1. Chapter 23: Abuse and Mistreatment of Older Adults

2. 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.

3. Learning Objectives (cont’d) Recognize signs that an older adult is being mistreated. Name two screening tools for elder abuse. Discuss strategies to prevent the mistreatment of older adults. Synthesize interventions in various cases of abuse.

5. 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.

6. Types of Elder Abuse Psychological or emotional neglect Psychological or emotional abuse Violation of personal rights Financial abuse Physical neglect Self-neglect Direct Physical Abuse

7. 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

8. 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)

9. 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

10. 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

11. 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 problemsof Elder Mistreatment or Abuse

12. 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.

13. Prevention of Abuse or Mistreatment Suggestions for older adults to reduce the potential for abuse –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.

14. Assessment and Screening Recognizing the signs and symptoms of elder abuse or mistreatment (Table 23-5, p. 821) –The 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=34 018&search=elder+abuse#Section405

15. Clues to abuse –The presence of several injuries in different stages of repair –Delays in seeking treatment –Injuries which cannot be explained or that are inconsistent with the history –Contradictory explanations by the caregiver and the patient –Bruises, burns, welts, lacerations, restraint marks

16. Clues to abuse (Cont’d) –Dehydration, malnutrition, decubitus ulcers or poor hygiene –Depression, withdrawal, agitation –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 –Missing prosthetic device(s), such as dentures, glasses, hearing aids

17. 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.