituting an elder’s court appearance with a conditional examination
using a magistrate or court reporter;
• videoconferencing;
• using videotaped testimony.
(Penal Code §§1335-1345)
Judicial officers hearing criminal matters are required to provide, upon request
of a party, an instruction informing the jury that although an elder with a
cognitive, mental, or communication impairment may perform differently as
a witness, that does not mean the elder is any more or less credible a witness,
and the jury should not discount the testimony solely on that basis. Penal
Code §1127g. Courts can also encourage elder abuse victims to provide impact
statements at sentencing.
Courts can impose requirements designed to make the victim of elder abuse
whole by ordering:
• restitution;
• return of property.
Judicial officers may also develop innovative practices to address elders’ needs
such as:
• arranging courtrooms to improve accessibility;
• recruiting volunteers to assist elderly litigants with locating courtrooms
and offices, completing court forms and applications, and reading court
materials;
• providing court accompaniment and support;
• providing referrals to other types of assistance programs.
California’s Elder Abuse and Dependent Adult Civil Protection Act (EADACP)
(Welfare & Institutions Code §§15600-15675), the statutory scheme protecting
elders and dependent adults from abuse by caretakers and others, defines abuse
of an elder or dependent adult to mean the following (Welf & I C §15610.07):
(a) (b)
• Physical abuse The deprivation by
• Neglect a care custodian of
• Financial abuse goods or services
• Abandonment and/or that are necessary
• Isolation to avoid physical
• Abduction, or harm or mental
• Other treatment with resulting physical suffering.
harm or pain or mental suffering.
A judicial officer may issue an ex parte emergency protective order (EPO) where:
• a law enforcement officer asserts reasonable grounds to believe
• an elder or dependent adult is in immediate and present danger of abuse
(as defined in Welfare & Institutions Code §15610.07)
• based on an allegation of a recent incident of abuse or threat of abuse by
the person against whom the order is sought.
An EPO for an elder may include all of the restraining and other orders
authorized under an Elder or Dependent Adult Protective Order (Welf & I
Protective Orders
II. 25
C §15657.03; Fam C §6252(e), as described below). An EPO remains in effect
for up to five court days after the day of issuance or the seventh calendar day
following issuance, whichever is earlier (Fam C §6256). Prior to the expiration of
an EPO, the elder may apply for a longer-term protective order.
There are three different types of long-term civil protective orders that may be
appropriate in elder abuse cases, depending on the facts of the situation:
• Elder or Dependent Adult Protective Order (Welf & I C §15657.03)
• Domestic Violence Restraining Order (Family Code §§6200 et seq.)
• Civil Harassment Restraining Order (Code of Civil Procedure §527.6)
A court with jurisdiction over a criminal matter may issue a protective order
for a victim or witness upon a good cause belief that harm to, or intimidation
of, or dissuasion of, a victim or witness has occurred or is reasonably likely to
occur (Penal Code §136.2). However, in cases not involving a crime of domestic
violence, there are limitations on the court's ability to use the underlying conduct
of the charged offense as a basis for determining whether good cause exists.
An elder or dependent adult who has suffered abuse as defined in Welfare &
Institutions Code §15610.07 may seek a protective order for himself/herself.
Note: the Elder Abuse and Dependent Adult Civil Protection Act is vital in
providing protections for dependent adults; this Pocket Reference, however,
focuses specifically on the EADACPA protections provided in response to
allegations of elder abuse.
A protective order petition may also be brought against “any person” on behalf
of an abused elder by:
• a conservator;
• a trustee;
• an attorney-in-fact who acts within the authority of the power of attorney;
• a guardian ad litem for the elder; or
• any other authorized person.
A support person may accompany the elder in court and may sit at counsel
table if the elder is not represented by an attorney, though the support person
is prohibited from providing legal advice.
The Elder or Dependant Adult Protective Order may enjoin a respondent from:
• abusing, intimidating, molesting, attacking, striking, stalking, threatening,
sexually assaulting, battering, harassing, telephoning, destroying personal
property, or contacting the petitioner, either directly or indirectly, by mail
or otherwise;
Protective Orders
II. 27
• coming within a specified distance of, or disturbing the peace of the
petitioner or, in the discretion of the court, on a showing of good cause, of
other named family or household members, or the petitioner’s conservator;
• entering the petitioner’s residence or dwelling unless title to or lease of the
residence or dwelling is in the sole name of the party to be excluded, or is
in the name of the party to be excluded and any other party besides the
petitioner;
• specified behavior that the court determines is necessary to effectuate
these orders (Welfare & Institutions Code §15657.03).
There is no filing fee required for a protective order, nor can the petitioner
be required to pay a fee for law enforcement to serve an order (Welfare &
Institutions Code §15657.03(l,m)). The prevailing party may be awarded court
costs and attorney’s fees.
The maximum duration of a protective order is five years, and the renewal
period may be either five years or permanently (Welfare & Institutions Code
§15657.03(f)).
The forms for an Elder and Dependent Adult Protective Order are available at:
http://courts.ca.gov/forms.htm.
Protective Orders
II. 29
D. Domestic Violence Restraining Order
Family Code §§6200 et seq.
When a DVRO is available, there are factors that may make obtaining this type
of protective order preferable to an Elder or Dependent Adult Protective Order
in some cases, including increased supports and services for DVRO applicants,
and the availability of broader relief. In addition to the restraining and other
orders available in an Elder or Dependent Adult Protective Order, a DVRO may
mandate:
• spousal support (Family Code §6341);
• batterer’s program (Family Code §6343);
• temporary use of property (Family Code §6324);
• temporary debt payment (Family Code §6324);
• restitution, and other orders.
An elder who has suffered harassment may seek a temporary restraining order
and an injunction in the form of a Civil Harassment Restraining Order. Many
of the provisions of the Elder or Dependent Adult Protective Order and the
Domestic Violence Restraining Order are also available in a Civil Harassment
Restraining Order. A Civil Harassment action can be used to protect elders from
harassment by roommates, neighbors, employees, family members, and others.
• The civil harassment restraining order may be issued to protect the elder
and all other family and household members who reside with the elder
(Code of Civil Procedure §527.6(c)).
Protective Orders
II. 31
III. CONSERVATORSHIPS
There are two common types of conservatorships in California: probate
conservatorships and Lanterman-Petris-Short Act (LPS) conservatorships.
Pursuant to the Probate Code, a limited conservatorship may be established
for the developmentally disabled subject to several restrictions. Discussion of
limited conservatorships is beyond the scope of this Pocket Reference.
A. Probate Conservatorship
32 III. Conservatorship
A probate conservator may be appointed for the estate of an adult who is
substantially unable to manage his/her own financial resources. A conservator
may also be appointed for the estate of an adult who may be prey to fraud and/
or unable to resist undue influence (Probate Code §1801(b)).
The court may appoint a conservator of both the person and the estate for
elders who have significant difficulties with the activities of daily living and
with handling finances (Probate Code §1801(c)).
Conservatorship
III. 33
B. Lanterman-Petris-Short Act Conservatorship
34 III. Conservatorship
The following chart outlines the most significant differences between the two
types of conservatorships:
PROBATE CODE LPS CONSERVATORSHIP
CONSERVATORSHIP
No mental disorder required. Mental disorder or impairment by chronic
Probate Code §1801(a): alcoholism required. Welfare & Institutions Code
Conservatee must be unable to §5350.
provide for personal needs or
manage financial resources.
Purposes are to protect Purpose is to treat disorder and protect the public.
conservatee’s rights, provide for See generally Welfare & Institutions Code §5358.
assessment, meet health and
psychosocial needs, etc.
Probate Code §1800.
No right to place conservatee in Conservator may place conservatee in locked
a locked mental health facility mental health facility without the conservatee's
without conservatee’s consent. consent. See Welfare & Institutions Code
Probate Code §2356. §5358(a),(c).
But see Probate Code §2356.5,
permitting conservator to place
a conservatee with dementia in a
secured facility after obtaining a
court order.
Indefinite duration. One-year duration. Welfare & Institutions Code
Probate Code §1860 §5361.
Minors may not be conservatees. Minors may be conservatees. Welfare &
Probate Code §1800.3 (exception Institutions Code §5350(a)
for married or formerly married
minors).
Burden of proof: clear and Burden of proof of grave disability: beyond a
convincing evidence. reasonable doubt. Conservatorship of Roulet (1979)
Probate Code §1801(e) . 23 C3d 219, 235, 152 CR 424.
Appointment of conservator is Appointment of conservator is subject to the list of
subject to the list of priorities priorities in Probate Code §1812 unless investigator
in Probate Code §1812(b) (i.e., recommends otherwise to the court. Welfare &
spouse/domestic partner, adult Institutions Code §5350(b)(1).
child, parent, brother/sister, etc.).
In appointing LPS conservator, court must consider
protection of the public as well as treatment of the
conservatee. Welfare & Institutions Code §5350(b)(2).
Probate conservatorship of estate No LPS conservatorship of estate when there is
is permitted even where there is Probate Code conservatorship of estate.Welfare &
LPS conservatorship of person. Institutions Code §5350(c).
Welfare & Institutions Code If Probate Code conservatorship of person already
§5350(c). exists, LPS conservatorship runs concurrently and
is superior to probate conservatorship. Welfare &
Institutions Code §5350(c).
Notice of LPS proceedings must be given to
Probate Code guardian or conservator. Welfare &
Institutions Code §5350(g).
Conservatorship
III. 35
IV. LEGAL RESOURCES RELATED
to ELDER ABUSE
A. National Resources
1. National Center for State Courts, Center for Elders and the Courts
www.eldersandcourts.org
The National Center for Elders and the Courts serves as one of the
primary resources for the judiciary and court management on issues
related to aging. The Center’s mission is to increase judicial awareness of
issues related to aging, provide training tools and resources to improve
court responses to elder abuse and adult guardianships, and develop a
collaborative community of judges, court staff, and aging experts.
39
40
V. ELDER ABUSE and NEGLECT
Elder abuse issues arise in a wide variety of cases. Judicial officers may be
presented with a range of medical evidence indicating that an elder has been or
may have been abused. In a case involving an elder, there may be even greater
complexity in the medical elements than in other types of abuse cases due to
the complicated physical and mental health status of the victim. Understanding
the ways medical and social service personnel assess for abuse and neglect can
assist judicial officers in evaluating the test results, descriptions, and opinions
these professionals provide to the courts.
1) ASSESSING BRUISES
A bruise or ecchymosis is formed when blood vessels rupture and leak blood
into surrounding tissues. Bruising results from blunt forces: either a body part
hits something harder than itself or a harder object hits a body.
• A bruise may take several days to appear if the cause of the bruise was a
deep injury.
• Older adults bruise more easily than younger adults due to a variety of
factors, including thinner, less elastic skin, fragile capillaries, and side
effects of medicines.
While trained personnel may attempt to estimate the age of a bruise by its
color, this method is imprecise.
• Shape
–– Pattern injuries; some bruises reflect the object that caused it. It
may have an identifiable pattern such as a fingertip or belt buckle.
–– A circumferential (encircling a limb or thorax) bruise may be the
result of restraint.
• Size
• Location: This may be misleading. A bruise that occurs in loose
tissue, such as the area under the eye, may spread a great distance
because the blood travels easily into the surrounding tissues.
• Tenderness
• Swelling
• Broken skin
• Illnesses or medical problems: Medical problems such as
clotting disorders, leukemia or liver disease may cause a person
to bruise easily.
• Medications: Medications do not in and of themselves cause
bruising but may allow a person to bruise more easily. It is
important to note both prescription and over-the-counter
products taken by the elder, including herbs and supplements.
• Senile purpura (aka solar purpura) is a geriatric condition
that mimics bruises. The purple/red bruises and brown skin
discoloration result from increased vessel fragility due to
connective tissue damage from chronic sun exposure.
• Bruises were large. More than half of older adults with bruises
who had been physically abused had at least one bruise 5 cm
(about 2 inches) in diameter or larger.
• Older adults with bruises who had been abused had more bruises
in areas indicated by brown arrows than older adults whose
bruises were accidental.
• 90% of older adults with bruises who have been physically abused
can tell you how they got their bruises, and this includes many
older adults with memory problems and dementia.
HEAD
ARMS BACK
Palm and
thumb side
• Unknown f=39
• Accidental f=23
• Inflicted f=93
This project was funded by Grant 2005-IJ-CX-0048 from the Department of Justice (DOJ),
Office of Justice Programs
Citation: Wiglesworth A, Austin R, Corona M, Schneider D, Liao S, Gibbs L, Mosqueda L.
Bruising as a marker of physical elder abuse. J Am Geriatr Soc. 2009 Jul;57(7):1191-6.
A basilar skull fracture (or basal skull fracture) is a fracture of the base of the
skull. There are two different types that have distinctive bruising:
• Fractures of the petrous temporal bone result in leakage of spinal fluid
through the ear. Bruising in this kind of skull fracture will occur behind
the ear(s). This bruise is known as a Battle’s sign.
• Fractures of the anterior cranial fossa result in leakage of spinal fluid
through the nose and bruising around the eyes. This kind of bruising is
known as “raccoon eyes.”
• Signs occur 1-3 days after injury and are bilateral (occur on both sides).
2) ASSESSING STRANGULATION
A pressure sore is an area of skin that breaks down due to unrelieved pressure.
Stage I
Red area with intact
skin. Redness persists
even when pressure is
relieved. May develop
within minutes or hours.
Stage II
Appears open like an abrasion or
shallow crater, or there may be a blister.
May develop within hours to days.
Stage III
Full thickness skin loss, deeper than a
superficial wound, but not as deep as
stage IV. May develop within hours to
days to weeks.
Stage IV
May see bones, muscles,
or tendons. May develop
within days to weeks.
4) ASSESSING DEHYDRATION
Laboratory tests are very helpful in determining the presence and severity of
dehydration.
5) ASSESSING MALNUTRITION
Compared to younger adults, older persons have reduced muscle mass and
reduced protein stores. These can be depleted in as little as three days, resulting
in malnutrition.
General guidelines:
• Unintentional loss of 10 pounds or more in the previous 6 months; or
• Unintentional loss of 5% or more of usual body weight in the past month.
Common chronic diseases and conditions may cause fever, chronic infection,
and disease-related changes in an elder’s metabolism. Some common chronic
diseases associated with malnutrition in older adults are:
• Alcoholism
• Cancer
• Chronic bronchitis and emphysema
• Dental and oral disease
• Depression
• Dementia (end stage)
• Thyroid disease
Terminal wasting is a type of extreme weight loss. When the body gets to a
more advanced stage of malnutrition, it starts to digest the muscles for energy.
A malnourished person also loses the fat on his/her face and the skin becomes
very taut, to the point where the face looks skeletal.
While pain is fairly easy to assess in most people, for a person with delirium or
dementia pain may be perceived differently and expressed differently.
B. Assessing Cognition
52 VI. Common Terms Used in Elder Health Care and Elder Abuse
VII. ELDERS’ HEALTH CARE PROVIDERS
Several types of professionals may have a role in providing care for an elder or
may study elder issues:
VII. Elders' Health Care Providers 53
VIII. ASSESSING FUNCTIONAL
ABILITIES
The terms “Activities of Daily Living” (ADL) and “Instrumental Activities of
Daily Living” (IADL) are used in evaluating a person’s functional abilities.
Judicial officers may encounter these terms when reviewing medical or social
service records, or when hearing testimony. Thirty-nine percent of elders have
some type of functional limitation; 14% experience Instrumental Activities
of Daily Living limitations, while 25% experience both IADL and at least one
ADL limitations.
2) Alzheimer’s disease
The most common form of dementia. See “dementia”, page 58. A syndrome
involving loss of memory and intellectual skills (such as language, judgment
and spatial relations) severe enough to cause dysfunction in daily life. More
than one in eight people aged 65 and older (13%) have Alzheimer’s disease.
Symptoms may include: problems with short term memory; confusion;
concentration deficits; inappropriate behavior; paranoia; lack of initiative.
3) Angina
A disorder of the heart marked by periods of intense pain that occurs
when a portion of the heart muscle temporarily does not receive an
adequate supply of oxygen.
4) Aphasia
Impairment of language (can be receptive, expressive or both).
5) Apraxia
Inability to perform a motor task despite intact motor function (e.g., the person
cannot put on clothing although there is nothing wrong with his/her arms).
6) Autism
A group of developmental disabilities that can cause significant social,
communication and behavioral challenges. Autism Spectrum Disorders can
range from very mild to severe, and affect each person in different ways.
7) Bedbound or sedentary
Confined to bed; bedridden. Physical disabilities and/or mental health issues
may lead to severe limitations in mobility or to a person becoming bedbound.
Secondary problems that can be caused by being sedentary or bedbound
include: pressure sores (bedsores); weakness/deconditioning; contractures
(frozen joints); malnutrition; dehydration; poor personal hygiene.
Psychiatric: Medical:
Depression Psychosis Delirium
Schizophrenia Dementia
20) Depression
More prevalent in the elderly than in younger people. Elders are often
coping with multiple losses – spouses, friends, financial, status, driver’s
license, independence – that may lead to depression. In 2006, 10% of
men and 18% of women aged 65 and over exhibited clinically relevant
depressive symptoms. Elderly men have the highest suicide rate. It is
very common to find depression in people with dementia, especially
early stage dementia. Depression in elders often affects thinking and
memory even in the absence of dementia. Effective treatment may lead
to improved thinking and memory, and improved quality of life. Some
elders suffering from depression may not admit to feeling depressed.
Symptoms may include: a decreased interest in activities; change in
personality; complaints of memory decline; irritability. Depression is
more common as the number of co-existing medical conditions increases.
23) Falls
A leading cause of death among the elderly. Indicators include: a slow
or unsteady gait; walking with a shuffle; difficulty moving or standing.
If an elder has fallen more than once in the past 6 months and abuse
is suspected, an investigation should determine the frequency of falls,
whether the elder has been injured or taken for medical care as a result,
and whether anyone pushed the elder.
24) Fibromyalgia
A chronic pain disorder that causes widespread pain and tenderness in
the muscles and soft tissues, as well as sleep problems and fatigue.
26) Hepatitis
Inflammation of the liver. Hepatitis can be chronic or acute, often due to
infection with viruses. Alcoholic hepatitis is also common and may lead
to cirrhosis. Symptoms may include: abdominal pain; nausea; decreased
appetite; jaundice; fatigue; fever.
29) Hypertension
High blood pressure that causes damage to the blood vessels in the
eyes, kidneys and heart over time. Called the “silent killer” as it usually
causes no symptoms for many years. A blood pressure reading consists
of an upper (systolic) and lower (diastolic) number written as (Systolic/
Diastolic). A reading of 140/90 represents the upper limits of normal
blood pressure, however many older adults have a systolic blood
pressure (SBP) of 160-180. While this is not usually an emergency, it
may be a cause for concern. If blood pressure rises to dangerous levels
quickly, it may cause headaches or chest pain and lead to heart attacks
or strokes. Blood pressure that is too high may also cause delirium or
confusion in some older adults.
30) Incontinence
Loss of bladder or bowel control; may be addressed with medication
and/or diapers.
35) Pancreatitis
A serious inflammation of the pancreas. There are many causes; one of
the more common is heavy alcohol intake, especially in recurrent cases.
Symptoms may include: abdominal pain; fever; nausea/vomiting.
38) Pneumonia
A serious lung infection. Symptoms may include: lethargy; shaking
chills; shortness of breath/difficulty breathing; decreased appetite; fever
and/or cough; altered mental status.
39) Seizures
Occur when electrical impulses in the brain are interrupted. The resulting
symptoms will depend on the part(s) of the brain involved in the seizure
and may affect the whole body or just a small part of the body.
40) Self-neglect
Behavior of an elder that threatens his/her health, welfare or safety. This
may include refusing or failing to provide themselves with food, water,
clothing, shelter, safety, hygiene and/or medication. The elder may or
may not understand the consequences of his/her decisions. Symptoms
of self-neglect may include: dehydration; malnutrition; unkempt
personal appearance; dirty environment; utilities turned off; medicines
mismanaged; signs of dementia, depression or drug/alcohol abuse.
Note
• The same medication may be used to treat different conditions.
• Dosages vary based on the patient and the condition.
Factors that may have significance in understanding the context and effect of
medication in a legal case include:
• The medication being taken;
• The purpose for taking the medication;
• The dosage;
• The person responsible for procuring the medications if not the elder
him/herself;
• The person responsible for dispensing the medications if not the elder
him/herself.
1. Name
The complete name of the medicine
2. Dose
mg (milligrams)
mcg (micrograms)
mEq (milliequivalent)
IU (International Units)
% (percent strength)
6. Quantity
7. Number of Refills
8. Expiration Date
Elders commonly use herbal treatments that are advertised as helpful for
memory enhancement, joint pains and various other maladies. Some of these
herbal medicines have been studied in the medical literature, although not
very thoroughly, and some have serious side effects or may lead to dangerous
complications when combined with other medications.
In the Penal Code, the most pertinent provisions are located in “Crimes
Against Elders, Dependent Adults and Persons with Disabilities,” Penal Code
§368 et.seq. but there are many other relevant penal statutes including those
that enhance punishment when a crime is committed against an elder. These
chapters are briefly outlined below, together with a limited list of other code
sections related to elder abuse.
Appendix A: Elder Abuse Provisions in the California Code 71
8. Financial Abuse of Elders 80
Business & Professions Code
Civil Code
Family Code
Government Code
Insurance Code
Penal Code
Probate Code
Welfare & Institutions Code
9. Judicial System Supports for Elderly Victims/Witnesses 84
Penal Code
10. Conservatorships and Related Probate Code Sections 84
Probate Code
11. Lanterman-Petris-Short Act Conservatorship 87
Welfare & Institutions Code §§5000-5550
Appendix A: Elder Abuse Provisions in the California Code 73
is made for the purpose of preventing the elder or dependent adult
from having contact with family, friends, or concerned persons;
false imprisonment as defined in the Penal Code, or physical
restraint of an elder or dependent adult to prevent the elder or
dependent adult from meeting with visitors, unless these actions
are taken pursuant to the instructions of the physician who is
caring for the elder or dependent adult, or if they are in response
to a reasonably perceived threat of danger to property or physical
safety (Welfare & Institutions Code §15610.43).
• Deprivation of goods or services necessary to avoid physical
harm or mental suffering includes deprivation of medical care for
physical and mental health needs, assistance in personal hygiene,
adequate clothing, adequately heated and ventilated shelter,
protection from health and safety hazards, and protection from
malnutrition under those circumstances where the results include,
but are not limited to, malnutrition and deprivation of necessities
or physical punishment; and deprivation of transportation and
assistance necessary to secure any of these needs (Welfare &
Institutions Code §15610.07; §15610.35).
• Neglect means the negligent failure of any person having the care
or custody of an elder or a dependent adult to exercise the degree
of care, or the elder himself or herself to exercise that degree of self-
care, that a reasonable person in a like position would exercise. This
includes, but is not limited to, failure to assist in personal hygiene,
or in the provision of food, clothing or shelter; failure to provide
medical care for physical or mental health needs; failure to protect
from health and safety hazards; and failure to prevent malnutrition
or dehydration. (No person shall be deemed neglected or abused
for the sole reason that he or she voluntarily relies on treatment by
spiritual means through prayer alone in lieu of medical treatment.)
Neglect also includes the failure of an elder to satisfy these needs
for himself/herself as a result of poor cognitive functioning, mental
limitation, substance abuse, or chronic poor health (Welfare &
Institutions Code §15610.57).
§15630: Mandated reporters include any person who has paid or unpaid
responsibility for care or custody of an elder or dependent adult or any
administrator, supervisor or licensed staff of a facility which provides care or
services of the elderly, or any employee of adult protective services or local law
enforcement. Mandated reporters must report knowledge of or suspicion of
abuse by phone and by a written report. Failure to report is a misdemeanor.
§15631: Any person who is not a mandated reporter may make a report of
elder abuse.
Appendix A: Elder Abuse Provisions in the California Code 75
§15636: Adult Protective Services agency or the Long-Term Care Ombudsman
may act only with the consent of the victim unless a violation of the Penal
Code is alleged. If the abuse victim is incapacitated, conservatorship
proceedings may be initiated.
Appendix A: Elder Abuse Provisions in the California Code 77
§§1599-1599.4: Skilled Nursing and Intermediate Care Facility Patient’s Bill Of
Rights.
§9722: Long-Term Care Ombudsmen have the right to enter long-term care
facilities for the purpose of hearing, investigating, and resolving complaints by,
or on behalf of, and rendering advice to, elderly individuals who are patients or
residents of the facilities, including complaints of elder abuse.
§13515: Every city police officer or deputy sheriff at a supervisory level and
below who is assigned field or investigative duties must complete an elder and
dependent adult abuse training course certified by the Commission on Peace
Officer Standards and Training within 18 months of assignment to field duties.
§6252: An Emergency Protective Order for an elder may include all of the
restraining and other orders authorized under an Elder or Dependent Adult
Protective Order.
Appendix A: Elder Abuse Provisions in the California Code 79
§§6300-6409: Protective orders and other domestic violence prevention orders.
§6324: The court may issue an ex parte order determining the temporary use,
possession, and control of real or personal property of the parties and the
payment of any liens or encumbrances coming due during the period the order
is in effect.
§6341: (a) The court may, if requested by the petitioner, order a party to pay
an amount necessary for the support and maintenance of the child if the order
would otherwise be authorized in an action brought pursuant to the Uniform
Parentage Act. (c) If the parties are married to each other and no spousal
support order exists, after notice and a hearing, the court may order the
respondent to pay spousal support.
§6343: (a) After notice and a hearing, the court may issue an order requiring the
restrained party to participate in a batterer’s program approved by the probation
department as provided in Section 1203.097 of the Penal Code.
§6126: Prohibits the unauthorized practice of law and makes a person holding
himself/herself out as an attorney, such as sellers of living trusts, guilty of a
misdemeanor. (Note: this provision is not enforceable by private parties.)
§2224: One who gains a thing by fraud, accident, mistake, undue influence or
other wrongful acts is an involuntary trustee for the benefit of the person who
would otherwise have had the thing.
§3344: Provides for protection against salespeople who falsely use trusted
names to legitimize their product.
§3345: Permits the trier of fact to impose treble damages when seniors are the
victims of misrepresentations by salespeople who falsely use trusted names to
legitimize their misrepresentations.
FAMILY CODE
Appendix A: Elder Abuse Provisions in the California Code 81
§6252: An Emergency Protective Order for an elder may include all of the
restraining and other orders authorized under an Elder or Dependent Adult
Protective Order.
GOVERNMENT CODE
§27388: Recording fees shall be used to fund the Real Estate Fraud Prosecution
Trust Fund for use by law enforcement agencies.
INSURANCE CODE
§785: Provides for a duty of honesty, good faith, and fair dealing (often covers
annuity salespeople).
PENAL CODE
PROBATE CODE
§259: Any person found liable for physical abuse, neglect, false imprisonment
or fiduciary abuse (fraud and undue influence) of an elder or dependent adult
decedent shall be deemed to have predeceased the decedent, and shall not
receive any award from the decedent’s estate or be allowed to serve as a fiduciary.
§15610.30: For purposes of the Elder Abuse and Dependent Adult Civil
Protection Act, financial abuse of an elder or dependent adult occurs when a
person or entity does any of the following:
1) Takes, secretes, appropriates, obtains, or retains real or personal
property of an elder or dependent adult for a wrongful use or with
intent to defraud, or both.
2) Assists in taking, secreting, appropriating, obtaining, or retaining real
or personal property of an elder or dependent adult for a wrongful
use or with intent to defraud, or both.
3) Takes, secretes, appropriates, obtains, or retains, or assists in taking,
secreting, appropriating, obtaining, or retaining, real or personal property
of an elder or dependent adult by undue influence, as defined in Section
1575 of the Civil Code. A person or entity shall be deemed to have taken,
secreted, appropriated, obtained, or retained property for a wrongful
use if, among other things, the person or entity engages in this conduct,
and the person or entity knew or should have known that this conduct
is likely to be harmful to the elder or dependent adult, and the elder or
dependent adult is deprived of any property right, including by means of
an agreement, donative transfer, or testamentary bequest, regardless of
whether the property is held directly or by a representative of an elder or
dependent adult. “Representative” means a person or entity that is either:
a conservator, trustee, or other representative of the estate of an elder or
dependent adult, or an attorney-in-fact of an elder or dependent adult
who acts within the authority of the power of attorney.
Appendix A: Elder Abuse Provisions in the California Code 83
9. Judicial System Supports for Elderly Victims/Witnesses
PENAL CODE
§264.02: An elder has the right to have a support person present at a forensic
examination.
§679.04: An elder has the right to have a support person present during a
formal interview by law enforcement, prosecutors and defense attorneys, when
the elder is the victim of a sexual assault.
§939.21: An elder has the right to have a support person present when an elder
who is a prosecution witness (and a “dependent person”) is providing grand
jury testimony.
PROBATE CODE
§259: Any person found liable for physical abuse, neglect, false imprisonment
or fiduciary abuse (fraud and undue influence) of an elder or dependent adult
decedent shall be deemed to have predeceased the decedent, and shall not
receive any award from the decedent’s estate or be allowed to serve as a fiduciary.
§810: Rebuttable presumption that all persons have capacity to make decisions.
A judicial determination that a person lacks legal capacity to perform a specific
act should be based on evidence of a deficit in the person’s mental function
rather than a diagnosis of a person’s mental or physical disorder.
§1800: Legislative intent to: protect the rights of persons who are placed
under Conservatorship; provide that an assessment of the needs of the
person is performed in order to determine the appropriateness and extent of
a conservatorship and to set goals for increasing the conservatee’s functional
abilities to whatever extent possible; provide that the health and psychosocial
needs of the proposed conservatee are met; provide that community-based
services are used to the greatest extent in order to allow the conservatee to remain
as independent and in the least restrictive setting as possible; provide that the
periodic review of the conservatorship by the court investigator shall consider
the best interests of the conservatee; ensure that the conservatee’s basic needs
for physical health, food, clothing, and shelter are met; provide for the proper
management and protection of the conservatee’s real and personal property.
§1801: A conservator of the person and estate may be appointed for a person
who is unable to provide for his/her personal needs or who is substantially
unable to handle his/her own financial resources or resist fraud or undue
influence. The standard of proof for the appointment of a conservator shall be
clear and convincing evidence.
Appendix A: Elder Abuse Provisions in the California Code 85
§1826: Court investigator’s duties; distribution and confidentiality of
investigator’s report.
Appendix A: Elder Abuse Provisions in the California Code 87
Appendix B:
Common Abbreviations for Medical Terms
The following terms are often abbreviated in medical records or other reports
that may be submitted to the court and considered as part of the judicial
officer’s deliberations.
Appendix B: Common Abbreviations for Medical Terms 89
PVD peripheral vascular disease
RA rheumatoid arthritis
SBE subacute bacterial endocarditis (infection of heart valve)
SBO small bowel obstruction
SI suicidal ideation
SOB shortness of breath
SOBOE shortness of breath on exertion
S/P status post (clinical shorthand referring to a state that follows
an intervention)
SZ seizure
THR total hip replacement
TIA transient ischemic attack (brief interruption of blood supply to a
part of the brain causing stroke-like symptoms that completely
resolve within 72 hours)
UI urinary incontinence
UTI urinary tract infection
VH visual hallucination
Y/O year old
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 91
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
ANUSOL-HC ✱ Hydrocortisone Inflammation
ANSAID Flurbiprofen Pain; Arthritis; Inflammation
ANTABUSE Disulfiram Alcohol
ANTIVERT Meclizine Dizziness
ANUSOL ✱ Phenylephrine Hemorrhoids
APRESOLINE Hydralazine Blood pressure
ARICEPT Donepezil Alzheimer’s disease
ARMOUR Thyroid Dessicated Thyroid hormone replacement
THYROID
ARTANE Trihexyphenidyl Parkinson’s disease
ASCRIPTIN ✱ Aspirin Pain; Fever; Inflammation
ASMACORT Triamcinolone Asthma
ATACAND Candesartan Blood pressure
ATARAX Hydroxyzine Itching
ATIVAN ©
Lorazepam Anxiety
ATROMID Clofibrate High cholesterol
ATROVENT Ipratropium Asthma
AUGMENTIN Amoxacillin/ Bacterial infection
Clavulanic Acid
AVANDIA Rosiglitazone Diabetes
AVAPRO Irbesartan Blood pressure
AVELOX Moxifloxacin Bacterial infection
AXID (AR✱) Nizatidine Ulcer; GERD
AZOPT Brinzolamide Glaucoma
BACLOFEN Lioresal Muscle relaxant
BACTRIM Sulfamethoxazole/ Bacterial infection
Trimethoprim
BECLOVENT; Beclomethasone Asthma; Allergy
BECONASE
BENADRYL ✱ Diphenhydramine Parkinson’s disease
BENEMID Probenecid Gout
BENTYL Dicyclomine Stomach problem
BENYLIN ✱ Dextromethorphan Cough
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 93
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
CHOLYBAR Cholestyramine High cholesterol
CHRONULAC Lactulose Laxative
CIBALITH Lithium Mania
CIPRO Ciprofloxacin Bacterial infection
CLEOCIN Clindamycin Bacterial infection
CLINORIL Sulindac Arthritis
CLOZARIL Clozapine Tranquilizer
COGENTIN Benztropine Parkinson’s disease
COGNEX Tacrine Alzheimer’s disease
COLACE ✱ Docusate Sodium Stool softener
COLESTID Colestipol High cholesterol
COMPAZINE Prochlorperazine Vomiting; Tranquilizer
COMTAN Entacapone Parkinson’s disease
COREG Carvedilol Blood pressure; heart failure
CORGARD Nadolol Blood pressure; chest pain
CORTAID; CORTEF; Hydrocortisone Inflammation
CORTIFOAM
COSOPT Dorzolamide Glaucoma
+ Timolo
COUMADIN Warfarin Prevent blood clots
COZAAR Losartan Blood pressure
CROLOM Cromolyn sodium Eye allergy
CYLERT Pemoline CNS stimulant
CYTOMEL Liothyronine Thyroid hormone replacement
CYTOTEC Misoprostol Ulcer
DALMANE ❖ Flurazepam Hypnotic
DANTRIUM Dantrolene Muscle Relaxant
DARVOCET ❖ Propoxyphene/ Pain
Acetaminophen
DARVON ❖ Propoxyphene Pain
DATRIL ✱ Acetaminophen Pain; Arthritis
DELSYM ✱ Dextromethorphan Cough
DELTASONE Prednisone Inflammation
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 95
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
DRIXORAL ✱ Phenylephrine Nasal stuffiness
Dexbropheniramine
DULCOLAX ✱ Bisacodyl Laxative
DURICEF Cefadroxil Bacterial infection
DYNACIRC Isradipine Blood pressure
DYNAPEN Dicloxacillin Bacterial infection
DYRENIUM Triamterene Diuretic
E.E.S. Erythromycin Bacterial infection
ethylsuccinate
ECOTRIN ✱ Aspirin Pain, Fever, Inflammation
ELAVIL Amitriptyline Depression
ELDEPRYL Selegiline Parkinson’s disease
EMPIRIN ✱ Aspirin Pain, Fever, Inflammation
E-MYCIN Erythromycin Bacterial infection
EQUANIL ❖ Meprobamate Anxiety
ERGOSTAT Ergotamine Migraine headache
ERYC Erythromycin Bacterial infection
ERYPED Erythromycin ethylsuccinate Bacterial infection
ERY-TAB Erythromycin Bacterial infection
ERYTHROCIN Erythromycin stearate Bacterial infection
STEARATE
ERYTHROMYCIN Erythromycin Bacterial infection
BASE
ESIDRIX Hydrochlorothiazide Diuretic
ESTACE; Estradiol Estrogen replacement
ESTRADERM
EXELON Rivastigmine Alzheimer’s disease
EX-LAX ✱ Bisacodyl Laxative
FELDENE Piroxicam Pain; Arthritis; Inflammation
FEOSOL; FERGON ✱ Ferrous sulfate Iron supplement
FIBERALL ✱ Psyllium Laxative
FIBERCON ✱ Calcium Polycarbophil Laxative
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 97
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
INDOCIN Indomethacin Pain; Arthritis; Inflammation
INH Isoniazid Tuberculosis
INTAL Cromolyn Asthma, Allergy
IOPIDINE Apraclonidine Glaucoma
ISOPTIN Verapamil Chest pain; Blood pressure;
Heart rate control
ISOPTO CARPINE Pilocarpine Glaucoma
ISORDIL Isosorbide dinitrate Chest pain
KAON Potassium chloride Potassium supplement
KAOPECTATE ✱ Attapulgite Diarrhea
K-DUR Potassium chloride Potassium supplement
KEFLEX; KEFTAB Cephalexin Bacterial infection
KENALOG Triamcinolone Inflammation
KEPPRA Levetiracetam Seizure
KERLONE Betaxolol Blood pressure
KLONOPIN Clonazepam Seizure
KLOR-CON; Potassium chloride Potassium supplement
KLOTRIX
KWELL Lindane Lice; Scabies
LAMICTAL Lamotrigine Seizure
LANOXIN Digoxin Heart rate control
LASIX Furosemide Diuretic
LEVOTHROID Levothyroxine Thyroid hormone replacement
LEVSIN Hyoscyamine Urinary incontinence
LIBRITABS ❖ Chlordiazepoxide Anxiety
LIBRIUM ❖ Chloridiazepoxide Anxiety
LIDEX Fluocinonide Inflammation
LIPITOR Atorvastatin High cholesterol
LIQUAEMIN Heparin Prevent blood clots
LITHOBID Lithium Mania
LODINE Etodolac Pain; Arthritis; Inflammation
LONITEN Minoxidil Blood pressure
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 99
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
MONOPRIL Fosinopril Blood pressure
MOTRIN ✱ Ibuprofen Pain; Arthritis; Inflammation
MYAMBUTOL Ethambutol Tuberculosis
MYCELEX Clotrimazole Yeast Infection
MYCOSTATIN Nystatin Fungal Infection
MYLANTA ✱ Magnesium/Aluminum/ Indigestion; Antacid
Simethicone
MYLICON ✱ Simethicone Stomach gas
MYSOLINE ❖ Primidone Seizure
NALDECON ✱ Guaifenesin Cough
NALFON Fenoprofen Pain; Arthritis; Inflammation
NAPROSYN Naproxen Pain; Arthritis; Inflammation
NARDIL Phenelzine Depression
NASALCORT Triamcinolone Asthma; Allergy
NASALCROM ✱ Cromolyn Allergy; Asthma
NAVANE Thiothixene Tranquilizer
NEOLOID ✱ Castor Oil Laxative
NEOSYNEPHRINE ✱ Oxymetazoline; Nasal stuffiness
Phenylephrine
NEPTAZANE Methizolamide Glaucoma
NEURONTIN Gabapentin Seizure; Pain
NICODERM; Nicotine Smoking cessation
NICORETTE ✱
NITRO-BID; Nitroglycerin Chest pain
NITRODISC;
NITRO-DUR;
NITROGARD;
NITROLINGUAL
SPRAY; NITROSTAT
NIZORAL Ketoconazole Fungal infection
NORFLEX Orphenadrine Muscle relaxant
NOROXIN Norfloxacin Urinary bacterial infection
NORPACE Disopyramide Heart rate control
100 Appendix C: Medications Commonly Prescribed for Elders (By Brand Name)
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
NORPRAMIN Desipramine Depression
NORVASC Amlodipine Blood pressure
NUMORPHAN Oxymorphone Pain
OCUPRESS Carteolol Glaucoma
OCUSERT Pilocarpine Glaucoma
OMNIPEN Ampicillin Bacterial infection
OPTICROM Cromolyn Allergy; Asthma
OPTIMINE Azatadine Allergy
OPTIPRANOLOL Metipranolol Glaucoma
ORGANIDIN Iodinated glycerol Cough
ORINASE Tolbutamide Diabetes
OS-CAL 500 ✱ Calcium carbonate Antacid; Calcium supplement
P.C.E. Erythromycin Bacterial infection
PAMELOR Nortriptyline Depression
PARAFLEX; Chloroxazone Muscle relaxant
PARAFON FORTE
PARLODEL Bromocriptine Parkinson’s disease
PAXIL Paroxetine Depression
PENTIDS Penicillin G Bacterial infection
PEN-VEE K Penicillin V Bacterial infection
PEPCID (AC ✱) Famotidine Ulcer; Heartburn
PEPTO-BISMOL Bismuth subsalicylate Diarrhea
PERCOCET ❖ Oxycodone/ Pain
Acetaminophen
PERCODAN ❖ Oxycodone/ Aspirin Pain
PERDIEM FIBER ✱ Psyllium Laxative
PERMAX Pergolide Parkinson’s disease
PERSANTINE Dipyridamole Stroke prevention
PERTUSSIN ES ✱ Dextromethorphan Cough
PHENERGAN Promethazine Allergy; Vomiting; Sedative
PILOCAR Pilocarpine Glaucoma
PLAVIX Clopidogrel Stroke prevention
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 101
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
PLENDIL Felodipine Blood pressure
PRAVACHOL Pravastatin High cholesterol
PRECOSE Acarbose Diabetes
PREMARIN Estrogens, conjugated Estrogen replacement
PREVACID Lansoprazole Ulcer; Heartburn
PRILOSEC (OTC ✱) Omeprazole Ulcer; Heartburn
PRINIVIL Lisinopril Blood pressure
PRO-BANTHINE Propantheline Bowel irritation
PROCAN Procainamide Heart rate control
PROCARDIA Nifedipine Blood pressure; Chest pain
PROLIXIN Fluphenazine Tranquilizer
PRONESTYL Procainamide Heart rate control
PROPINE Dipivefrin Glaucoma
PROSCAR Finaasteride Prostate enlargement
PROSOM ❖ Estazolam Hypnotic
PROTONIX Pantoprazole Heartburn
PROVENTIL Albuterol Asthma
PROZAC Fluoxetine Depression
PYRIDIUM Phenazopyridine Urinary tract pain
PZA Pyrazinamide Tuberculosis
QUESTRAN Cholestyramine High cholesterol
QUINAGLUTE; Quinidine Heart rate control
QUINIDEX
REGLAN Metoclopramide Vomiting; stomach motility
RELA Carisoprodol Muscle relaxant
RELAFEN Nabumetone Pain; Arthritis; Inflammation
RELENZA Zanamivir Influenza treatment
REMERON Mintazapine Depression
REQUIP Ropinorole Parkinson’s disease
RESTORIL ❖ Temazepam Hypnotic
RETIN-A Tretinoin Acne
RETROVIR Zidovudine Viral Infection
102 Appendix C: Medications Commonly Prescribed for Elders (By Brand Name)
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
RIFADIN Rifampin Tuberculosis
RISPERDAL Risperidone Tranquilizer
RITALIN Methylphenidate CNS Stimulant
ROBAXIN Methocarbamol Muscle relaxant
ROBITUSSIN ✱ Guaifenesin/ Cough
Dextromethorphan
ROGAINE Minoxidil Male pattern baldness
SECONAL ❖ Secobarbital Hypnotic
SECTRAL Acebutolol Blood pressure
SENOKOT ✱ Senna concentrate Laxative
SEPTRA Sulfamethoxazole/ Bacterial infection
Trimethoprim
SERAX ❖ Oxazepam Anxiety
SEROQUEL Quetiapine Tranquilizer
SERPASIL Reserpine Blood pressure
SERZONE Nefazodone Depression
SINEMET Carbidopa/ Levodopa Parkinson’s disease
SINEQUAN Doxepin Depression
SLO-BID Theophylline Asthma
SLOW-K Potassium chloride Potassium supplement
SLOW- PHYLLIN Theophylline Asthma
SOMA Carisoprodol/ Aspirin Muscle relaxant
SONATA ❖ Zaleplon Hypnotic
STELAZINE Trifluoperazine Tranquilizer
SUDAFED Pseudoephedrine Nasal stuffiness
SUPRAX Cefixime Bacterial infection
SYLLACT ✱ Psyllium Laxative
SYMMETREL Amantidine Parkinson’s disease
SYNTHROID Levothyroxine Thyroid hormone replacement
TAGAMET (HB ✱) Cimetidine Ulcer; Heartburn
TAMIFLU Oseltamivir Influenza treatment
TASMAR Tolcapone Parkinson’s disease
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 103
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
TAVIST ✱ Clemastine Allergy
TEGOPEN Cloxacillin Bacterial infection
TEGRETOL Carbamazepine Seizure
TELDRIN ✱ Chlorpheniramine Allergy
TENORMIN Atenolol Blood pressure; chest pain
TEQUIN Gatifloxacin Bacterial infection
TERAZOL Terconazole Vaginal fungal infection
TEVETEN Eprosartan Blood pressure
THEO-24; Theophylline Asthma
THEO-DUR;
THEOLAIR
THORAZINE Chlorpromazine Tranquilizer
TICLID Ticlopidine Prevent blood clots
TIGAN Trimethobenzamide Vomiting
TILADE Nedocromil Allergy; Asthma
TIMOPTIC Timolol Glaucoma
TINACTIN ✱ Tolnaftate Fungal infection
TOFRANIL Imipramine Depression
TOLECTIN Tolmetin Inflammation
TOLINASE Tolazamide Diabetes
TOPAMAX Topiramate Seizure
TORADOL Ketorolac Pain; Arthritis; Inflammation
TRANSDERM SCOP Scopolamine Motion sickness
TRANSDERM- Nitroglycerin Chest pain
NITRO
TRANXENE ❖ Clonazepate Anxiety
TRENTAL Pentoxifylline Poor circulation in legs
TRILAFON Perphenazine Tranquilizer
TRILEPTAL Oxcarbazepine Seizure
TRUSOPT Dorzolamide Glaucoma
TUMS ✱ Calcium carbonate Antacid; Calcium supplement
TUSSIONEX ❖ Chlorpheniramine/ Nasal stuffiness; cough
Hydrocodone
104 Appendix C: Medications Commonly Prescribed for Elders (By Brand Name)
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
TUSSI- Codeine/ Cough; Nasal stuffiness
ORGANIDIN ❖ Iodinated Glycerol
TYLENOL ✱ Acetaminophen Pain; Osteoarthritis
TYZINE ✱ Tetrahydrozoline Nasal stuffiness
ULTRAM Tramadol Pain
UNIPEN Nafcillin Bacterial infection
UNISOM ✱ Doxylamine Sedative
UNIVASC Moexepril Blood pressure
URECHOLINE Bethanechol Urinary retention
VALISONE Betamethasone Inflammation
VALIUM ❖ Diazepam Anxiety; Muscle relaxant
VANCENASE; Beclomethasome Asthma; Allergy
VANCERIL
VANTIN Cefpodoxime Bacterial infection
VASCOR Bepridil Blood pressure; chest pain
VASOTEC Enalapril Blood pressure; heart failure
V-CILLIN K; Penicillin V Bacterial infection
VEETIDS
VELOSEF Cephradine Bacterial infection
VENTOLIN HFA Albuterol Asthma
VIAGRA Sildenafil Erectile dysfunction
VIBRAMYCIN Doxycycline Bacterial infection
VICODIN ❖ Hydrocodone/ Pain
Acetaminophen
VISINE ✱ Tetrahydrozoline Eye redness
VISKEN Pindolol Blood pressure
VISTARIL Hydroxyzine Itching
VIVACTIL Protriptyline Depression
VOLTAREN Diclofenac Pain; Inflammation; Arthritis
WELLBUTRIN Bupropion Depression
WESTCORT Hydrocortisone Inflammation
WYGESIC Propoxyphene/ Pain
Acetaminophen
Appendix C: Medications Commonly Prescribed for Elders (By Brand Name) 105
✱ = Available without a prescription ❖ = Controlled substance
Brand Name Generic Name Usage
XALATAN Latanoprost Glaucoma
XANAX ❖ Alprazolam Anxiety
ZANTAC ✱ Ranitidine Ulcer; Heartburn
ZAROXOLYN Metolazone Diuretic
ZESTRIL Lisinopril Blood pressure; heart failure
ZITHROMAX Azithromycin Bacterial infection
ZOCOR Simvastatin High cholesterol
ZOLOFT Sertraline Depression
ZYBAN Bupropion Smoking cessation
ZYLOPRIM Allopurinol Gout
ZYPREXA Olanzapine Tranquilizer
ZYRTEC Cetirizine Allergy
106 Appendix C: Medications Commonly Prescribed for Elders (By Brand Name)
IMPORTANT LOCAL NUMBERS
We encourage judicial officers to add local contact names, phone numbers,
and email addresses here.
Medical Services:
Victim Services: