dementia/ elder abuse Flashcards
describe the types of elder neglect and abuse
- physical, psychological, sexual, emotional, financial
identify risk factors for elder abuse and neglect
- women, maori and separated/ divorced/ widowed elder people are specific groups high at risk
acts about elder abuse and what RNs do
- crimes amendment act 2011 ‘section 151 provides that anyone who has actual care or charge of a vulnerable adult is under a duty to provide that person with necessaries and to take reasonable steps to protect them from injury
- routine screening is a routine enquiry by healthcare providers of all patients about their personal history of partner abuse, child abuse or neglect
- family violence intervention guidelines elder abuse and neglect, MOH- 2017
signs and symptoms of elder abuse
- anxious for no reason
- irritable
- presents as helpless, sad
- disturbed sleep or loss of appetite
- lack of spending on necessities
- depleted savings
- fear of bathing or toileting
- avoids eye contact or recoils when touched
- reluctant to talk openly or defer to caregiver to answer
FINANCIAL SIGNS
- misuse of EPOA- control over the persons money or resources
- little spent on necessary aids- hearing aids, meds, glasses
- little spent on social or cultural stimulation
- absence of basic hygiene and personal care/ inappropriate clothing
behaviours an abuser may exhibit
- blaming the older person for their behaviour
- refusing treatment for the older person or seeing a variety or clinicians
- responding defensively
- overly concerned or under concerned
- minimal eye contact, evades questions
- treating the older person as a like
6 step approach for caregivers
- identify- questioning to elicit information ‘are you afraid of anyone’ ‘do you ever feel worried for your safety’
- support and empower- listen to the person and acknowledge what has happened, validate they are not alone and that you will support them to get help
- assess risk- first priority is determining immediate risk- call police or security. There may be risk of self harm or homicide
- plan safely- is emergency assistance required, consider who needs to be notified, is an urgent referral to mental health services required?
- document- document concerns in the progress notes and on an incident form, use their own words when possible, document names and injuries, a physical examination may be required
- refer- will be influenced by the urgency of safety concerns, the complexity of the older persons condition and the readiness of the person to disclose information
what are the different types of dementia
- alzhiemers- slow progression, short term memory loss, poor judgement, word finding difficulties, behavioural and psychological symptoms of dementia (BPSD) at some stage
- vascular dementia- step wise progression, word finding difficulties, executive function issues, slow reasoning and impaired problem solving
- mixed dementia- occurs when a person has more than one type of dementia, usually alzhiemers and vascular dementia
- lewy body and parkinsons disease dementia- movement disorders, visual hallucinations, sleep difficulties, depression, impaired cognition, poor autonomic regulation, apathy
distinguish between the 3 D’s- dementia, delirium and depression
Dementia- slow and gradual onset, progressive and unpredictable course, progresses until death unless precipitated by comorbidity
Delirium- rapid over a short period, hours to days onset, fluctuates over 24 hours course and lasts days to weeks. it is a disorienting mental state caused by confusion. it starts suddenly and appears and disappears at any time
Depression- can be sudden or gradual, often not recognised or misdiagnosed in the elderly, self limiting and may last up to 2 years
BPSD- behavioural and psychological symptoms of dementia
assessment and person centered care
effects of providing support
- prioritise non pharmacological interventions
- individualise care
- identify target behaviours and update personal care
- exclude medical causes e.g delirium
agencies and support services
- carers NZ
- Alzheimers NZ
- carer support
- WINZ
screening tools to assist in the diagnosis of dementia
- abbreviated mental test
- montreal cognitive assessment
- addenbrookes cognitive examination
- rowland universal dementia assessment scale
- General practitioner assessment of cognition (GPCOG)
- mini- ACE
behavioural and psychological symptoms of dementia
- agitation and aggression
- depression
- apathy
- anxiety
- wandering
- nocturnal disruption
- psychotic symptoms
dealing with scenarios
- is this hitting boredom?
- music therapy, touch therapy, a twiddle muff or board - is this withdrawal actually sadness
- increase social contact, pet contact or diversional activity - is this anxiety actually fear
- create a familiar structured routine, have a prominent clock and calendar - is this wandering related to continence, pain or loneliness
- ensure wandering is safe, signage for toilets, display familiar people and things
