Detecting Elder Abuse and Neglect PDF

DETECTING ABUSE and NEGLECT ELDER ABUSE: A GLOBAL DEFINITION “Elder abuse is a violation of human rights and a significant cause of injury, illness, lost productivity, isolation and despair. Confronting and reducing elder abuse requires a multi- sectoral and multi-disciplinary approach” …World Heal...

DETECTING ABUSE and NEGLECT ELDER ABUSE: A GLOBAL DEFINITION “Elder abuse is a violation of human rights and a significant cause of injury, illness, lost productivity, isolation and despair. Confronting and reducing elder abuse requires a multi- sectoral and multi-disciplinary approach” …World Health Organization ICEBERG THEORY OF ELDER ABUSE Reported Abuse 6% Unidentified and Unreported Abuse 94% Elder abuse is an invisible yet understood to be a growing crisis. Elder Abuse is a product of global ageing. The consequences of elder abuse have been computed in terms of 'direct' and 'indirect and human costs.” “The direct costs of elder abuse are those associated with prevention and intervention, provisions of services, criminal and justice procedures, institutional care, education and research programs.” “The indirect and human costs are those resulting from reduced productivity, diminished quality of life, emotional pain and suffering, distress and loss of self-esteem, disability and premature death.” …UN Secretary General's Report, 2002 A SOCIOLOGICAL PHENOMENON: A golden (historical) age for older persons is a myth. Elder abuse is not the result of modernization or industrialization. Elder abuse knows no geographical or cultural boundaries. ELDER ABUSE IS A CRIME: Affecting both provincial & rural areas Taking place in both the community & care homes Going unpunished Older persons are afraid PHYSICAL ABUSE: The use of non-accidental physical force that may result in bodily injury. Examples are: physical pain, or impairment, striking (with or without an object), hitting, beating, pushing and shoving; shaking, slapping, kicking, pinching; inappropriate use of drugs/physical restraints; force-feeding; physical punishment of any kind EMOTIONAL ABUSE: The infliction of anguish, pain, or distress through verbal or nonverbal acts. Examples: verbal assaults, insults, threats, intimidation, humiliation, harassment, treating an older person like an infant, isolating an older person from family, friends, or regular activities, giving an older person the ‘silent treatment’, forced social isolation SEXUAL ABUSE: Non-consensual sexual contact of any kind with an elderly person; sexual contact with any person incapable of giving consent Examples: Unwanted touching; All types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing; Forcing individual to watch sex acts; Showing an elderly person pornography Forcing the elder to undress FINANCIAL ABUSE: Illegal or improper use of an older persons finances, property or assets Examples: Cashing an older person's money without authorization or permission; Forging an older person's signature; Misusing or stealing an older person's money or possessions; Coercing or deceiving an older person into signing any document (e.g., contracts or will); Improper use of conservatorship, guardianship, or power of attorney. NEGLECT: The refusal or failure to fulfill any part of a person’s obligations or duties to an older person; Failure of a person who has fiduciary responsibilities to provide care for an older person (e.g. pay for necessary home care services); The failure on the part of an in-home service provider to provide necessary care Examples: Refusal or failure to provide older person with: food, water, clothing, shelter, personal hygiene, medicine, personal safety, other essential needs, either implied or agreed ABANDONMENT: The desertion of an older person by an individual who has assumed responsibility for providing care and support for an individual, or by a person who has guardianship and administration responsibilities for an older person. Examples: The desertion of an older person at a hospital, a nursing care facility, or other similar institution; The desertion of an older person at a shopping center or other public location ; An older persons own report of being abandoned. WARNING SIGNS OF ELDER ABUSE Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment. Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse. Bruises around the breasts or genital area can occur from sexual abuse. Sudden changes in financial situations may be the result of exploitation. Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect. Behaviors such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse. Strained or tense relationships, frequent arguments between the caregiver and older person are also signs. ELDER ABUSE IN THE COMMUNITY Females are more likely to be abused that males. Abused elderly are more likely to be dependent and older than 70 years. Financial & psychological abuse and neglect…the most predominant type of elder abuse. Most professionals dealing with elder abuse…are not aware of what can be offered locally. UNDER/NO REPORTING OF ELDER ABUSE Fear of retaliation; Embarrassment; Do not know to whom to report; Deem themselves as the cause of the problem; Believe that they are being paid back for their earlier abuse of a spouse or child; Afraid of being labeled demented or mentally impaired; Judge that the solution of being removed from home is worse than the abuse; Do not wish to label a child or spouse as an ‘abuser’; THE DARK SIDE OF THE FAMILY Abusers of older adults are both women and men. Family members are more often the abusers than any other group. For several years, data showed that adult children and spouses were the most common abusers of family members INTERVENTIONS: 1. Comprehensive assessment 2. Ethical concerns 3. Education 4. Social Interventions 5. Legal interventions 1. Comprehensive assessment ✓ If you suspect abuse, interview the patient privately so his account of events is not influenced by the presence of the family member. ✓ Make sure your documentation of the interview is accurate, detailed and objective. As much as possible, write down the exact words your patient and his family members used in verbatim. ✓ Keep your questions simple, direct, non-threatening and nonjudgmental. Avoid confrontation. It’s unlikely that either party will readily admit the existence of an abusive relationship since you are a stranger to both; they have no reason to trust you. ✓ Avoid answering leading questions from family members. (your answers may reveal what you consider important and you risk losing control of the interview) ✓ A history of illness is important. Ask when, where, and how all injuries occurred. Be alert for inconsistencies between answers and related physical evidence. Medical history may suggest previous abuse or patterns of hospital or physician “hopping.” ✓ Perform a thorough physical examination keeping in mind that the bruises alone don’t necessarily indicate abuse (due to physiologic changes in aging) ✓ Use the institution’s protocol of identifying and assessing elder abuse & neglect (eg. use of tools like skin care flow sheet, caregiver strain index, etc)  ✓ If policy permits, obtain photographs of the wounds to be placed in the patient’s record (obtain pt’s written consent, take head-to-toe shot including the face, ff up photo at 24- 48 hrs if possible, label the photographs with pt’s name, hospital no., date/time each picture was taken.) 2. Ethical concerns: In choosing interventions for abuse, be guided primarily by the ff. criteria: safety needs of the older patient; his rights to self-determination, autonomy & freedom of choice; and the legal requirements for reporting abuse & neglect. Ethical dilemmas – situations requiring a choice between what seem to be equally desirable or undesirable alternatives – may develop at any point during the comprehensive assessment. A desirable choice, for example, would be an older adult obliged to choose to live with 1 of 2 children with whom he has a good relationship. Both children want him but they live in different places. An example of undesirable choice would be deciding whether to move to a nursing home or to remain in an abusive situation. In such situations, the nurse’s role is to help the older person understand all his options and to support him in his decision. 3. Education: Regardless of whether the older person consents to or refuses interventions, he needs education about the incidence of mistreatment and the tendency for it to increase overtime. In teaching older adult, it’s useful to provide both written and oral information. Always ask the older person to repeat your instructions before the teaching session is over. In some cases, you’ll need to provide instructions to the caregiver rather than the older person. In that case, same principles apply. 4. Social interventions: The social worker becomes the lead person on the multidisciplinary team (if the cause of abuse is primarily social in nature). Nurses stay involved to monitor health issues. Support services for older persons can be organized in 4 categories: o Health support o Social resources (senior citizens groups, respite care, support groups, community talks, meals on wheels, etc.) o Assistive services o Housing support The older person’s financial resources and the ability of the community-based resources, particularly for home-bound patients, are pertinent when you assist him to select social interventions. 5.Legal Interventions A variey of legal interventions may be used when working with elder abuse. However, taking legal actions requires serious and careful thought to avoid infringing on an older person’s right and freedom. Experts recommend that you consider 3 questions when suggesting a specific legal option: Is the older adult unable to make or carry out decisions about major issues (health care, housing, living arrangements, sale/mgt of property and money) on his own behalf? Is there a risk to his health and safety? (risk of theft or loss of property or money because he’s unable to act on his own behalf) Do the actions that someone else would have to take on the older adult’s behalf require legal authority? You always try to implement the least restrictive legal interventions – those that least limit an older person’s right to make decisions and that least restrict his personal freedom. References: 1. Lecture by Dr. Marvin Formosa, Director of International Institute on Ageing United Nations - Malta (INIA) during International Training Programme in Geriatrics and Gerontology, Manila, Philippines 7 - 11 September 2015 2. Mayer, BH (Senior Associate Editor) (2002). Better Elder Care: A Nursing Guide to Caring for Older Adults Pennsylvania: Springhouse AMSR