1. Elderly Abuse Presented by Dr. Soad H. Abd El Hamid El Tantawy Lecturer of Gerontological Nursing Faculty of Nursing Mansoura University

2. Elderly Abuse  Outline: Introduction Definition of elder abuse Incidence of elder abuse Types of elder abuse Risk factors for elder abuse Preventing of elder abuse Health education to prevent elder abuse

3. Introduction Abuse and neglect of the elderly tends to regarded as relatively recent phenomena. Elder abuse is alarming social problem, it is a difficult, complex and sensitive area. It involve interpersonal relationships and difficulties in relationships which may have lasted for years

4. Definition of elderly abuse Elderly abuse was defined as an act or omission which results in harm or threatened harm to the health or welfare of an elderly person.

5. Incidence of elderly abuse Abuse in institutional settings is difficult to measure, yet is thought to exceed that in community settings. In the USA,10% of nursing staff in institutional settings admitted committing physical and 40% psychological abuse against residents.

6. Types of elder abuse  Physical abuse  Sexual abuse  Neglect ( intentional or unintentional)  Emotional or Psychological abuse  Material abuse  Financial exploitation.  Domestic abuse  Self-neglect

7. Physical abuse Physical abuse means at least one act of physical violence against the elderly

8. Forms of physical abuse  Direct beatings  Hitting  Slapping  Cutting  Burning  shaking  Physical coercion  Unreasonable physical restraints  Maltreatment of medical conditions  Sexual assault  Prolonged deprivation of food or water.

9. Sings of physical abuse  Include bruises  Broken bones, sprains, or dislocations  Report of drug overdose or apparent failure to take medication regularly  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

10. Sexual abuse Sexual abuse is unwanted sexual contact with an elder including touching, sexual assault, and rape. Signs of sexual abuse  Signs Bruises around breasts or genitals  Unexplained venereal disease or genital infections  Unexplained vaginal or anal bleeding  Torn, stained, or bloody underclothing

11. Neglect The failure of a designated caregiver to meet the needs of an elderly person, and withholding of physical, material, or emotional necessities of physical and mental health, whether intentionally or unintentionally. This includes failure to assist in personal hygiene or the provision of clothing for an elder, failure to provide medical care for the physical and mental health needs of an elder, and failure to protect an elder from health and safety hazards.

12. Signs of neglect  Malnutrition, dehydration  Lack of personal care  Inadequate heating  Unclean clothes or bedding  Lack of needed medications, eye glasses, hearing aids, or dentures  Contractures, decubitus ulcers, wasting and muscle atrophy

13. Psychological abuse or emotional abuse  Psychological abuse is more difficult to define and operationalize.  Usually defined as an act carried out with the intention of causing emotional pain or distress.  Psychological abuse often accompanies physical abuse. Emotional abusers can use verbal and non verbal to inflict elder damage.

14. Verbal forms of emotional elder abuse  Intimidation through yelling or threats  Name –calling  Harsh orders  Humiliation and ridicule  Habitual blaming or scapegoat Nonverbal psychological elder abuse can take the form of:-  Ignoring the elderly person  Isolating an elder from friends or activities  Terrorizing or menacing the elderly person  Forbid visitors and isolate form sympathetic friend

15. Signs of psychological abuse  Anxiety (mild to severe).  Depression, hopelessness, helplessness, thoughts of suicide  Confusion, disorientation  Trembling, lack of eye contact  Agitation

16. Financial or material abuse Any theft or misuse of an elderly money or property by a person in a position of trust with an elder constitutes financial abuse. Material abuse involves the misappropriation or misuse of funds or possessions. Forms of financial abuse :-  Misuse an elder’s personal checks, credit cards, or accounts  Steal cash, income checks, or household goods  Forge the elder’s signature

17. Domestic abuse Refer to forms of maltreatment by someone who has a special relationship with the elder such as family member or caregiver.

18. Institutional elder abuse Refers to abuse that occur in residential institutions such as nursing facilities usually by someone who is paid caregiver, such as nursing facility staff member. Residents at the greatest risk for institutional abuse or neglect includes resident with dementia, resident who seldom have visitors.

19. Risk factors for elderly abuse I. factor related to the abused elderly:  The intensity of an elderly person’s illness or dementia  Social isolation  The elder’s role, at an earlier time, as an abusive parent or spouse  A history of domestic violence in the home  Dependency

20. II. factors related to the abuser:  Inability to cope with stress (lack of resilience)  Depression, which is common among caregivers  Lack of support from other potential caregivers  The caregiver’s perception that taking care of the elder is burdensome and without psychological reward  Substance abuse

21. Preventing elder abuse and neglect Preventing elder abuse means doing three things:  Listening to elderly and their caregivers  Intervening when you suspect elder abuse  Educating others about how to recognize and report elder abuse

22. Reporting elder abuse If you are an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust.

23. Health education to prevent elder abuse Instructions to a caregiver:- If the caregiver overwhelmed by the demands of caring for an elder, instruct (he /she ) to do the following:  Request help, from friends, relatives, or local respite care agencies, so you can take a break, if only for a couple of hours.  Find an adult day care program.  Stay healthy and get medical care for yourself when necessary.  Adopt stress reduction practices.  Seek counseling for depression, which can lead to elder abuse.  Find a support group for caregivers of the elderly.  If caregiver is having a problems with drug or alcohol abuse, get help.

24. Instructions to a concerned friend or family member  Watch for warning signs that might indicate elder abuse. If you suspect abuse, report it.  Take a look at the elder’s medications. Does the amount in the vial matched with the date of the prescription?  Watch for possible financial abuse. Ask the elder if he may scan bank accounts and credit card statements for unauthorized transactions.  Call and visit as often as you can. Help the elder consider you a trusted confidante.  Offer to stay with the elder so the caregiver can have a break — on a regular basis, if you can.

25. Instructions to the elderly  Make sure your financial and legal affairs are in order. If they aren’t, enlist professional help to get them in order, with the assistance of a trusted friend or relative if necessary.  Keep in touch with family and friends and avoid becoming isolated, which increases your vulnerability to elder abuse.  If you are unhappy with the care you’re receiving, whether it’s in your own home or in a care facility, speak up. Tell someone you trust and ask that person to report the abuse or neglect.

26. Thank you