Elder Abuse

Capacity (clinical) vs Competency (legal)

-Can they make their own decisions

-Older adults are presumed competent unless determined otherwise

Capacity assessment- Can the patient:

-Understand the situation

-Weight pros and cons

-Apply personal values

-Arrive at and communicate a consistent decision

-They have the right to refuse if they can tell you why they are taking it and the risks if they don’t

Assess decision making capacity

-MacArthur Competency Assessment tool (MacCAT-T) for treatment is widely used

-Nursing responsibility: document specifically and descriptively what are patient’s/surrogate’s understanding and wishes

-occurs over time - not a once time occurrence

-Decisional capacity may fluctuate- “window of lucidity”

-Decision specific and directly related to risk

Elder Abuse

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

-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 serous risk of harm to a vulnerable older adult

Elder Abuse Stats

-Abused seniors are 3x more likely to die than non-abused seniors

-Cognitive decline is a risk factor in exploitation

-1:10 seniors is abused each year (under-reported)

-1:23 cases is reported to Adult Protected Services

Types of Elder abuse

-Physical

-Sexual

-Financial

-Emotional/Psychological

-Neglect

-Abandonment

-Self-neglect

Risk factors for elder abuse

-Functional dependence or disability

-Poor physical health

-Cognitive impairment

-Low income

-Being female

-Financial dependence

-Race/ethnicity (hispanic experience lowest rates of elder abuse)

Perpetrator risk factors

-Mental health issues

-Substance use issues

-Dependency on older adult

-Ineffective coping- high rates of stress

Societal risk factors

-ageism

-Cultural norms

Protective factors

-Social embeddedness and social support

-Independent living arrangements

Elder abuse in nursing home

-Misuse of psychotropic medication: sedation meds- chemical restrains

-Physical restraint can also be viewed as elder abuse

-High prevalence of mistreatment of nursing home residents by other residents, in the form of physical, verbal and sexual aggression

Elder abuse screening

-No routine screening for elder abuse

-USPSTF: insufficient evidence to recommend universal screening

-Use the Elder Mistreatment Assessment (EMA) when you suspect or red flags appear

Screening Questions

•Patients should be interviewed 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 of funds to a caretaker

Nursing Responsibilities

•Mandated Reporting

•Any person having reasonable cause 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 nurse is to assure the safety of the older adult.

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

•Adult Protective Services reporting

Physical Abuse

Mrs. K, 84, has bruises in different stages of healing on her upper arms. Her son says she 'falls a lot.'

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 in front 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.

Self-neglect

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