Module 8: Identifying Abuse in Elderly, Spouses, and Children

what is abuse?

a pattern of behavior used by one person to gain and maintain power and control over another

what is the first stage of abuse?

tension build up

what is the second stage of abuse?

acute explosion

what is the third stage of abuse?

honeymoon

what occurs during stage 1 of abuse?

an increase of tension, which can be described as the feeling of "walking on eggshells";

victim becomes fearful

what occurs during stage 2 of abuse?

an outburst of physical or emotional abuse by the abuser

what occurs during stage 3 of abuse?

the abuser apologies and may try to explain their behavior;

can seem as if the perpetrator has changed;

leads to denial of the severity of the situation and holds the victim back from leaving the situations or seeking help

who is affected by abuse?

child

elderly

spousal

what are the main forms of abuse?

physical

neglect

psychological/emotional

sexual

what are other forms of abuse?

financial abuse

abandonment

exploitation

self-neglect

what is physical abuse?

use of non accidental physical force, which results in injury, pain, or impairment

what are examples of physical abuse?

kicking, using weapons, sleep and food deprivation, trying to strangle or choke, spitting, biting, driving dangerously, locking someone out of the house, destroying property, throwing things

what is neglect?

defined as an omission of care, which results in harm or risk of harm

what is child neglect?

failure of a parent to provide the child with needs

(physical, emotional, medical, and educational neglect)

what is elderly neglect?

the failure or refusal of the person who has fiduciary responsibility or the service provider to give proper care and to provide the elder with physical life necessities

(food, medicine, clothing, shelther)

what is sexual abuse?

any physical or non physical sexual acts, sexual exploitation, or sexually motivated behavior

what is child sexual abuse?

a minor cannot consent to sexual activity and therefore, any form of sexual activity is considered abuse;

may include showing a child obscene texts or images

what is elderly sexual abuse?

any nonconsensual sexual activity or unwanted touching

what is spousal sexual abuse?

involves any forced sexual activity, sexual violence, using sex to assign value to a partner, causing them to feel guilty if they refuse

what is psychological abuse?

causing a person to have emotional/psychological stress through verbal or nonverbal actions, usually combined with other forms of abuse and signs that are hard to identify

what is child psychological abuse?

threatening a child, calling them names

humiliating them, blaming them

never expressing positive feelings or praises

persistently ignoring them

what is elderly psychological abuse?

threatening, intimidating, or humiliating an elderly person

treating an elderly person as an infant

isolating them from friends or family

what is spousal psychological abuse?

name calling, yelling

constant comparison

telling them what to wear

preventing them from seeing family or friends

what is elderly abuse?

physical, emotional, or sexual harm inflicted upon an older adult, their financial exploitation, or neglect of their welfare by people who are directly responsible for their care

who are perpetrators of elderly abuse?

children

spouses

other family members

staff at nursing homes, assisted living, and other facilities

what are the types of elderly abuse?

neglect

physical abuse

financial exploitation

emotional abuse

sexual abuse

what is physical elderly abuse?

physical assaults

inappropriate use of drugs, restraints or confinement

what is emotional elderly abuse?

intimidation through yelling/threats

humiliation and ridicule

ignoring an elderly person

isolating an elderly person from their friends or activities

what is sexual elderly abuse?

showing elderly pornographic material

forcing elderly to undress

what is neglect elderly abuse?

ignorance or denial that an elderly person needs as much care as they do

what is financial exploitation elderly abuse?

misusing personal checks, credit cards, or accounts

forging elder's signature

target for phony charities

what is healthcare fraud and abuse elderly abuse?

medicaid fraud

not providing healthcare to the elderly but charging for it

overcharging or double-billing for medical care sevices

what are signs of elderly abuse?

unexplained signs of injury (bruises or scars)

broken bones, sprains, dislocations, bedsores

threatening, belittling, or controlling behavior of the caregiver

unexplained vaginal or anal bleeding

unusual weight loss, malnutrition, dehydration

unsanitary living conditions

significant withdrawals from the elder's account

evidence of overmedication or under-medication

what is the most common type of elder abuse?

neglect

who are the greatest culprits of physical abuse?

spouses or other partners

where are rates of abuse the highest?

institutions, including nursing homes and long term care facilities

are elderly men or women more likely to experience abuse in nursing homes?

elderly women

what race are more likely to be neglected by others?

elderly african americans

what race are more likely to be associated with self neglect?

elderly caucasians

how can you educate elderly patients in order to stay safe?

taking care of their health

seeking professional help for drug, alcohol, and depression concerns

attending support groups

planning their own future with a power of attorney or living will, and reviewing their will periodically

not giving personal information on the phone

posting and opening their own mail

what is spousal abose?

continuous use of controlling behavior to limit the victim's thoughts, emotions, and behavior through physical psychological, financial, or sexual power moves that progress in frequency and severity over the course of time

what is a global public-health concern that can increase morbidity and mortality rates?

domestic violence

how do you identify spousal abuse in a patient behaviorally?

appears depressed

fearful of visitors, caregivers, and hospital staff

poor eye contact

withdrawn

absence of support during hospital visit can indicate domestic violence in the form of social isolation

how do you identify spousal abuse in a partner behaviorally?

controlling behavior

possessiveness or hovering over the patient (victim)

answers for the patient

what is the signal for help?

facing your palm to a camera, tucking your thumb towards your palm, and closing your fist

how do you identify spousal abuse physically?

impression marks from fingernails

scratch marks

claw marks

contusion/ecchymosis

bite marks

strangulation (petechiae)

multiple sites of injury

scratches, cigarette burns, rope burns

abrasions, lacerations, welts

subconjunctival hemorrhage

heavy makeup

inappropriate attire for the season

how do you identify sexual abuse?

labial/vaginal/genital hematomas

genital lacerations

dried blood or semen

recurrent STDs

what responses assist successful communication in discussing sexual abuse?

listening

communicating belief

validating the decision to disclose

emphasizing the unacceptability of violence

what shouldn't you say when discussing sexual abuse?

responses that undermine the victim's actions

what are possible effects of spousal abuse?

stress-related illness

anxiety, panic attacks, stress and/or depression

drug abuse

chronic headaches, asthma, vague aches and pains

abdominal pain, chronic diarrhea

sexual dysfunction, vaginal discharge

joint pain, muscle pain

sleeping and eating disorders

suicide attempts, psychiatric illness

gynecological problems, miscarriages, chronic pelvic pain

what is child abuse/maltreatment?

when a parent or caregiver, whether through action or failing to act, causes injury, death, emotional harm or risk of serious harm to a child

what is included in child abuse/maltreatment?

physical abuse

sexual abuse

emotional abuse (psychological abuse)

neglect

exploitation

what is emotional child abuse?

pattern of behavior that damages a child's sense of self worth and negatively impacts their emotional development;

withholding love and support;

reject, criticize, threaten, demean, and berate the child;

humiliate the child, engage in name calling, and insult them

what is child exploitation?

use of children for someone else's advantage, gratification, or profit often resulting in unjust, cruel, and harmful treatment of the child

what age of children have the highest rates of abuse in the US?

children < 1

what is the most common form of child maltreatment?

neglect

what is polyvictimization?

most children experience multiple types of maltreatment

what are signs and symptoms of child maltreatment?

any injury that cannot be explained

fading bruises or other marks

failure to gain weight or sudden dramatic weight gain

genital pain or bleeding

sexually transmitted disease

fearful behavior

bed-wetting

sudden change in self confidence

sudden failure in school

extreme sexual behavior inappropriate for child's age

social withdrawal

shows extremes in behavior

seems frightened of the parents

protests or cries when it is time to go home

shrinks at the approach of adults

what is a form of abuse prevention?

recognition

how can health care workers assist victims of violence?

avoiding victim-blaming behavior

conducting screenings

documenting injuries and details of abuse

referring pts to resources in the community

maintaining privacy and confidentiality

what are social determinants of health?

circumstances in which people are born, grow up, live, work, and age, and the systems put into place to deal with illness

what are examples of social determinants of health?

economic stability

neighborhood and physical environment

education

food

community and social context

health care systems

how can hospitals internally address SDOH?

screening

connecting pts to community resources

implementing hospital-wide initiatives

how can hospitals externally address SDOH?

engaging with the community

partnering with the community

investing in the community

what is the Medicaid transportation program?

non-emergency transportation, such as pre-scheduled trips to primary care and the dentist;

ensures Medicaid members can get to and from their medical appointments at no cost to them

what are the Housing and Support Services (HSS)?

administers an array of programs to address the problems of homelessness in the State;

provide a continuum of services for homeless, at risk, and low-income households

what is the goal of Housing and Support Services (HSS)?

designed to prevent homelessness, provide shelter for the homeless, construct supportive housing for the homeless, and offer essential services to stabilize housing situations and increase levels of self-sufficiency

what programs address violence?

NY-Presbyterian/Weill Cornell Medical Center (victim intervention program)

Mount Sinai (sexual assault and violence intervention program)

Victims Information Bureau of Suffolk (VIBS)

what is the victim intervention program at NYP-Weill Cornell?

provide care to victims 24/7

collaborate and coordinate care with over service providers

provide violence prevention education to the community

what is the Mount Sinai sexual assault and violence intervention program (SAVI)?

meet the needs of survivors by offering crisis intervention

follow up with psychotherapy, counseling and information

educate public and professionals regarding sexual and domestic violence

what is the victims information bureau of suffolk (VIBS)?

free and confidential counseling and advocacy

experts in legal options and procedures in domestic abuse cases

trained certified social workers and advocates

what is GetSetUp?

designed to combat social isolation and promote independence through live, interactive classes and online connectivity with a community