Elder Abuse

Question 1

***What are the different types of abuse?

Answer 1

1. Passive and Active Neglect
2. Physical abuse
3. Financial abuse
4. Psychological abuse (violations of basic rights)
5. Sexual abuse
6. Self Neglect

Question 2

***What is Passive and Active Neglect? What is the difference between passive and active?

Answer 2

The failure to meet the physical, social and/or emotional needs of the older person.
Active = intentional
Passive = unintentional (often the result of caregiver overload or lack of training/information)
***Difference is the INTENT!!!

Question 3

What is the most common type of elder abuse?

Answer 3

Neglect (passive, active and self)

Question 4

***Passive and Active Neglect: What are the indicators of abuse?

Answer 4

• Evidence that personal care is lacking or neglected
• Signs of malnourishment
• Chronic health problems both physical and/or psychiatric
• Pressure sores

Question 5

What are some examples of physical abuse?

Answer 5

slapping, chaining/tying down, pinching, beating, pushing

Question 6

***Physical abuse: What are the indicators of abuse?

Answer 6

Injuries, pain upon being touched, weird explanations of injuries

Question 7

What is Financial abuse?

Answer 7

Misuse, misappropriation, and/or exploitation of an older adult’s possessions (material possessions, property or monetary assets).

Question 8

***Financial Abuse: What are the indicators of abuse?

Answer 8

Unusual banking activity, missing personal belongings, weird checks

Question 9

What is Psychological Abuse?

Answer 9

Intentional infliction of mental harm/psychological distress on the older adult:
Insults, Verbal assaults, Threats of physical harm, Isolation, Violation of basic rights such as right to privacy, freedom of religion, etc.

Question 10

***Psychological Abuse: What are the indicators of abuse?

Answer 10

• Ambivalence, deference, passivity, shame, anxiety, depression, hopelessness, helplessness, suicidal thoughts, confusion, disorientation.
• Trembling, clinging, cowering, lack of eye contact, evasiveness, agitation.

Question 11

What is Sexual abuse?

Answer 11

Any sexual activity for which the older person doesn’t consent or is incapable of giving consent.
Examples: exhibitionism, fondling, oral, anal or vagina intercourse

Question 12

***Sexual abuse: What are the indicators of abuse?

Answer 12

Genital trauma, venereal disease, infections

Question 13

What is Self-Neglect?

Answer 13

The older person fails to meet their own physical, psychological and/or social needs.
Represents the highest percentage (40-50%) of cases of elder abuse reported to APS.

Question 14

What are some risk factors for Self-Neglect?

Answer 14

• Long-term Self-Neglect: Pattern of self-neglect not unique to old age.
• Often times individual w/ underlying undiagnosed or untreated mental health problem (dementia)
• Escalates when paired with physical impairment, social isolation, malnutrition, substance abuse, cognitive impairment and/or limited financial resources.
• Cognitive impairment d/t: hypothyroid, anemia, infections, malnutrition, overmedication.
• Substance abuse
• Isolation
• Poverty
• May be resistant to intervention due to past negative experiences (voluntary or involuntary)

Question 15

***How should you intervene in cases of self-neglect?

Answer 15

Begin small with high degree of respect for the individual and their decisions. As trust increases, so can the amount of intervention or help accepted by the senior
• If depression, rapid intervention and treatment is essential (highly treatable, but high risk of suicide especially white males (12x higher than others)).

Question 16

***What are some other indicators of abuse?

Answer 16

• Overmedication or oversedation
• Elder is not given the opportunity to speak without the caregiver being present
• Caregiver exhibits high levels of indifference or anger towards the older adult

Question 17

What are some of the causes of abuse?

Answer 17

1. Caregiver stress
2. Impairment of the older adult
3. External Stress on the Caregiver
4. Social Isolation
5. Intergenerational Transmission
6. Intra-individual Dynamics

Question 18

***What is the #1 reason of institutionalization of the frail older adult? What is the #1 reason family caregivers give as their decision to place patient in a nursing home?

Answer 18

Caregiver stress.

Lack of sleep.

Question 19

How does impairment of the older adult lead to abuse?

Answer 19

1. Studies have found that individuals in poor health are more likely to be abused than those in relatively good health (As dependency increases so does caregiver resentment and stress)
2. Caregivers financially dependent on senior are more likely to perpetrate abuse (Hypothesized to counteract the feelings of powerlessness experienced by the CG)

Question 20

What are some examples of external stress on the caregiver that can lead to abuse?

Answer 20

Financial problems, job stress, family stressors

Question 21

What is a risk factor for all forms of elder abuse?

Answer 21

Social isolation

Question 22

What is intergenerational transmission (cause of abuse)?

Answer 22

Violence as a response to conflict, anger or tension.

Controversial hypothesis: “what goes around comes around”.

Question 23

What are some examples of Intra-individual Dynamics?

Answer 23

Alcoholism
Drug addiction
Emotional disorder

Question 24

What are some examples of preventative measures for abuse?

Answer 24

• Maintain social contacts
• Ask friends to visit at home
• Participate in social and community activities
• Plan for the future (DPOA, DPAHC, trusts, wills)
• Arrange for direct deposit
• Examine ability to provide long-term, in-home care
• Explore advice/resources offered by agencies (local aging services, AARP, Alzheimer’s Association, geriatric social workers)
• Assess caregiver resources

Question 25

What must you do if you suspect abuse?

Answer 25

Must report suspicions to Adult Protective Services (APS)