Legal/Ethical issues and elder. abuse

How to assess decision-making capacity for older adults

Is there a concern that the patient lack capacity and there a decision to be made → is there evidence of a disturbance of brain or mind → Have you taken all reasonable steps to optimize decision-making capacity → are they able to A- understand information, B- retain the information, C- weigh up the information, D- communicate their decision → Yes to A and D they have decision-making capcity even if decision feels unwise, No to any A to D best interest. decision to be made in least restrictive way

Occurs over time- not a one time occurance

Decisional capacity may fluctuate “window of lucidity”

Decision specific and directly related to risk

Elder abuse

Intentional actions that cause harm to create a serious risk of hard (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship

Failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm

Any knowing intention, or negligent act that causes harm or a serious risk of harm to a vulnerable older adult

Physical abuse

Mrs. K, 84, has bruises in different stages of healing on her upper arms her son says she “falls alot”

Sexual abuse

Mr. R, 78, has dementia. A new aide brought him on her shifts. He now has bruising on his inner thighs

Financial abuse

Mrs. L, 82, has $30,000 missing from her account. Her nephew has new power of attorney and a new car

Emotional abuse

Mr. T, 76, is withdrawn and tearful. His daughter yells at him infront of staff and calls him “useless”

Neglect

Mrs. P, 88, is admitted dehydrated, with a stage 3 pressure injury. Her caregiver was paid to feed her

Abandonment

When the caregiver takes their patient somewhere and forgets them ot leaves the somewhere on purpose

Scams

When spam callers try to get elders to give them their credit card or bank information

Self-neglect

Mr.D, 80, lives alone, hoards food, hasn’t bathed in weeks, and refuses all help. No family contact

Risk factors of elder abuse

Functional dependence or disability

Poor physical health

Cognitive impairement

Low income

Being female

Financial dependence

Race/Ethnicity (hispanic experience lowest rates of elder abuse)

Perpertrator risk factors

Mental health issues

Substance use issues

Dependency on older adult

Ineffective coping- high rate of stress

Socital risk factors

Ageism

Cultural norms

Proper screening for elder abuse

No routine screening for elder abuse

• USPSTF (U.S. Preventive Services Task Force): insufficient evidence to recommend universal screening

Screen when you suspect

• Use the Elder Mistreatment Assessment (EMA) when red flags appear

Patients should always be interviews by themselves to avoid intimidation by possible abusers

Asked about family situation and living arrangements

Patients should be asked directly about abuse, neglect, or exploitation

• Has anyone at home ever hurt you

• Has anyone ever touched you without your consent

• Has anyone taken anything that was yours without asking

• Has anyone ever scolded or threatened you

• Have you signed any documents that you didn’t understand

• Are you afraid of anyone at home

• Are you alone a lot of the time

• Has anyone ever failed to help you take care of yourself when you needed help

Should look for indicators of abuse, including poorly explained injuries, evidence of neglect (dehydration, malnutrition, poor hygiene, lack of medical compliance), isolation, fear of a caretaker, or transfer funds to a caretaker

What are nursing responsibilities such as mandated reporting

Any person having reasonable causes to believe that. an older adult, or someone within the state who is 60 years of age or older, is in need of protective services may report such information to the agency which is the local provider of protective services

The first obligation of nurses is to assure the safety of the older adults

• A home visit may sometimes be needed to make that determination → collaboration with case managers, community workers, etc.

• Adult protective service reporting

Mandatory reporting laws do not require reporters to know whether abuse ot neglect has occured, but merely to report it if they suspect its occurence