ELDER MISTREATMENT

Definition (National Research Council 2003) Intentional actions that cause harm or create a serious risk of harm, whether or not intended, to a vulnerable elder by a caregiver or other person who is in a trust relationship to the elder Types of Abuse: Self-neglect Neglect by caregiver Exploitation Psychological of emotional abuse Physical abuse Sexual abuse

Abuse & Neglect Members of any population who are physically or psychosocially impaired are vulnerable to abuse These populations are now protected through legislation Children individuals with mental retardation Victims of domestic violence and older adults are newer vulnerable populations now recognized as groups in need of legislative protection

ELDER ABUSE Approximately 1 million cases reported annually Elder abuse is severely underreported 10% of nursing home staff report that they committed some form of physical abuse, 40% reported at least one psychologically abusive act (See NCEA Website) In one study of 577 nursing home personnel, 36% reported having seen at least one incident of physical abuse in the past year

Reports of Elder Abuse Increasing Elder population increasing rapidly. Most vulnerable group ; over 85 years increasing at fastest rate Adult children increasingly called upon to provide care to parents, may not have resources to do so Increase in research calling attention to problem Professionals and public are more aware Now in public policy

RISK FACTORS Socially isolated Age Old-old most at risk Female gender Functional impairments Inability to meet own needs for food, shelter or warmth Cognitive impairments Inability to manage own finances Dementia, depression, long-term mental illness Poor health Dependency on abuser Lack of willing caregivers, Inability to seek services for themselves

Caregiver Factors Lacks resources to assume caregiver role Physical limitations Cognitive impairment Dependence Social Isolation Recent decline in health External locus of control Poor interpersonal relations with the dependent elder

CATEGORIES OF ABUSE PHYSICAL PSYCHOLOGICAL NEGLECT LEGAL/FINANCIAL Medication misuse, assualt, sexual abuse PSYCHOLOGICAL Intimidation, harrassment, humiliation NEGLECT Physical and psychological Intentional or unintentional LEGAL/FINANCIAL Theft, financial mismanagement, neglecting care to reap financial benefits

FACTORS INFLUENCING ABUSE SOCIAL ISOLATION PATHOLOGIC CONDITION EMOTIONAL/FINANCIAL DEPENDENCY UPON VICTIM ALCOHOL AND DRUG ABUSE DEPRESSION CAREGIVER STRESS

POTENTIAL SIGNS OF MISTREATMENT PHYSICAL ABUSE BRUISING, BURNS, REPEATED “FALLS” NEGLECT POOR HYGIENE, INAPPROPRIATE DRESS, PRESSURE ULCERS, WEIGHT LOSS, FATIGUE, EXACERBATION OF MEDICAL PROBLEMS EXPLOITATION UNEXPLAINED LOSS OF MONEY, LACK OF FOOD, MEDICATION, UTILITIES PSYCHOLOGICAL ABUSE SLEEP DISORDERS, PHOBIAS, ANTI-SOCIAL BEHAVIOR, FEAR, DEPRESSION

ASSESSMENT AND REPORTING HISTORY REASON FOR PRESENTATION, MEDICAL HISTORY, MEDICATIONS, RECENT FALLS, FREQUENT ADMISSIONS SOCIAL ASSESSMENT: LIVING ARRANGEMENTS, RECENT CHANGES IN ARRANGEMENTS, CAREGIVER CHARACTERISTICS, SATISFACTION WITH RELATIONSHIPS

ASSESSMENT AND REPORTING Nurse as Detective Physical examination Nutrition Hydration Bruises On torso Various stages of healing Injuries Burns Advanced pressure ulcers with no previous attempts for help Injuries not in keeping with client’s abilities Personal dress, hygiene and grooming

ASSESSMENT AND REPORTING Delay in seeking care Explanation for injury is vague or implausible Observe interaction with caregiver Arguing Fearful Belittleing Individual may be depressed or withdrawn

ASSESSMENT AND REPORTING ASSESS THREAT TO LIFE, POTENTIAL FOR SUICIDE ASSESS CURRENT SAFETY OF SITUATION, DOES THE PATIENT NEED TO BE REMOVED FROM SITUTATION IMMEDIATELY? FOLLOW INSTITUTION PROTOCOL FOR ASSESSMENT AND REPORTING NOTIFY CHARGE NURSE/SUPERVISOR, REPORT TO AUTHORITIES AND ADULT PROTECTIVE SERVICES PER PROTOCOL

FACTORS INFLUENCING DETECTION AND REPORT OF ABUSE OLDER ADULTS HAVE LESS CONTACT WITH THE COMMUNITY VICTIM IS RELUCTANT TO REPORT ABUSE FOR FEAR OF CONSEQUENCES AGEISM IMPAIRED COGNITIVE FUNCTION

INTERVENTIONS Essential/Core Emergency Support Rehabilitative Protective Services Emergency Police, Medical intervention Support Respite, Legal Assistance, Adult Day Care Additional services to support the caregiver and the patient Rehabilitative Mental health counseling, Temporary residence Preventative Public education, Caregiver training

NURSING ROLES Reporter/investigator Educator Discharge planner Counselor Advocate Case manager

Adult Protective Services Adult Protective Services (APS) are those services provided to insure the safety and well-being of elders and adults with disabilities who are in danger of being mistreated or neglected, are unable to take care of themselves or protect themselves from harm, and have no one to assist them.

ADULT PROTECTIVE SERVICES ROLE: Identification and referral Convey authority Establish a system of protective services to prevent, correct, or discontinue abuse and neglect To permit under certain circumstances involuntary access for the purpose of investigation and service

PRINCIPLES OF APS FREEDOM OVER SAFETY SELF-DETERMINATION PARTICIPATION IN DECISION MAKING LEAST RESTRICTIVE ALTERNATIVE PRIMACY OF THE ADULT CONFIDENTIALITY BENEFIT OF DOUBT DO NO HARM AVOIDANCE OF BLAME MAINTENANCE OF THE FAMILY

ADULT PROTECTIVE SERVICES REPORTING ABUSE AND NEGLECT IS MANDATORY RESPONSE IN GENERALLY 48-72 HOURS INTERVENTION MUST BE ACCEPTED VOLUNTARILY BY A MENTALLY CAPABLE ADULT MOST LAWS PROVIDE IMMUNITY FOR THOSE WHO REPORT THE CRIME YOU MAY BE ASKED TO GIVE TESTIMONY MOST INSTITUTIONS HAVE POLICIES REGARDING REPORTING OF ABUSE AND USE OF APS

Resource http://www.youtube.com/watch?v=VpD13z9iPfQ