By Laura K. Byerly, Rebecca T. Brown, Brie A. Williams and Anna Chodos
From conducting welfare checks to intervening in behavioral altercations and responding to medical emergencies, police officers provide frontline triage for older adults in distress. However, when police lack understanding about conditions affecting older people, situations can end in tragedy.
In 2016, Francisco Serna of Bakersfield, Calif., was shot and killed by local police after 911 was called to investigate his suspicious behavior. Officers incorrectly assumed he was carrying a firearm in his pocket; a subsequent search found the item to be a wooden crucifix. Serna, who was 73, had dementia, and during the incident he was not responding to officers’ verbal orders to stop and show his hands, leading to an officer opening fire. This and other episodes of unintended harm illustrate the need for police officers to understand dementia, as well as other conditions older people face.
Allying with First Responders
As a result of adverse events between police and community-dwelling older adults, training programs have emerged that educate community police officers about the physiological, functional and cognitive changes associated with aging. The goal of such programs is to increase police officers’ understanding and appreciation of common causes of the wide range of incidents involving older adults for which police are first responders.
For more than five years, the University of California, San Francisco (UCSF) Division of Geriatrics has contributed to the San Francisco Police Department’s (SFPD) 40-hour Crisis Intervention Training (CIT) course, which educates patrol division officers about vulnerable populations in San Francisco, including older adults. In 2014, Dr. Rebecca Brown and colleagues published the results of a needs assessment conducted with CIT-trained SFPD officers.
At baseline, officers reported that while 45 percent had daily interactions with older adults, they lacked knowledge regarding aging-related health issues, were unsure how to appropriately assess for medical and social service needs and struggled to communicate with clinicians. The UCSF team, led by Dr. Brie Williams, created a 90-minute course to target those challenges and it is now an integrated part of the CIT’s week-long course.
Walk a Mile … in Shoes with Popcorn Kernels
The SFPD course, “Aging America,” has a lecture on the challenges identified by police officers, and provides practical tips related to cognitive and functional impairment, dementia-related behaviors, alcohol use and evaluating for elder abuse. This is followed by experiential training adapted from the Oklahoma Healthy Aging Initiative’s Age ASiST kits, which includes “stations” that simulate sensory and functional deficits such as vision impairment (“impairment glasses”), hearing loss (earplugs), peripheral neuropathy (popcorn kernels put in shoes), dexterity impairment (cotton gloves) and gait impairment (bungee corded ankles). Officers are asked to perform daily tasks, including filling a mediset (medication organizing container), buttoning a shirt and walking across a room with a cane (with kernels in place and bungee cords attached) and these simulated impairments.
Training participants’ conversations often start with joking comments such as “getting old sucks!”, but as exercises continue, the tone evolves into genuine expressions of how aging can lead to difficulties with basic tasks of everyday living. Many officers have questions about specific experiences with older adults they have encountered on patrol, or how to best help their parents and grandparents—or even how to optimize aging for themselves. The discussion brings out the universality of aging and internalized ageism.
From Empathy to Practical Experience
Since its rollout, CIT has trained more than 750 police officers in San Francisco. Overall, course-training evaluations have shown positive impact for this frequent part of their work. One officer stated that the training will help him treat all individuals “as if they were my parents,” highlighting an important outcome of the training: to build empathy. Officers noted motivation to slow down with the older adults they meet on patrol, deliberately focus on good communication techniques and anticipate challenges that might result if a patient has a cognitive or sensory impairment. Officers also showed improved scores in knowledge about aging-related health changes that can affect a patient’s safety in the community, elder abuse and how alcohol may have a different effect on older adults. Armed with the combination of knowledge and attitudinal changes, the goal is that officers will be able to triage a situation involving an older adult without using excessive force. While there is no simple way to track police use of excessive force with older adults, prior work has suggested that changing someone’s attitude can have significant changes to subsequent behavior.
Going forward, the course will continue to emphasize skills training on dementia-related behaviors, as well as concrete means of communicating with community-based healthcare providers. The long-term relationship between UCSF and the SFPD highlights the potential for other collaborations between academic centers and our front lines: the men and women of police forces who work with older adults on a daily basis.
Laura K. Byerly, M.D., is a geriatrics and health professions education fellow at the UCSF School of Medicine in San Francisco. Rebecca T. Brown, M.D., M.P.H., is an assistant professor of Medicine in the Division of Geriatrics at UCSF. Brie A. Williams, M.D., is a professor of Medicine in the Division of Geriatrics at UCSF. Anna Chodos, M.D., is an assistant professor of Medicine in the Division of Geriatrics at UCSF. The authors wish to thank Helen Horvath, R.N., M.S., A.N.P., for her current directorship of the geriatrics CIT curriculum; Tideswell at UCSF; and the Geriatrics Workforce Enhancement Program, sponsored by the Health Resources and Services Administration of the U.S. Department of Health and Human Services, for their generous support of this program.
Editor’s Note: This article appears in the November/December, 2017, issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.