Violence and Elder Mistreatment 10 Lecture Note PowerPoint Presentation

LEARNING OUTCOME 1 Discuss current trends in elder mistreatment, including incidence and prevalence.

E LDER A BUSE I S The least addressed, U 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 Self-neglect Sexual abuse

T HREE B ASIC C ATEGORIES OF E LDER M ISTREATMENT : Domestic mistreatment generally occurs within the older adult’s home by a significant other 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 : 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

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 ( الاستهانة ), or controlling caregiver behavior Behavior from the elder that mimic dementia, such as rocking ( الهزّ ), sucking, or mumbling ( غمغم ) 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 ectocervixscreening testgynecologyectocervix

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 ( مد, أرجأ, أمهل )services 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