Week. 4.Older Adult & Elder Abuse

Abuse

intentional actions that cause harm or create a serious risk of harm, whether or not intended, to a vulnerable elder by a caregiver or other persons who stand in a trust relationship to the elder"

Overview of Elder Abuse and Neglect

Awareness of elder abuse as a social problem began in the 1950s and 1960s. • Now recognized as a major social and public health problem and a significant aspect of domestic violence

Types of Abuse

Physical

Neglect

Financial

Emotional or psychological

Sexual

Self -Neglect

Abandonment

Elder Abuse Facts

Important issue for Canadians • Estimated that somewhere between 4 &10% of seniors in Canada experience some kind of abuse

Statistics from research by Teaster

self-neglect: 29% - Neglect by caregiver: 26% - Exploitation: 19% - Psychological or emotional abuse: 12% - Physical abuse: 12% - Sexual abuse: < 1%

Characteristics of the abuser

Alcohol abuse, mental illness, history of violence or hostility, dependence on victim, stress.

Characteristics of the victim

Social isolation, chronic illness or functional limitation, cognitive impairment, shared living arrangements with the abuser.

Profiles of Abused

Women age 80 or older Lives alone or with abuser Mental or physical disability Dependency on abuse

Profiles of abusers

Middle-age male sibling or offspring Mental health & substance abuse problems Financially dependent on abused Hx. of abuse or being abused

Why elders refuse to report abuse?

Vast majority of cases go unreported • Less contact with the community than other populations • Reluctant to admit to being abused or neglected • Afraid of consequences or alternative could be worse • Myths and negative stereotypes foster strong denial of aging and social problems

Factors that contribute to the invisibility of elder abuse include all of the following except:

Most older adults live in long-term care settings.

Psychological/Emotional Abuse

Defined as the infliction of mental anguish or the provocation of fear of violence or isolation. It diminishes the identity, dignity and self-worth of the person. Eg. Name calling • Ignoring the person • Threatening, infantilization, isolation • Removal of decision making power

Financial Abuse

Includes theft or misuse of money or property, withholding funds and/or fraud; most common, followed by neglect. Eg.Unexplained or sudden inability to pay bills • Unexplained or sudden withdrawl of money from accounts • Absence of required aides

Neglect

Defined as the failure of any person having care or custody of older adult to meet his/her needs when the older person to meet their needs themselves. Eg. Withholding or inadequate provision of physical requirements such as food, housing, medicine, physical aids

Self-neglect

failure to provide for oneself through inattention or wastefulness. Eg. Inability to manage finances, activities of daily living, including personal care, shopping, meal preparation, etc. without adequate assistance

Exploitation, as a form of abuse, is defined as:

Illegal taking, misuse, or concealment of funds, property, or assets

Assessment of elder abuse differs from usual nursing assessments in which of the following ways

A major focus is to determine whether legal interventions are necessary.

A major focus is to determine whether legal interventions are necessary.

Physical health look at:

•Nutrition & hydration •Injuries, bruises, & other physical harm •Specific indicators •Degree of frailty •Pathologic conditions

The most immediate nursing consideration in determining whether legal intervention is necessary in an abusive situation is:

Threats to life

Interventions in Community Settings

Teaching • Supervising • Providing direct care • Working with home health aides • Facilitating referrals

Referrals

Nurses facilitate referrals to decrease the burden of caregiving & increase elders independence.

•Physical, occupational, & speech therapy

•Skilled home care

•Continued assessment & evaluation of needs for skilled home care

•Durable medical equipment or other assistive devices to improve functioning.

Ethical Issues

No clear answers to the issues of abuse

•Rights of older adults •Ethical dilemmas that relate to personal rights •CNO Practice guidelines

•Principles of adult protective services

Which of the following statements is true related to mandatory reporting laws?

Mandatory reporting laws do not require reporters to know whether abuse has occurred.

Providing Care

Nurses' role

•Correction of conditions caused by abuse

•Prevention of recurrence of abuse

•Cooperation with other health care professionals