Chapter 23: Abuse and Mistreatment of Older Adults

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Chapter 23 Abuse and Mistreatment of Older
Adults
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Learning Objectives

• Distinguish between elder abuse and self-neglect.
• Describe several categories of the mistreatment
  of older adults.
• Recognize risk factors for elder abuse.
• Identify characteristics of perpetrators of
  mistreatment.

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Learning Objectives (contd)

• Recognize signs that an older adult is being
  mistreated.
• Discuss strategies to prevent the mistreatment of
  older adults.
• Synthesize interventions in various cases of
  abuse.

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Background

• Elder abuse is a single, or repeated act, or
  lack of appropriate action, occurring within any
  relationship where there is an expectation of
  trust which causes harm or distress to an older
  person or the mistreatment of an older adult
  that threatens his or her health or safety (WHO)
• National Center on Elder Abuse (2010) 1 in 10
  older adults experience some form of abuse but,
  of those, less than 1 in 5 report it. under
  recognized problem.

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Types of Elder Abuse

• Psychological or emotional neglect (P. 812)
• Psychological or emotional abuse
• Violation of personal rights
• Financial abuse
• Physical neglect
• Self-neglect
• Direct Physical Abuse

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• Emotional Abuse Test
• Do you...
• feel afraid of your partner much of the time?
• avoid certain topics out of fear of angering your
  partner?
• feel that you can't do anything right for your
  partner?
• believe that you deserve to be hurt or
  mistreated?
• wonder if you're the one who is crazy?
• feel emotionally numb or helpless?
• Does your partner...
• humiliate or yell at you?
• criticize you and put you down?
• treat you so badly that you're embarrassed for
  your friends or family to see?
• ignore or put down your opinions or
  accomplishments?
• blame you for their own abusive behavior?
• see you as property or a sex object, rather than
  as a person?
• have a bad and unpredictable temper?
• hurt you, or threaten to hurt or kill you?
• threaten to take your children away or harm them?
• threaten to commit suicide if you leave?

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Case Studies

• 23-1 65-year-old woman has bruises and small
  burns belligerent son
• 23-2 80-year-old neighbor with Alzheimers
• 23-3 Older male neighbor giving money to and
  afraid of young couple that is doing work for him
• 23-4 Brother borrowing money from elderly
  parents
• 23-5 Woman says she was in car accident
• 23-6 81-year-old malnourished man with loud wife

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Characteristics of Victims (T. 23-1)

• Lives alone or with another person (shared living
  arrangement)
• Elderly (with financial abuse, between 80 and 89
  years of age)
• Poor or of limited means
• Physical disability
• Significant functional or cognitive limitations
  (such as memory loss or dementia)

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Characteristics of Victims (contd)

• Impaired psychosocial health
• Female
• Socially isolated, depressed, or lacking social
  support
• Substance abuse issues
• Dependent on others for care or assistance
• Verbally or physically combative

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Characteristics of Perpetrators of Elder Abuse
(T. 23-2)

• Substance abuse, especially alcoholism
• Increased stress
• Lack of social support
• Depression, anxiety, or other mental health
  issues
• Lack of knowledge or training about caring for an
  older adult

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Characteristics of Perpetrators of Elder Abuse
(contd)

• Overwhelmed caregiver
• Poor coping skills
• History of family violence
• Maladaptive personality traits
• Other social, psychological or emotional problems
  of Elder Mistreatment or Abuse

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Prevention of Abuse or Mistreatment

• Nursing interventions in the prevention of elder
  abuse (Table 23-3)

Establish a trusting relationship with the elder. Know about community resources and be able to appropriately refer people for help. Strengthen social supports and networking of older adults. Encourage regular respite for the caregiver. Identify and refer to appropriate caregiver support groups. Identify caregivers who are at high risk to be abusers and target interventions to prevent stress from caregiver burden. Interview the patient and family or caregiver to find out normal patterns for stress management. Identify possible scenarios and facilitate strategies to cope with those. Observe family interactions, dynamics, and body language. Encourage single older adults to remain involved and connected to society. Be aware of risk factors and contributing factors. Perform thorough physical assessments and carefully document findings, including appearance, nutritional state, skin condition, mental attitude and awareness, and need for aids to enhance sensory perception. If abuse is suspected, interview caregivers and other possible informants separately to confirm or refute suspicions. Know the reporting laws for your own state. Encourage the older person to let a trusted person know where valuable papers are stored.
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Prevention of Abuse or Mistreatment

• Suggestions for older adults to reduce the
  potential for abuse (T.23-4, P. 820)
• Stay activekeep involved in social activities.
• Have access to a telephone and use of it in
  private.
• Store important contact information in two
  separate places (e.g. in a cellphone and a phone
  directory).
• Maintain contact with family and friends.
• Know your financial situation and when to expect
  deposits and automatic withdrawals.
• Have a secure, private place where your important
  files are kept.
• Have a family members or friends visit regularly
  and unannounced.
• Have an emergency safety plan if you are
  concerned about potential abuse.
• Let a trusted person know where you are going if
  you are traveling or visiting out of town.

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Assessment and Screening (1)
Recognizing the signs and symptoms of elder abuse
or mistreatment (Table 23-5, p. 821)

• Poor hygiene
• Unexplained bruises of different stages of
  healing
• Broken bones
• Malnutrition
• Dehydration
• Depressed mood
• Withdrawn, fearful, agitation, cowering
• Missing prosthetic devices denture, glasses,

• Person is brought for treatment by someone other
  than the caregiver
• Elder expresses feelings of hopelessness,
  helplessness
• Elder expresses ambivalent feelings toward family
• History of treatment in a variety of facilities
  and by different physicians

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Assessment and Screening (2)

• - Delays in seeking treatment
• - Contradictory explanations by the caregiver and
  the patient
• Bruises, burns, welts, lacerations, restraint
  marks
• - Decubitus ulcers or poor hygiene
• - Signs of medication misuse
• - Pattern of missed or cancelled appointments
• - Frequent changes in healthcare providers
• - Discharge, bleeding or pain in rectum or vagina
  or sexually
• transmitted disease

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Assessment and Screening

• Three Rs in detecting and reporting elderly
  abuse Recognize, Respond, Report (T. 23-6, P.
  823)
• The Role of the gerontological nurse in reporting
  elder abuse
• Clinical practice guidelines Elder abuse
  prevention program is available at
  http//www.guideline.gov/content.aspx?id34018sea
  rchelderabuseSection405

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Nursing intervention

• Alone (not) let the victim to be aware that
  he/she is not alone
• Believe
• Confidentiality
• Documentation
• Education
• Safety

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Summary

• Elder abuse occurs across many socioeconomics
  groups and settings.
• All gerontological nurses should be educated in
  the prevention, detection, and treatment of elder
  abuse.
• Better mechanisms are needed for reporting abuse
  and neglect of older adults.