1. Elder Mistreatment and Abuse Tammy Garcia RN Ferris State University Nursing 314-Spring 2012

2. Background “According to the best available estimates, between one and two million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection (Hartford Institute for Geriatric Nursing, 2011).”

3. Elder Mistreatment and Abuse Types of abuse and neglect ◦Physical-when a person makes physical contact with the intent to do harm ◦Emotional/Psychological-when a person causes pain or fear through verbal or nonverbal means ◦Sexual abuse-sexual contact without consent or with someone unable to provide consent ◦Financial abuse/exploitation-use of another's resources without authorization or for unauthorized reasons

4. Types of abuse and neglect ◦Caregiver neglect-failure to provide for the needs-safety, personal care, and comfort-of someone under one’s care ◦Self neglect-failure to take care of oneself in personal, living, safety needs

5. Risk Factors Caregiver stress Childhood trauma Cultural sanctions against seeking help to care for elderly Delirium Dependency of abuser on victim for housing and finances Dependency of elder on caretaker for assistance with activities Family history of violence Financial strain Increased age Isolation of the caregiver or victim Lack of close family ties Mental illness in family members/caretakers New, worsening, or prolonged depression New, worsening, or prolonged physical impairment Poverty/lack of financial resources Progressing dementia Shared living arrangement Substance abuse in family members/caretakers Unsafe living situation ◦(Hartford Institute for Geriatric Nursing, 2011)

6. Assessment and Intervention of Elder Abuse and Mistreatment Interview the patient and caregiver separately ◦Assess for:  Physical abuse ◦ Has anyone ever tried to hurt you? ◦ Has anyone touched you without your permission? ◦ Is there anyone your afraid of? ◦ Any recent injuries? ◦ Restrained without permission? ◦ Is there physical evidence of abuse?  If present-dig deeper. Any other injuries like this? How did this happen? Did someone do this to you?

7. ◦Emotional/psychological abuse  Have you been threatened? Verbally, physically?  Is there stress and violence happening where you live?  Who provides care for you?  Are you afraid of anyone?  Any history of abuse in the background of caregivers?

8. Sexual abuse ◦Have you ever been touched without permission? ◦Does anyone in your house abuse drugs or alcohol? ◦Have you ever been made to do things you do not want to?

9. Financial abuse/exploitation ◦Who pays the bills? ◦Does anyone have access to your bank accounts? ◦Who has power of attorney for you? ◦Have you ever had to sign paperwork you did not understand or were forced to sign? ◦Has anyone stolen from you?

10. Caregiver Neglect ◦Are you left alone frequently? ◦Does the person/persons caring for you provide for your needs?

11. Self Neglect ◦Do you take your medications as ordered? ◦How frequently do you bathe? ◦Do you eat and drink enough? ◦Have enough clothing?

12. Assessment/Screening Tools Indicators of Abuse Screen (IOA) ◦http://www.uihealthcare.com/depts/med/famil ymedicaine/research/geriatrics/eledermistreat ment/indicators.pdf http://www.uihealthcare.com/depts/med/famil ymedicaine/research/geriatrics/eledermistreat ment/indicators.pdfhttp://www.uihealthcare.com/depts/med/famil ymedicaine/research/geriatrics/eledermistreat ment/indicators.pdf ◦Risk Assessment Instruments  http://www.elderabusecenter.org/default.cfm?p=r iskassessment.cfm http://www.elderabusecenter.org/default.cfm?p=r iskassessment.cfm http://www.elderabusecenter.org/default.cfm?p=r iskassessment.cfm  Caregiver Strain Index (CSI) ◦ http://links.lww.com/A291 http://links.lww.com/A291

13. Expected Outcomes Patient ◦Decrease risk factors for abuse and/or neglect ◦Decrease in caregivers stress ◦Support systems in place ◦Removal of patient from potential harmful situation Caregiver  Stress assessed and decreased  Respite care if needed  Treatment of mental health or substance abuse issues if indicated

14. Health Care Provider ◦Complete documentation, including history, physical exam, treatments, referrals, and reporting ◦Identification of risk factors that may lead to abuse and neglect ◦Elder abuse and neglect-alleged or suspected- identified and reported per state laws

15. Institution ◦Provide education to staff ◦Policies and procedures in place to deal with suspected abuse and or neglect that meet Joint Commission on Accreditation of Healthcare Organizations (JCHAO) Standards ◦Identification of potential victims ◦Evaluation of home environment and caregivers in the discharge planning process ◦Cases of suspected abuse and neglect reported to proper authorities. ◦List of community agencies for evaluation and assessment of victims of abuse and neglect

16. Follow up Monitoring ◦Team collaboration ◦Patient safety ◦Caregiver stress ◦Communication Adult Protective Services (APS)

17. Trail of Protocal Current referral from hospital ◦Patient living with daughter. Patient became ill and EMS called. EMS reported to ED staff unsanitary living conditions. Hospital case management interviewed patient and daughter. Daughter became hostile and defensive, refusing to answer questions. Further investigation revealed daughter had a recent sub acute rehab stay where patient was left alone at home. Hospital initialed guardianship proceedings. Currently awaiting placement of emergency guardian to admit patient for long term care.

18. Strengths and Weaknesses of Protocol Strengths ◦Detailed assessment tools ◦Addresses many different forms of abuse and neglect ◦Weaknesses  Assessment tools need to be utilized  Common sense needs to be applied to situations that don’t follow a “normal” pattern  Assessment tools are only as good as the professional using them

19. Application and Use in Current Practice Setting Current employer has abuse and neglect trraining mandatory for all employees Protocals in place for reporting cases of suspected cases of abuse and neglect Care plans for patients and screenings for abuse and neglect Social workers on staff to assist discharge planning to safe envorinments

20. References Hartford Institute for Geriatric Nursing. (2010). ConsultGeriRN.org. Retrieved from http://consultgeririn.org?