CRISIS, VIOLENCE, ELDER ABUSE, & NEGLECT

violence

“Intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in, or has a high likelihood of, resulting in injury, death, psychological harm, maldevelopment, or deprivation.” (WHO)

• Many different forms at all social-ecological levels

crisis

• an event that precipitates an emotional response that cannot be managed with normal coping mechanisms ⟶ emotionally overwhelming

• Struggle to restore equilibrium via coping

Maturational/Developmental/Internal Crisis

A period of disruption that occurs at a transition point during normal growth and development

• Examples: marriage, retirement, puberty, moving

Situational/External Crisis

An unexpected period of upset in normalcy that jeopardizes an individual’s physical and psychological well-being

• Examples: divorce, job loss, serious illness/injury to self or a loved one, bankruptcy

Traumatic/Adventitious/Social Crisis

Unexpected, overwhelming, and unusual events that occur to an individual or community and result in death, destruction, injury, or sacrifice

• Examples: natural or human-made disasters, war, violent

events that precipitate crises in acute care settings

• Fear, uncertainty, or frustration regarding diagnosis/prognosis

• Pain/physical discomfort

• NPO status

• Overstimulation from monitors/roommates/staff/lights

• Loss of autonomy over body, schedule, environment

• Concerns about obligations outside of the hospital

intervention before aggression and violence are present

• Active listening: listen to the problem, acknowledge the underlying emotion

• Collaborate to maximize patient’s sense of safety/address material issues (i.e. Hi, doc, do we really need to be NPO?)

Do NOT overpromise

• Recognize/promote internal coping strategies

• Teach new coping strategies

SOCIO-ECOLOGICAL MODEL

Interplay of individual, interpersonal, communal, and societal/institutional factors that contribute to who perpetuates violence and influence who is protected from or vulnerable to violence

Individual factors in Socio-Ecological model

Personal exposure to violence, coping/problem-solving skills, substance use, untreated mental illness, income/material resources, age

Relational factors in Socio-Ecological model

Positive/caring social support systems (friends, family) vs. social isolation

Communal factors in Socio-Ecological model

Neighborly support/cohesion, behavioral norms, community resources (i.e. libraries, playgrounds, green spaces, community centers)

Societal factors in Socio-Ecological model

Inequity (distribution of material resources and opportunities), social norms (discrimination, aggression, gender roles), policing and legal protections, violence in media

SPECIFIC TYPES OF VIOLENCE

• Workplace violence

• Intimate partner violence

• Child abuse

• Commericial sexual exploitation/human trafficking

• Gang violence

• Self-directed violence

• Elder abuse and neglect

Physical

Sexual

Financial

Neglect

Emotional/psychological

WORKPLACE VIOLENCE

“Any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.” (OSHA)

• Nurses experience physical assaults at a rate of 13.2 per 100 and non-physical violent events at a rate of 38.8 per 100 annually (CDC)

Three times greater than any other occupation

And it’s underreported!!!!!!

OCCUPATIONAL HAZARDS

Work-related traumatic stress

• Primary traumatic stress: Direct exposure to a traumatizing event (i.e. a workplace assault)

• Secondary traumatic stress: Caused by hearing about, witnessing, or providing care for someone who has experienced trauma⟶indirect exposure

Compassion fatigue: A psychological state of exhaustion impacting an individual’s ability to notice, care about, and respond to others’ distress caused by secondary trauma

Burnout: A psychological state of exhaustion impacting an individual’s ability to notice, care about, and respond to others’ distress caused by chronic abuse of labor

• May also result from repeated moral injury/moral distress

Addressing basic needs for occupational hazards

• Sleep, food, hygiene, movement, sunshine, social connection, fun/joy

Important both at work and home

• Avoid overworking when possible

Say no to overtime!!!!! (Management’s staffing failures are not your responsibility)

• Consistent shifts when possible

• Helping our friends/coworkers when we notice these areas slipping

Make a meal for them, go on a walk outside with them, provide a safe space for them to express their needs/feelings

Professional support for occupational hazards

• Trauma therapists

• Psychiatric care

Demanding institutional support when injured (physically or psychologically)

• Report violence to management

• Family and Medical Leave Act (FMLA), Workers’ Compensation

• Union support

ELDER/OLDER PERSON ABUSE

"Intentional act or failure to act that causes or creates risk of harm to an older adult, a person aged 60 or older.” (CDC)

Experienced by 1 in 10 older adults who live at home

Half of these individuals have dementia

Older adults who are dependent on others, have limited social support, and functional impairments/disabilities are most at risk

• Perpetrators are most often spouses or adult children

ELDER/OLDER PERSON Neglect

• Failure to provide necessary care such as food, hygiene, and medication, resulting in harm or risk

• May be intentional or passive/unintentional

Can be perpetuated by oneself!!!!: self neglect

If the perpetrator is aware, may be willful deprivation or a result of being under resourced

• Most reported form of elder abuse

• Can present as lack of basic hygiene and/or medical aids, unexplained weight loss, pressure injuries

ELDER/OLDER PERSON Financial exploitation

• Misuse or theft of an older adult’s money, property, or assets

• Older adults may be vulnerable to fraud and scams

• Second most reported form of elder abuse

• Can present as large bank withdrawals, unusual ATM or credit card activity, unpaid bills

ELDER/OLDER PERSON Physical abuse

• Inflicting physical pain or injury

Hitting, pushing, pinching, restraining, burning

• Can present as unexplained bruises, burns, cuts, or scars (especially in varied stages of healing) as well as behavioral changes

ELDER/OLDER PERSON Emotional/psychological abuse

• Behavior that causes mental anguish including yelling, swearing, insulting, humiliating, and isolating the individual

• Can present as anxiety, social withdrawal, behavioral changes

ELDER/OLDER PERSON Sexual abuse

• Non-consenual sexual contact of any kind

• Can present as unexplained vaginal bleeding, anal bleeding, STIs, vaginal infections, new incontinence, behavioral changes

ELDER ABUSE AND MISTREATMENT Screening

• Thorough physical assessment and history

• Elder Abuse Suspicion Index

• Detecting caregiver stress early and intervening

Respite care

Community supports

MANDATED REPORTING

Laws and procedures vary by state/municipality, however, regardless of where you are, you must report suspicions of abuse to an older adult to your local authority

• Not doing so in PA may result in criminal liability

Confidential verbal report followed by a confidential written report

Report elder abuse in Philadelphia (Philadelphia Corporation for Aging, PCA)

• Also applies to adults aged 18 to 59 who are disabled