Violence and Elder Mistreatment

10Lecture Note PowerPoint Presentation

LEARNING OUTCOME 1Discuss current trends in elder mistreatment,

including incidence and prevalence.

ELDER ABUSE IS The least addressed, U underreported Under-recognized crime Only 1 out of every 14 cases of abuse in the

domestic settings are reported to authorities.

ACCORDING TO THE 2004 SURVEY OF STATE ADULT PROTECTIVE SERVICES (APS) 19.7 % increase in total reported elder

abuse and neglect and a 15.6% increase in proven elder abuse and neglect since the 2000 survey

Majority of abuse and neglect (89.3%) occurred in the domestic setting (-elder's home -caregiver's home)

TABLE 10-2ELDER MISTREATMENT CHARACTERISTICS

ONE SURVEY OF NURSING HOME STAFF MEMBERS REVEALED THAT 36% had witnessed at least one incident of

physical abuse by another staff member in the previous year

81% had observed at least on incident of psychological abuse

THE PANEL TO REVIEW RISK AND PREVALENCE OF ELDER ABUSE AND NEGLECT (2002) Defined abuse types

Physical abuse Sexual abuse Emotional / psychological abuse Neglect Abandonment Financial / material exploitation Self-neglect Sexual abuse

THREE BASIC CATEGORIES OF ELDER MISTREATMENT: Domestic mistreatment generally occurs within

the older adult’s home by a significant other Institutional mistreatment occurs when an older

adult has a contractual arrangement and suffers abuse

Elder abuse can occur in a domestic setting, such as one’s home or the home of a caregiver, or in an institutional setting, such as a nursing home, board and care home, or other health care or residential facility.

THREE BASIC CATEGORIES OF ELDER MISTREATMENT: Self-neglect occurs when older adults who

are mentally competent enough to understand the consequences of their own decisions engage in behaviors that threaten their own safety.

LEARNING OUTCOME 2Review key reasons why elder mistreatment occurs.

COMMON CHARACTERISTICS OF THE ABUSER Likely to be male History of substance abuse, mental illness History of violence Lack a strong social support network Dependent on the care recipient for financial

or other needs

THEORIES OF THE ETIOLOGY OF ELDER ABUSE “Psychopathology of the abuser”

Caregivers who have preexisting conditions that impair their capacity to give appropriate care

“Transgenerational violence” Part of the family violence continuum

THEORIES OF THE ETIOLOGY OF ELDER ABUSE “Situational theory,” also know as “caregiver

stress Care burdens outweigh the caregiver’s capacity

“Isolation theory” Mistreatment is prompted by a dwindling social

network

LEARNING OUTCOME 3Conduct clinical assessment for screening and

detection of elder mistreatment.

CHARACTERISTICS OF VICTIMS OF ABUSE Older than age 75 years Female Live with abusers Suffer from chronic, debilitating illnesses

impairing function creating heavy care needs

CAREGIVERS FOR OLDER ADULTS SHOULD BE ASSESSED For caregiver stress For substance abuse For a history of psychopathology Using the Caregiver Strain Index (CSI), which

may aid in assessment The Caregiver Strain Index (CSI) is a tool that can be

used to quickly identify families with potential caregiving concerns. It is a 13-question tool that measures strain related to care provision. There is at least one item for each of the following major domains: Employment, Financial, Physical, Social and Time.

SEPARATE INTERVIEWS SHOULD BE CONDUCTED FOR THE CAREGIVER AND THE PATIENT Inconsistencies might increase the suspicion

of abuse

ASSESSMENT SHOULD INCLUDE Awareness of differences based on culture

perceptions of mistreatment An interdisciplinary team A nonjudgmental environment

POTENTIAL SIGNS OF MISTREATMENT Physical abuse Unexplained signs of injury such as bruises,

welts, or scars, especially if they appear symmetrically on two side of the body

Broken bones, sprains, or dislocations Report of drug overdose or apparent failure

to take medication regularly (a prescription has more remaining than it should)

Broken eyeglasses or frames Signs of being restrained, such as rope marks

on wrists Caregiver’s refusal to allow you to see the

elder alone

Emotional abuse In addition to the general signs above,

indications of emotional elder abuse include Threatening, belittling (االستهانة), or

controlling caregiver behavior Behavior from the elder that mimic

dementia, such as rocking (الهّز), sucking, or mumbling (غمغم) to oneself

NEGLECT BY CAREGIVERS OR SELF-NEGLECT Unusual weight loss, malnutrition, dehydration Untreated physical problems, such as bed sores Unsanitary living conditions: dirt, bugs, soiled

bedding and clothes Being dirty or unbathed Unsuitable clothing or covering for the weather Unsafe living conditions (no heat or running

water; faulty electrical wiring, other fire hazards)

Desertion of the elder at a public place

Financial exploitation Significant withdrawals from the elder’s accounts Sudden changes in the elder’s financial condition Items or cash missing from the senior’s household Suspicious changes in wills, power of attorney, titles,

and policies Addition of names to the senior’s signature card Unpaid bills or lack of medical care, although the elder

has enough money to pay for them Financial activity the senior couldn’t have done, such as

an ATM withdrawal when the account holder is bedridden

Unnecessary services, goods, or subscriptions

Sexual abuse Bruises around breasts or genitals Unexplained venereal disease or genital infections Unexplained vaginal or anal bleeding Torn, stained, or bloody underclothing

TESTING TO CONFIRM ABUSE Laboratory findings that supporting the

presence of dehydration and malnutrition without medical causes.

Papanicolaou smear Cultures for sexually transmitted disease The Papanicolaou test (also called Pap smear, Pap

test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix

TESTING TO CONFIRM ABUSE Radiological testing

Have students perform a complete history, including assessment for mistreatment of a patient.

Have students administer a caregiver stress inventory.

LEARNING OUTCOME 4Create a nursing care plan for the ongoing well-

being of older patients.

NURSES SHOULD PLAN FOR EDUCATIONAL INTERVENTIONS FOR THE CAREGIVER Disease management Aging changes Maximizing healthcare services Respite ( , أمهل, أرجأ services(مد Behavioral management Caregiver support groups

LEARNING OUTCOME 5Summarize key resources for elder mistreatment

information.

ELDER MISTREATMENT RESOURCES National Elder Abuse Study National Center On Elder Abuse Worldbridges Association For The Protection Of The Elderly National Center For Victims Of Crime American Bar Association

ELDER MISTREATMENT RESOURCES National Committee for the Prevention of

Elder Abuse Elder Justice Center Elder Abuse in Long-Term Care Facilities

Website