Elder Abuse

• Elder abuse, as covered in Health Care Assistant Program 1220 (HCAP 1220)

Defining Elder Abuse

• HealthLink BC's definition emphasizes the care context and distinctive abuse categories

• Elder abuse includes maltreatment of an older person by a caregiver, family, spouse, or friend

• Elder abuse is categorized into domestic, institutional, and self-neglect

• Domestic elder abuse occurs in the older adult's or caregiver's home, with the abuser often being a relative, friend, or paid companion

• Institutional abuse happens in residential settings like nursing homes or assisted-living facilities, where abusers have a financial or contractual duty of care

• Self-neglect involves an older adult’s behavior that endangers their own health or safety, like refusing adequate necessities

• The Executive Director of the British Columbia Centre for Elder Advocacy and Support defines elder abuse as deliberate behavior by someone in a position of trust that causes physical, emotional, or financial harm to an older adult

• Elder abuse is often a systematic tactic to gain power and control, not a random act of violence

• Types of elder abuse include physical, sexual, emotional, financial, and neglect

Types of Abuse Explained

• Physical abuse is intentional force causing harm or impairment, such as hitting or inappropriate medication use
• Sexual abuse involves non-consensual sexual contact or activity
• Emotional abuse includes actions or words causing emotional pain, distress, or psychological harm, such as insults or threats
• Financial abuse is the illegal or improper use of an older adult's money, property, or assets, like theft or fraud
• Neglect is the failure to provide necessary care, assistance, or attention, leading to harm, including not providing food, shelter, or medical care

Self-Neglect

• Self-neglect is an adult's failure to care causing harm, serious physical or mental damage, or financial loss
• It includes living in unsanitary conditions, suffering from untreated conditions, malnutrition, creating hazardous situations, or mismanagement of financial affairs

Causes and Consequences of Elder Abuse

• Elder abuse is multifaceted, with no single cause, involving personal and societal factors which can happen anywhere, once or over a long period, and be complicated by life events

• Possible causes of abuse include ageism, insensitivity, lack of knowledge, continuation of domestic abuse, lack of understanding the care-giving role, and response to violence, especially from individuals with dementia

• Health consequences of elder abuse:

• Physical abuse can cause injury or death

• Verbal or emotional abuse correlates with a higher risk of cardiovascular death

• Neglect results in a lack of food, bathing, or liquids

• Other consequences:

• Financial abuse leads to loss of income and security

• Abuse and neglect can have lasting repercussions on families

Ageism and its Role

• Ageism is discrimination based on age

• Ageism is treating older adults as less valued because of their age

• Ageism involves systematic stereotyping or discrimination because people are old

• Systematic ageism is ageism built into laws, policies, or procedures

• An example is clinical trials excluding older adults, or housing rules excluding grandchildren visiting

• Ageism in the media:

• Emphasis primarily on the negative aspects of aging; Focus on societal costs of aging, rather than societal contribution of older adults

• Age-based stereotypes are perpetuated in entertainment

• Targeted advertising for older adults are limited to products associated with infirmity (wheelchairs and meal replacements, not hybrid vehicles and restaurants)

• Personal ageism can be subtle or blatant:

• Subtle forms include invasive compliments that stereotype how an older person should act

• Blatant forms include assuming an older adult is unable to learn or feeling entitled to their time or money

• Ageism assumes older adults are "less than," contributing to acceptance of abuse and neglect

Recognizing Risk Factors

• Factors increasing older persons' vulnerability to abuse may also intensify abuse effects
• Risk factors placing older adults at risk for elder abuse include:
  • Sharing living situations that can increase the risk of conflict, dependence, or access for potential abusers
  • Lack of a support network which can leave older adults more vulnerable to abuse and less likely to report it
  • Cognitive impairments make it harder to recognize or report abuse, and behavioral symptoms may trigger caregiver frustration
• Caregivers under stress may resort to neglect or abuse due to burnout or frustration
• Older adults who are financially dependent being at higher risk of financial abuse
• Immigrants or those with language barriers facing additional risks due to isolation or lack of access to support services
• Untrained or unprepared caregivers causing harm or engaging in neglect due to ignorance or frustration
• Caregivers who are mentally or physically unwell may struggle to provide appropriate care, leading to neglect or abuse
• Abuse can occur in care facilities where there may be staff shortages, insufficient training, or inadequate supervision
• Negative stereotypes about aging can lead to disrespect, neglect, or minimization of older adults's needs and rights

Indicators of possible Elder Abuse

• Indicators are not evidence

• Many situations can cause changes in an older adults behaviour

• If you see potential indicators of abuse or neglect, or someone tells you about something that concerns them, pay attention and don't jump to conclusions

• Possible indicators of physical abuse:

  • Untreated, frequent or unexplained injuries; Vague or illogical explanations of injuries; Fractures of limbs or skull; Bruises, sores, abrasions or cuts; Internal injuries or bleeding; Black eyes, welts and marks from restraints; Skin indications: lacerations, burns, dehydration or bites

• Possible indicators of sexual abuse:

  • Unexplained venereal disease, genital infections; Torn, stained or bloody underclothes; Difficulty walking or sitting; Bruising or swelling around anal or genital area; Withdrawal, fear, depression, anger, insomnia; Changed level of interest in sex; Aggressive behaviour; Strong reaction to discussion of sexual abuse

• Possible indicators of emotional abuse: - Changes in behaviour: Upset or agitated turning into Withdrawn and/or non-responsive

  • Changes in behaviour when a particular individual enters or leaves the room
  • Verbal aggression from a particular individual (tone of voice, insults, lack of eye contact, glaring)

• Possible indicators of financial abuse:

  • Sudden changes of banking practices (Withdrawal of large amounts of money); Changes in financial situation (Failure to pay bills, Cancellation of usual services (internet, phone, cable television); Appears confused about financial situation
  • A relative/stranger/caregiver is always present for in-person banking, showing behaviours such as encouraging changes in accounts or practices

• Possible indicators of neglect can include Unkempt appearance, Lack of appropriate clothing, Lack of necessary assistance devices (hearing aids, glasses, canes, walker, etc.), Hazardous or unsafe living conditions, Poor nutritional status, Prescriptions not filled regularly, and a Pattern of missed/cancelled appointments (medical and other)

• Passive neglect:

• Caregiver may lack knowledge, skills and resources to provide adequate care

• Caregiver may be basing actions on misguided information (for example, using restraints to keep an older adult safe)

• Active neglect:

• Caregiver is aware that his/her actions are not in older adult's best interest

Disclosure Complexities

• Older adults may not disclose abuse due to fear for their own or others' safety, concern about the consequences of disclosure, not recognizing the situation as abuse or neglect, self-blame, inability to communicate, or feeling like they need to talk to someone
• Barriers occur when wanting to:
• Protect the family (embarrassment, self blame)
• Protect community (fear of judgement or divisive behaviour)
• or protect themselves (fear of retaliation, loss of connection, facility admittance)
• Disclosure can be impacted by a lack of information, cognitive barriers, or life experiences

HCAs Response

• All Canadian provinces and territories legally mandate the public and professionals, including support workers, to report suspected abuse of children, older adults, or persons with physical or mental challenges

• Challenging misconceptions that abuse is a private family matter; reporting concerns promptly to relevant authorities, anonymously when needed

• Those reporting abuse in good faith are legally protected from repercussions, unless the report is false and malicious

• How to report abuse:

  • First you should record all observations and make your reports in writing and keep all notes
  • Record the alleged victim's name, address, phone number, age, and gender and the alleged abuser's name, address, phone number, and relationship to the victim

• A description of abuse or neglect, suspicions, and evidence obtained to date; the date, time, and place; only the facts that you know or were told by the victim- do not make assumptions

• It essential when sharing any information that you Tell only those who need to know and never gossip or tell anyone who is not directly involved

• Steps to reporting abuse, including the alleged victims details name, address, phone number, age and gender andProvide the alleged abuser's name, address, phone number, and their relationship to the victim

• Finally Describe the abuse or neglect, suspicions, evidence and relevant details (date, time, place) based solely on known facts or what the victim shared - avoid assumptions

• Seniors Abuse and Information Line (SAIL) is a safe, confidential place for older adults and those who care about them to talk to someone about situations where they feel they are being abused or mistreated, or to receive information about elder abuse prevention

• To call SAIL call Toll-free: 1-866-437-1940 or 604-437-1940 in the Lower Mainland

  • or contact them on there Website: http://seniorsfirstbc.ca/
  • They are Available 8:00 am 8:00 pm daily (excluding holidays)

BC-CACHWR Role & Mandate

• The BC Care Aide & Community Health Worker Registry protects patients, residents and clients by maintaining a database of care aides and the following points will establish a standardized process for employers to report and investigate complaints of abuse

• Employers must report any suspension or termination of an employee due to alleged abuse within seven calendar days of notifying the employee

• It is within the mandate to suspend or remove any potential abusers and maintain an appropriate level of training

  • The Registry enforces the following definitions: -Financial abuse: Misuse or unauthorized obtaining of a person's funds or assets;Emotional abuse: Actions or inactions that diminish a person's sense of dignity, such as verbal harassment or confinement; Physical abuse: Use of excessive or inappropriate physical force -Sexual abuse: Any sexual behavior directed towards a person in care, including exploitation by someone in a position of trust or authority; Neglect: Failure to meet a person's needs for food, shelter, care, or supervision; Deprivation of food or fluids as punishment

• Through supporting these processes the Registry protects the citizens and maintains standards of care, particularly in regards to the vulnerable

Instruction on abuse scenarios

• This learning activity invites analysis of real-life scenarios focusing on reportable incidents of abuse
• The emphasized components are Critical Evaluation (assess actions), Discussion (align responses with abuse definitions), and Alternative Solutions (propose improved responses)
• It deepens the HCA’s safe and respectful roles The discussions cover abuse definitions from the Community Care and Assisted Living Act
• Potential conflicting opinions may link additional concepts like DIPPS, ethical and legal parameters, and employer policies