Scope and Nature of Elder Mistreatment Module 3 Nurse Responses to Elder Mistreatment An IAFN Education Course

2 Case Analysis: Mrs. Kennedy 1. What are the issues in this case? 2. What do you currently know to help you address these issues? 3. What do you think you still need to know to respond to these issues?

Intentional acts by a caregiver or “trusted other” that cause harm or serious risk of harm to a vulnerable older adult and/or omission of acts wherein a caregiver or trusted other fails to meet basic needs of a vulnerable older adult Impairments can increase vulnerability to mistreatment Typically not one-time event 3 Elder Mistreatment

Types Suspected and Clues Emotional/psychological abuse? Neglect? Physical abuse? Sexual abuse? Abandonment? Financial exploitation? Violation of personal rights? 4

Clues? It can sometimes be difficult to distinguish elder mistreatment (EM) from problems that occur due to progression of aging, disease or chronic conditions and/or medication changes 5

6 Module 3 Topics Incidence, prevalence and risk factors of EM Signs of possible EM Common age, disease-, chronic condition- and medication-related changes that may mimic possible EM Family violence in later life, elder mistreatment in institutional settings and elder sexual abuse

7 Prevalence and Misconceptions What misconceptions about extent and nature of EM have nurses seen held as truth in their work settings or in their communities? How do these misconceptions impact interactions between patients and health care providers and subsequent interventions?

8 Prevalence Estimates 1 to 2 million Americans age to 10% of 65+ population Drawn from National Center on Elder Abuse, Elder Abuse Prevalence and Incidence

Additional Data… Rates of reporting Who are victims? Who are perpetrators? Risk factors o Caregiver stress? Intentionality of mistreatment? 9

One Sign Doesn’t Indicate EM A pattern of physical, behavioral and environmental signs point to a need to question whether mistreatment occurred National Center on Elder Abuse, Frequently asked questions Center for Substance Abuse Prevention, Out of the shadows:, Uncovering substance use and elder abuse,

Signs of EM Emotional/psychological abuse Neglect Physical abuse Sexual abuse Abandonment Financial exploitation Violation of personal rights 11

Health Changes and Functional Effects in Older Adults Skin Cardiovascular system Musculoskeletal system Neurological System Sensory System Gastrointestinal system Hormonal system Also, medication effects… 12

Focus on… Family violence in later life Institutional elder mistreatment Elder sexual abuse 13

Questions to Consider… For each case, what is alleged perpetrator’s relationship with victim? Where did EM occur (community or institution)? What types of mistreatment do you think occurred? How does perpetrator use victim’s vulnerabilities to control or exploit? Is victim able to reach out for help? What are challenges that nurses might face when presented with these different types of cases? 14

Abuse in Later Life Wheel 15 National Clearinghouse on Abuse in Later Life, 2006 Based on the Power and Control/Equality wheels developed by the Domestic Violence Intervention Project, Duluth, MN

Pattern of Controlling Tactics Wheel shows pattern of controlling behaviors that make it very difficult for victim to leave abusive relationship Perpetrators often use victims’ vulnerabilities to maintain control National Clearinghouse on Abuse in Later Life, Interactive training exercises on domestic abuse in later life,

Who are the Perpetrators? Spouse/intimate partner o Domestic violence grown old o New life partnership/marriage in later life o Late onset abuse Adult child, grandchild, or other family member (e.g., sibling) B. Brandl & D. Horan, Domestic violence in later life: An overview for health care providers, Women and Health,

Health Care Providers Domestic violence at any age may be criminal Assist victims in making their own decisions Dangerous to believe abuser accounts Don’t medicate patients rather than identify abuse Make safety/support options available 18

Health Care Providers Don’t blame victim or collude with batterer Don’t minimize potential danger to patients or health care providers 19

Family Violence in Later Life Strangulation/suffocation Homicide-suicide 20

Institutional EM Research suggests that vulnerable individuals living in licensed nursing homes and other residential care facilities, on any given day, are at much higher risk for abuse and neglect than older persons who live at home C. Hawes, Elder abuse in residential long-term care settings: What is known and what information is needed?, in R. Bonnie & R. Wallace (Eds.), Elder mistreatment, abuse, neglect and exploitation in an aging America,

One study of 80 residents in 23 nursing homes in Georgia 44 % reported being abused 48 % reported being treated roughly 38 % reported seeing other residents being abused 44 % reported seeing other residents being treated roughly 95 % reported they had been neglected or witnessed other residents being neglected Atlanta Long-Term Care Ombudsman Program, The silenced voice speaks out: A study of abuse and neglect of nursing home residents,

Flags: Resident Examples Signs/symptoms out of proportion to current problem/resident’s history Unexplained injuries or injuries from improbable causes Behavior changes after resident has visitors or a particular staff member is in room (crying, depression, etc.) L. Phillips, Issues in Identification of Mistreated Elders (Slide presentation) 23

Offenders: Institutional Settings Staff Family of residents Other visitors to facility 24

Underreporting Health care professionals Residents and family Ombudsmen 25

Sexual Abuse Continuum can include: o - Forcing victim to view pornography or listen to explicit sexual accounts or comments o -Coerced nudity/sexually explicit photographing o -Sexualized kissing and fondling o -Oral-genital contact/digital penetration o -Vaginal rape/anal rape o -Rape by objects/attacking victim’s genitals with blows or weapons o K. Vierthaler, Addressing Elder Sexual Abuse: Developing a Community Response,

Sexual Abuse How do older persons react to/cope with sexual abuse? o Emotionally o Physically 27

Offenders: Elder Sexual Abuse Vast majority are male Husband/intimate partner with domestic violence history Adult son or grandson Caregiver in home Caregiver in facility 28

Underreporting What are barriers to self-reporting sexual abuse for older persons, in addition to those discussed already? Barrier or healthcare providers to reporting elder sexual abuse? 29

Closing Assessment What one important thing did you learn in this module that you can apply in your practice setting? 30