10 Violence and Elder Mistreatment Lecture Note PowerPoint Presentation
10
Lecture Note PowerPoint Presentation
Violence and Elder
Mistreatment
LEARNING OUTCOME 1
Discuss current trends in elder mistreatment, including incidence and prevalence.
E LDER A BUSE I S
The least addressed,
Underreported
Under-recognized crime
Only 1 out of every 14 cases of abuse in the domestic settings are reported to authorities.
A
CCORDING TO THE
2004 S
URVEY OF
S
TATE
A
DULT
P
ROTECTIVE
S
ERVICES
(APS)
19.7 % increase in total reported elder abuse and neglect and a 15.6% increase in proven elder abuse and neglect since the 2000 survey
Majority of abuse and neglect (89.3%) occurred in the domestic setting (-elder's home -caregiver's home)
T ABLE 10-2
E LDER M ISTREATMENT C HARACTERISTICS
O NE S URVEY OF N URSING H OME S TAFF
M EMBERS R EVEALED T HAT
36% had witnessed at least one incident of physical abuse by another staff member in the previous year
81% had observed at least on incident of psychological abuse
T
HE
P
ANEL TO
R
EVIEW
R
ISK AND
P
REVALENCE OF
E
LDER
A
BUSE AND
N
EGLECT
(2002)
Defined abuse types
Physical abuse
Sexual abuse
Emotional / psychological abuse
Neglect
Abandonment
Financial / material exploitation (management)
Self-neglect
Sexual abuse
T HREE B ASIC C ATEGORIES OF E LDER
M ISTREATMENT :
A- Domestic mistreatment generally occurs within the older adult’s home by a significant other
B- Institutional mistreatment occurs when an older adult has a contractual arrangement and suffers abuse
Elder abuse can occur in a domestic setting, such as one’s home or the home of a caregiver, or in an institutional setting, such as a nursing home, board and care home, or other health care or residential facility.
T HREE B ASIC C ATEGORIES OF E LDER
M ISTREATMENT :
C- Self-neglect occurs when older adults who are mentally competent enough to understand the consequences of their own decisions engage in behaviors that threaten their own safety.
LEARNING OUTCOME 2
Review key reasons why elder mistreatment occurs.
C OMMON C HARACTERISTICS OF THE
A BUSER
Likely to be male
History of substance abuse, mental illness
History of violence
Lack a strong social support network
Dependent on the care recipient for financial or other needs
T HEORIES OF THE E TIOLOGY OF E LDER
A BUSE
“Psychopathology of the abuser”
Caregivers who have preexisting conditions that impair their capacity to give appropriate care
“Transgenerational violence”
Part of the family violence continuum is based on the belief that violence is a learned behavior pattern. A child observes violence as an acceptable reaction to stress and then internalizes this as an acceptable behavior. In cases of elder abuse, violent behavior becomes cyclical: the abused – the child becomes the abuser of the parent.
T HEORIES OF THE E TIOLOGY OF E LDER
A BUSE
“Situational theory,” also know as “caregiver stress
Care burdens outweigh the caregiver’s capacity
“Isolation theory”
Mistreatment is prompted by a dwindling social network
LEARNING OUTCOME 3
Conduct clinical assessment for screening and detection of elder mistreatment.
C HARACTERISTICS OF V ICTIMS OF A BUSE
Older than age 75 years
Female
Live with abusers
Suffer from chronic, debilitating illnesses impairing function creating heavy care needs
C AREGIVERS FOR O LDER A DULTS S HOULD
B E A SSESSED
For caregiver stress
For substance abuse
For a history of psychopathology
Using the Caregiver Strain Index (CSI), which may aid in assessment
The Caregiver Strain Index (CSI) is a tool that can be used to quickly identify families with potential caregiving concerns. It is a 13-question tool that measures strain related to care provision. There is at least one item for each of the following major domains: Employment, Financial,
Physical, Social and Time.
S
EPARATE
I
NTERVIEWS
S
HOULD
B
E
C
ONDUCTED FOR THE
C
AREGIVER AND
THE
P
ATIENT
Inconsistencies might increase the suspicion of abuse
A SSESSMENT SHOULD INCLUDE
Awareness of differences based on culture perceptions of mistreatment
An interdisciplinary team
A nonjudgmental environment
P OTENTIAL S IGNS OF M ISTREATMENT
Physical abuse
Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body
Broken bones, sprains, or dislocations
Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
Broken eyeglasses or frames
Signs of being restrained, such as rope marks on wrists
Caregiver’s refusal to allow you to see the elder alone
Emotional abuse
In addition to the general signs above, indications of emotional elder abuse include
Threatening, belittling ( ةناهتسلاا ), or controlling caregiver behavior
Behavior from the elder that mimic dementia, such as rocking ( ّ زهلا ), sucking, or mumbling ( مغمغ ) to oneself
N EGLECT BY CAREGIVERS OR SELF -
NEGLECT
Unusual weight loss, malnutrition, dehydration
Untreated physical problems, such as bed sores
Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
Being dirty or unbathed
Unsuitable clothing or covering for the weather
Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
Desertion of the elder at a public place
Financial exploitation
Significant withdrawals from the elder’s accounts
Sudden changes in the elder’s financial condition
Items or cash missing from the senior’s household
Suspicious changes in wills, power of attorney, titles, and policies
Addition of names to the senior’s signature card
Unpaid bills or lack of medical care, although the elder has enough money to pay for them
Financial activity the senior couldn’t have done, such as an
ATM withdrawal when the account holder is bedridden
Unnecessary services, goods, or subscriptions
Sexual abuse
Bruises around breasts or genitals
Unexplained venereal disease or genital infections
Unexplained vaginal or anal bleeding
Torn, stained, or bloody underclothing
T ESTING TO C ONFIRM A BUSE
Laboratory findings that supporting the presence of dehydration and malnutrition without medical causes.
Papanicolaou smear
Cultures for sexually transmitted disease
The Papanicolaou test (also called Pap smear, Pap
test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant
(cancerous) processes in the ectocervix
T ESTING TO C ONFIRM A BUSE
Radiological testing
Have students perform a complete history, including assessment for mistreatment of a patient.
Have students administer a caregiver stress inventory.
LEARNING OUTCOME 4
Create a nursing care plan for the ongoing well-being of older patients.
N
URSES
S
HOULD
P
LAN FOR
E
DUCATIONAL
I
NTERVENTIONS FOR
THE
C
AREGIVER
Disease management
Aging changes
Maximizing healthcare services
Respite ( لهمأ , أجرأ , دم )services:
Short-term, temporary care provided to an individual in their home or outside their home
Designed to give the primary caregiver(s) a break from their care giving duties
Respite may be just a few hours or several days in length depending on the plans of the caregiver
Respite may be planned in advance or may be made available to assist in a crisis/emergency situation
Behavioral management
Caregiver support groups
LEARNING OUTCOME 5
Summarize key resources for elder mistreatment information.
E LDER MISTREATMENT RESOURCES
National Elder Abuse Study
National Center On Elder Abuse
Worldbridges
Association For The Protection Of The Elderly
National Center For Victims Of Crime
American Bar Association
E LDER MISTREATMENT RESOURCES
National Committee for the Prevention of Elder
Abuse
Elder Justice Center
Elder Abuse in Long-Term Care Facilities
Website
