Ethics and Elder Abuse

What are the AOTA (2025) core values?

- Altruism

- Equality

- Freedom

- Justice

- Dignity

- Truth

- Prudence

- Advocacy

What are the steps to ethical decision-making?

1. Gather information

2. Identify the type of ethical problem

3. Use ethical theories or approaches to analyze the problems

4. Explore alternatives

5. Complete the action

6. Evaluate the process and outcome

What is the prevalence and incidence of elder abuse?

- 1 in 60 people, 60+ years old, experienced some form of abuse during the past year

- Rates of abuse are higher in institutions such as nursing homes and long-term care facilities

- 64% of staff members admitted to committing some form of abuse or neglect

- Rates have increased during the COVID-19 pandemic

- Elder abuse is expected to increase

Who are potential involved parties when it comes to elder abuse?

- Older adult/elder

- Victim

- Perpetrator/offender

- Current or former legal spouse

- Other intimate partners

- Child

- Other family member/relative

- Caregiver (informal/formal)

- Care custodian

- Legal guardian

- Other person in a position of power or trust

- Friend

- Acquaintance

- Stranger

How is physical abuse defined?

The intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death

What are examples of physical abse?

- Striking

- Burning

- Choking

- Shaking

- Inappropriate use of medications and physical restraints

- Force feeding

How is sexual abuse defined?

- Forced and/or unwanted sexual interaction of any kind with an older adult

- Also considered if acts are committed against an incapacitated person who is not competent to give informed approval

What are examples of sexual abuse?

- Unwanted intentional touching through clothing

- Unwarranted, intrusive, and/or painful procedures in caring for genitals or rectal area

What is emotional/psychological abuse?

Verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress, that is perpetrated by a caregiver or other person who stands in a trust relationship to the elder

What are examples of emotional/psychological abuse?

- Humiliation/disrespect

- Threats

- Harassment

- Isolation/coercive control

- Infantilization

What is infantilization?

The act of treating an adult as if he or she were an infant or young adult

How is neglect defined?

- Failure by a caregiver or other person in a trusting relationship to protect an elder from harm

- Failure to meet needs for essential medical care, nutrition, hydration, hygiene, clothing, basic ADLs or shelter, which results in a serious risk of compromised health and/or safety, relative to age, health status, and cultural norms

- Can also be self-neglect

What can self-neglect include?

- Persistent inattention to personal hygiene and/or environment

- Inability of a person to understand the consequences of their actions or inactions, which may lead to self endangerment

- Excludes situations in which a mentally competent elder makes a conscious decision to engage in acts that threaten their safety

How is financial abuse/exploitation defined?

The illegal, unauthorized, or improper use of an older individual's resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the individual

What are examples of financial abuse/exploitation?

- Occupying, selling, or transferring property against an older adult's wishes or best interest

- Unauthorized credit or debit card use

- Creating or changing insurance policies

- Changing wills, trusts, or inheritance arrangements

What are other related phenomena to elder abuse?

- Abandonment

- Abduction

- Criminal record identity theft

- Medical abuse

- Resident-to-resident abuse/aggression

- Self-neglect

- Violation of rights

What problems are risk factors for elder abuse?

- Physical health

- Cognitive ability (ex. Dementia)

- Mental health

- Substance use

- Dependency

- Stress and coping

- Attitudes

- Victimization

- Previous abuse

- Relationships

- Environment/Living arrangements

What are some physical signs for elder abuse according to the National Center of Elder Abuse?

- Dehydration or unusual weight loss

- Missing daily living aids

- Unexplained injuries bruises, cuts, or sores

- Unsanitary living conditions and poor hygiene

- Unattended medical needs

What are some emotional/behavioral signs for elder abuse according to the National Center of Elder Abuse?

- Increased fear or anxiety

- Isolation from friends or family

- Unusual changes in behavior or sleep

- Withdrawal from normal activities

What areas should OTs pay attention to during screening and assessment?

- Health issues

- Caregiver attitudes/problems

- Financial issues

- Support systems for caregiver and/or client

- Observations/perception

What should you know about reporting elder abuse in Texas?

- Elder abuse is considered a felony in Texas (first or second degree)

- Any person suspecting abuse and not reporting it can be held liable for a misdemeanor or state jail felony

What is Adult Protective Services (APS)?

- Provides a variety of assistance to adults as young as 18 with a disability and to those 65 and older

- Investigates reports of abuse, neglect, and exploitation

- Conducts investigations and provides services when adults live in the community

- Educates the public about the prevention of elder abuse

- APS services are equitable

What are priorities for healthcare providers?

1. Combat ageism

2. Educate individuals/organizations

3. Generate more and better data to raise awareness of the problem

4. Advocate for change