Chapter 23: Abuse and Mistreatment of Older Adults

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.

Learning Objectives (cont’d) 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.

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.

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

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? force you to have sex? destroy your belongings? act excessively jealous and possessive? control where you go or what you do? keep you from seeing your friends or family? limit your access to money, the phone, or the car? constantly check up on you?

Case Studies 23-1: 65-year-old woman has bruises and small burns; belligerent son 23-2: 80-year-old neighbor with Alzheimer’s 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

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)

Characteristics of Victims (cont’d) 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

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

Characteristics of Perpetrators of Elder Abuse (cont’d) Overwhelmed caregiver Poor coping skills History of family violence Maladaptive personality traits Other social, psychological or emotional problems of Elder Mistreatment or Abuse

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.

Prevention of Abuse or Mistreatment Suggestions for older adults to reduce the potential for abuse (T.23-4, P. 820) Stay active—keep 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.

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

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

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?id=34018&search=elder+abuse#Section405

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

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.