Elder Abuse in Canada (2024) PDF

Elder Abuse in Canada H&H II – WEEK 4 Copyright This presentation and all its content is copyright and is owned by Durham College or its Licensors (2022). © Durham College or its licensors 2022 Learning O...

Elder Abuse in Canada H&H II – WEEK 4 Copyright This presentation and all its content is copyright and is owned by Durham College or its Licensors (2022). © Durham College or its licensors 2022 Learning Objectives After completing this module, you will be able to demonstrate the following: Identify key indicators of physical, emotional, financial and sexual abuse of the older adult. Describe the nurses role in identify and addressing elder abuse Describe how to advocate for an older adult experiencing elder abuse. Explore online and community resources related to elder abuse. H&H II – WEEK 4.2 Elder Abuse in Canada Elder Abuse Elder abuse is "any action by someone in a relationship of trust that results in harm or distress to an older person. Neglect is a lack of action by that person in a relationship of trust with the same result." (Touhy et al., 2019, p. 365) Elder abuse involves any form of physical, emotional, financial, sexual abuse and neglect. The most common forms of elder abuse in Canada are emotional and financial abuse. As nurses is it important to be able to identify signs of elder abuse and to protect and intervene when abuse is suspected. Prevalence Approx 5-10% of older adults in Canada have experienced some form of abuse. Prevalence of elder abuse in Canada is difficult to distinguish as it is felt to be difficult to define, measure and is significantly under-reported. It is frequently under-reported as many older adults do not participate in surveys related to abuse and are much less likely to report abuse. © Durham College or its licensors 2022 Stats & Trends Most instances of abuse are committed by family members Older women experience abuse more than older men Older women usually experience abuse by spouses and children Older men usually experience abuse by children and close friends Individuals with cognitive impairment are at higher risk for abuse than those who are not cognitively impaired. © Durham College or its licensors Impact of Elder Abuse Consequences of elder abuse include physical trauma, diminished self worth, reports of feeling unsafe and an increase risk of early death. Older adults can experience increased hospitalization, economic costs, exposure to additional health interventions and lost productivity. Elder abuse involves any form of physical, emotional, financial or sexual abuse and neglect. © Durham College or its licensors  Physical Abuse Definition Actions Indications Using physical force against a Hitting, punching, slapping, Unexplained injuries (bruises, person without the person's pushing, biting or throwing the burns, bites, fractures) consent. It can cause pain, older person Untreated medical problems injury or impairment Burning the person History of "accidents" Confining the person, including Signs of over or under use of the use of unnecessary medications restraints Wasting Throwing objects at the older person Dehydration Touhy et al., (2019). Ebersole & Hess' Gerontological Nursing & Healthy Aging. Elsevier Canada. Table 22.1. p. 365 © Durham College or its licensors  Emotional Abuse Definition Actions Indications Using words or actions to Threatening Fear, anxiety, withdrawl control, frighten, isolate or Blaming, insulting, lying Depression erode a persons’ self respect Deciding what the person can do or Cowering not do Reluctance to talk openly Not keeping promises Fearful interaction with Humiliation caregiver Alienating others from the older Family or caregiver talking person on behalf of the person and Making fun of the persons heritage, not allowing privacy traditions, or religious or spiritual beliefs Constant yelling Touhy et al., (2019). Ebersole & Hess' Gerontological Nursing & Healthy Aging. © Durham College or its licensors Elsevier Canada. Table 22.1. p. 365  Financial Abuse Definition Actions Indications Acting without the Misuse of power of attorney Standard of living is older person's consent Theft inconsistent with with in a way that benefits income or assets the abuser at the Misusing control over a person's funds by not providing them for the person's benefit Theft or missing property expense of the older noted person through Pressuring the person to provide financial threats, intimidation, support Unusual or inappropriate or deceit. most forms activity in bank accounts Making the person sign a legal document of financial abuse are Forged signatures on crimes Overcharging for services cheques Failing to relay loans Overdue bills Pressuring the person to sign over house or Missing mail property Touhy et al., (2019). Ebersole & Hess' Gerontological Nursing & Healthy Aging. Elsevier Canada. Table 22.1. p. 365 © Durham College or its licensors  Neglect Definition Actions Indications Failing to adequately provide failing ot provide adequate Unkemp appearance necessities of care for a nutrition, personal care or a Inappropriate or dirty clothing dependent or older person clean, warm, safe environment Signs of infrequent bathing Withholding medical services or treatments Unhealthy living conditions Failing ot provide proper Dangers or disrepair in home needed supervision environment Failing to prevent physical Hoarding harm Lack of social contact No regular health care appointments Touhy et al., (2019). Ebersole & Hess' Gerontological Nursing & Healthy Aging. Elsevier Canada. Table 22.1. p. 365 © Durham College or its licensors Sexual Abuse Definition Actions Indications Direct or indirect involvement in Coercing an older person Pain, bruising & bleeding in sexual activity without consent through force, trickery, threats genital area or other means into unwanted sexual activity. Victimization of older adults who cannot consent RNAO (2014). Preventing & Addressing Abuse and Neglect of Older Adults. Toronto, ON. RNAO. Appendix D. © Durham College or its licensors Scams targeted towards older adults. Scams can come in many forms. Scams are a form of financial abuse Scams play on older adults emotion and fear. Older adults are often targeted because they are easily accessible, more trusting and polite, and most have money and assets.. As nurses, you can educate your older adult patients on how to recognize and respond to scams, as well as support services that can help if they are a victim of a scam. Scam education for older adults should include: Resist pressure to act immediately and don’t buy on impulse Watch out for products promoted by “prizes” or “free trips” Before buying or investing, check with family and friends or attorney Do not give your credit card over the phone unless you are sure who you are giving it to. Hang up and call your credit card company and speak to the fraud department Do not give personal information over the phone Always check email addresses and don't click on links you are unsure of. If in doubt call or email the person separately to ask if they send you the link © Durham College or its licensors Nursing Assessment & Implications H&H II – WEEK 4.3  RNAO (2014). Preventing & Addressing Abuse and Neglect of Older Adults. Toronto, ON. RNAO. p.103-104 © Durham College or its licensors Touhy et al., (2019). Ebersole & Hess' Gerontological Nursing & Healthy Aging (2nd ed.). Elsevier Canada. p. 370 Assessment of Abuse Nurses must be sensitive and alert to signs of abuse in each interaction with an older adult. Signs to be Aware of: Unexplained bruising or fractures Missed appointments without explanation Injuries that do not align with the history and physical assessment. Family members changes in normal behaviour or speaking for the older adult. An assessment should be done to determine the “immediate safety of the victim; the desires of the victim, if capable; and supports available to reduce the persons risk" (Touhy et al., 2019, p. 369). Suspected Abuse When abuse is suspected or confirmed: Use an interprofessional approach Consider if law enforcement needs to be involved Was a criminal code violated Follow jurisdictional laws regarding mandatory reporting Consider consent and privacy when working with capable adults Capable older adults decisions need to be respected  Think broadly about who on the interprofessional team should be consulted. Include physicians & social workers and collaborate with the team and client to determine if law enforcement needs to be involved. It is essential that nurses follow the policies and procedures set out by their organization when reporting abuse. Jurisdictional laws regarding mandatory reporting, consent and privacy are key factors to consider when working with a capable older adult. When working with a capable older adult, their wishes regarding reporting need to be respected. There are situations when a violation to the criminal code has occurred where reporting to police is mandatory. It is essential to consult with the interprofessional and leadership teams for guidance and direction. The RNAO BPG on Elder Abuse (2014), describes the challenges of determining when to report abuse of capable older adults. The RNAO states: Capable Older Adults "Reporting abuse or neglect of mentally capable adults may be inappropriate, and reporting harms without their consent may actually be a breach of the older adults' right to make their own decisions and their right to confidentiality. When reporting abuse is not required or appropriate, nurses and other health care provider should determine what other supports can be offered to the older adult, such as providing emotional support or referrals to appropriate resources" (p. 34). The RNAO BPG on Elder Abuse (2014) RNAO Decision Tree Decision tree needs to be tailored to the type of abuse, the sector, the scope of practice of the care provider and relevant laws Collaborate with the older adult, family (if appropriate) when making decisions. As a nurse it is important to remember to utilize your institution policies to guide your practice. RNAO BPG - Preventing Abuse & Neglect of Older Adults Community Resources Region of Durham, Advisor-Seniors' Safety: 905-668-7711 ext. 2460 Durham Regional Police, Seniors Support Co- ordinator: 905-579-1520 ext. 1865 Seniors CRIMESTOPPERS: 1-800-222-8477 RNAO BPG: Preventing & Addressing Abuse and Neglect of Older Adults (Appendix I) Institutional Abuse H&H II – WEEK 4.3 Institutional Abuse Institutional abuse refers to any form of abuse that occurs within health care institutions, such as Long Term Care (LTC) facilities, hospital or retirement homes There are 2 types of institutional abuse Resident-to-resident abuse Staff-to-resident abuse Resident-to-Resident Abuse Recent studies found that up to 41% of residents experience some form of resident- to-resident abuse Resident-to-resident abuse there this the potential for harm for both residents the same power dynamic is not usually at play in the same way it would for other forms of abuse. This form of abuse does not occur within the context of a therapeutic relationship. Nursing Implications Separate residents involved Follow other institution policies for mandatory reporting Resident-to-Resident Abuse Resident-to-resident abuse is considered differently as there this the potential for harm for both residents, as well as the same power dynamic is not usually at play in the same way it would for other forms of abuse. This form of abuse does not usually occur within the context of a trusting therapeutic relationship. Recent studies found that up to 41% of residents experience some form of resident-to-resident abuse. Older adults at highest risk for elder abuse are usually female, have some degree of cognitive impairment, are known to wander and have mobility concerns. When resident-to-resident abuse does occur, it is important that residents are separated and protected, in addition to following other institution policies for mandatory reporting (if applicable). Staff to Resident Abuse Staff-to-resident abuse Any form of abuse that exists between a staff member and a resident and occurs within a trusting, therapeutic relationship. Older adults are at risk because they are isolated and dependent on staff for caregiving. Factors influencing abuse Institutional Factors: If an organization has poor or ineffective leadership, inadequate staffing levels, high burnout or turnover or where intimidation of staff is permitted, then this often translates to resident abuse. Staff Factors: Staff are more likely to be abusive if they experience workplace stress, dissatisfaction with work, emotional exhaustion, job pressures, inexperience, lack of knowledge about older persons, negative attitudes such as ageism, personal problems, a personal history of abuse, alcohol or substance misuse and deficiencies in communication skills or problem-solving Resident Factors: Aggressive, hyperactive, or responsive behaviours; dependency in regard to activities of daily living; a history of previous abuse; social isolation; and impaired communication all put residents at higher risk for abuse (Touhy et al., 2019, p. 369). Nursing Implications Health care organization have a responsibility to ensure they have healthy workplace environments that support staff and empower them to provide exceptional, patient centred care to their residents. Nurses must be routinely trained and updated on prevention and assessment of elder abuse. This education should include the following: Ageism Residents' rights Abuse, neglect, and the factors that contribute to them Staff members' responsibilities to report abuse Relevant laws Positive care approaches Managing responsive behaviours Fostering a safe and healthy work environment Mandatory Reporting Mandatory reporting exists within the Long Term Care sector If a staff member suspects any form of abuse they MUST report to their supervisor Superviso Staff MoHLTC +/- Police r Whistle-blower protection policies must be in place Institutional Abuse Please watch this video and complete the Practice Activity on DC Connect RNAO Reporting S uspected Abuse & Neglect Video https://youtu.be/jwt-i0XpJuo