Health and healing week 4

what is elder abuse

• any action by someone in a relationship of trust that results in harm or distress to an older person

• neglect is the lack of action by that same person in a relationship of trust with the same result

types of elder abuse

• any form of physical, emotional, financial, sexual abuse and neglect

most common forms of abuse

• emotional

• financial

stats and trends

• most instances of abuse is committed by family members

• older women experience abuse more than men

• older women usually experience abuse by spouse and children

• men usually experience abuse by spouses and children

• individuals with cognitive impairment are at higher risk for abuse than those who are not cognitively impaired

impact of elder abuse

• physical trauma

• diminished self worth

• reports of feeling unsafe

• increase risk of early death

• increased hospitalization

• increased economic costs

• exposure to additional health interventions

• lost productivity

relational dynamics that contribute to abuse and neglect

• power and control

• caregiver stress

• abusive behaviours that have been learned over time

individual factors that contribute to abuse and neglect

• being depended on caregivers

• experiencing cognitive challenges

• social isolation

• caregivers that have alcohol or substance abuse problems

• older adults who have a history of being abused

institutional factors that contribute to abuse and neglect

• chronic staffing shortages

• bed shortages

• lack of capacity at the system level to address the complex needs of older adults

physical abuse

• definition

  • using physical force against a person without the persons consent can cause pain injury or impairment

• actions

  • hitting punching, slapping, pushing, biting, throwing, burning, confining (unnecessary restraints), throwing things at them

• indications

  • unexplained injuries, untreated medical problems, history of accidents, signs of over or under use of meds, wasting, dehydration

emotional abuse

• definition

  • using words or actions to control, frighten or isolate or erode a persons self respect

• actions

  • threatening, blaming, insulting, lying, deciding what the person can or can not do, not keeping promises, humiliation, alienating others from the person. making fun of the persons heritage, traditions, or religious/spiritual beliefs, constant yelling

• indications

  • fear, anxiety, withdrawal, depression, cowering, reluctance to talk openly, fearful interaction with caregiver, family or caregiver talk on behalf o the person and not allowing privacy

financial abuse

• definition

  • acting without the older persons consent in a way that benefits the abuser at the expense of the older person through threats, intimidation or deceit. most of this is a crime

• actions

  • misuse of POA, theft, misusing control over a persons funds by not providing them for the persons benefit, pressuring the person to provide financial support, making the person sign a legal document, overcharging for services, failing to repay loans, pressuring the person to sign over house or property

• indications

  • standard of living is inconsistent with income or assets, theft or missing property notes, unusual or inappropriate activity in bank accounts, forged signatures on cheques, overdue bills, missing mail

neglect

• definition

  • failing to adequately provide necessitates of care for a dependent or older person

• actions

  • failing to provide adequate nutrition, personal care or a clean warm safe env, withholding medical services or treatments, failing to provide proper needed supervision, failing to prevent physical harm

• indications

  • unkept appearance, inappropriate or dirty clothing, signs of infrequent bathing, unhealthy living conditions, dangers or disrepair in home env, hoarding, lack of social contact, no regular health care appointments

sexual abuse

• definition

  • direct or indirect involvement in sexual activity without consent

• actions

  • coercing an older person through force, trickery, threats or other means into unwanted sexual activity, victimization of older adults who can not consent

• indications

  • pain, bruising and bleeding in genital area

scams

• a form of financial abuse

• play on older adults emotion and fear

• older adults are often target because they are easily accessible, more trusting and polite and most have money and assets

scam education

• resist pressure to act immediately and dont buy on impulse

• watch out for products promised by prizes and free trips

• before buying or investing check with family and friends or attorney

• dont not give out your credit card over the phone unless you are sure who you are giving it to. hang up and call the credit card company and speak to the fraud department

• do not giver personal info over the phone

• always check email addresses and dont click on links you are unsure of

• if in doubt call or email the person separately to ask if thay sent you a link

questions to ask when suspected physical abuse

• has anyone every tried to hurt you in any way

• have you had recent injuries

• has anyone ever tired to tough you without permission

• have you ever been tied down

questions to ask if you suspect emotional abuse

• has anyone ever yelled at or threatened you

• has anyone been insulting you and using degrading language

• are you care for by anyone who abuses drugs or alcohol

questions to ask if you suspect financial abuse

• who pays your bills, do you go to the bank with them, does this person have access to your accounts does this person have POA

• have you ever signed documents that you dont understand

• are any of ur family members exhibiting a great interest in ur assets

• has anyone ever taken anything that was yours without asking

questions to ask if you suspect neglect

• are you alone alot

• has anyone ever failed you when you needed help

• does anyone care for you or provide regular assistance to you

• are you cared for by anyone who abuses drugs or alcohol

signs to be aware of

• unexplained bruising or fractures

• missed appointments without explanation

• injuries that do not align with the history and physical assessment

• family members change in normal behavior or speaking for the older adult

Assessment

• should be done to determine the immediate safety of the victim the desires of the victim, if capable; and supports available to reduce the persons risk

when abuse is suspected or confirmed

• interprofessional approach

• consider if law enforcement needs to be involved

  • was a criminal code violated

  • follows jurisdictional laws regarding mandatory reporting

  • consider consent and privacy when working with capable adults

• capable older adults decisions need to be respected (if they are capable and understand what is going on you need their consent to report abuse, unless they are in LTC)

institutional abuse

• any form of abuse that occurs within healthcare institutions

• 2 types

  • resident to resident

  • staff to resident

resident to resident abuse

• potential for harm to both residents

• the same power dynamic is not usually at play as it would for other forms of abuse

• this form of abuse does not occur within the context of a therapeutic relationship

nursing implications for resident to resident abuse

• separate people involved

• follow institution policies for mandatory reporting

staff to resident abuse

• any form of abuse that exists between a staff member and a resident and occurs within a trusting therapeutic relationship

• older adults are at risk because they are isolated and dependent on staff for caregiving

• factors influencing

  • institutional

  • staff

  • resident

institutional factors for staff to resident abuse

• if an organization has poor or ineffective leadership, inadequate staffing high burnout or turnover or where intimidation of staff is permitted then this often translates to resident abuse

staff factors for staff to resident abuse

• Staff are more likely to be abusive if they experience workplace stress, dissatisfaction with work, emotional exhaustion, job pressures, inexperience, lack of knowledge about older persons, negative attitudes such as ageism, personal problems, a personal history of abuse, alcohol or substance misuse and deficiencies in communication skills or problem-solving

resident factors for staff to resident abuse

• Aggressive, hyperactive, or responsive behaviours; dependency regarding activities   of daily living; a history of previous abuse; social isolation; and impaired communication all put residents at   higher risk for abuse

mandatory reporting

• mandatory reporting exists within the LTC sector

• if a staff member suspects any form of abuse they must report to their supervisor

• whistle blower protection polices must be in place

• staff —> supervisor —> MoHLTC —> police