Elder Abuse

Question 1

What is elder abuse?

Answer 1

• Any pattern of behaviour by a person or caregiver resulting in physical or mental harm to an older person
• Implies actions taken by caregiver, relative or acquaintance causing injury or creating unmet needs
• Acts of commission

Question 2

What is elder neglect?

Answer 2

• Implies failure or refusal to fulfill any part of a person’s obligations or duties to an elder
• Acts of omission

Question 3

What is the main difference between elder abuse and neglect?

Answer 3

Act of commission vs. omission

Question 4

Who are informal caregivers?

Answer 4

• Family member or friend whose assistance allows people to be able to live in the community
• Unpaid care provided by family and/or friends

Question 5

What are the 7 categories of elder abuse?

Answer 5

1) Financial (stealing money, pension, old age security, etc.; selling home and keeping profits for self)
2) Psychological/emotional (isolation, verbally intimidating them, humiliating them, manipulation in DNR’s)
3) Physical (intentional harming; restraints, assault)
4) Neglect (acts of omission, neglecting necessities of life, keeping them safe)
5) Medication abuse (taking meds for themselves, not giving it to them)
6) Sexual abuse (form of physical abuse)
7) Violation of rights

Question 6

What is the exchange theory or dependency theory?

Answer 6

• Emphasizes the care recipient’s dependency on others through physical or mental impairments
• Elderly have multiple co-morbidities and can be completely co-dependent on caregivers

Question 7

What is the political economic theory?

Answer 7

Changing voles via loss of independence and income

Question 8

What is the situational theory of abuse?

Answer 8

• Recipient is a source of stress to abuser (caregiver)

- Unrelenting responsibility of chronically ill older person may trigger abuse

Question 9

What is the trans-generational (social learning) theory?

Answer 9

• May not be as contributory as once thought; not as strong as other four
• Violence as learned set of behavior’s passed from generation to generation

Question 10

What is the pathologic personality theory?

Answer 10

• Focuses on abuser
• Low tolerance for frustration, passive-aggressive, sadistic tendencies, habitual use of aggression (i.e. ineffective coping patterns, marital or family conflict, substance abuse, mental illness)

Question 11

What are three factors that are more likely to predict elder abuse?

Answer 11

1) Drugs/alcohol
2) Dependency on caregiver
3) History of family violence

Question 12

What are informal caregiver objective stressors?

Answer 12

• Concrete manifestations of the care-giving situation

- Cognitive impairment, problematic behavior, ADL dependency and resistance

Question 13

What are informal caregiver subjective stressors?

Answer 13

• Issues within the caregiver

- Unremitting feelings of entrapment, confinement, exhaustion, depression and burnout

Question 14

What are covert manifestations of psychological abuse?

Answer 14

• Ambivalence, deference to caregiver

- Passivity, denial, mild anxiety, non-responsiveness, implausible stories when compared to their physical condition

Question 15

What are overt manifestations of psychological abuse?

Answer 15

• Isolation, trembling, cowering in presence of caregiver
• Confusion, anger, agitation when caregiver present
• Fearfulness, depression, helplessness, hopelessness, severe anxiety, nervous breakdown

Question 16

What are manifestations of physical abuse?

Answer 16

• Multiple injuries or fractures in various stages of healing
• Bruises in clusters or in shape of objects i.e. ‘wraparound injuries’ or shape of belt buckles
• Bilateral or parallel injuries i.e. control or forceful restraining/shaking
• Burn marks i.e. soles of feet, palms
• Sprains / dislocations
• Unusual hair loss, swollen scalp, scalp hemorrhage

Question 17

What are manifestations of neglect?

Answer 17

• Deteriorating health i.e. cachexia, wasting
• Dehydration/malnutrition
• Pressure ulcers or contractures
• Excessive dirt or odor on body/clothing
• Urine burns
• Glasses, dentures, hearing aids, walking devices in poor repair, or missing
• Left alone or unsafe for long periods
• Over or under medication

Question 18

What are potential profiles of the abused?

Answer 18

• 65+ years
• Living with relatives or informal caregiver (vulnerable situation where care is expected)
• Females
• Isolated, lack of social contacts
• Physical or mental impairments

Question 19

What are potential profiles of abusers/perpetrators?

Answer 19

• Middle aged
• Poor mental health, drug or alcohol dependence
• In same household as victim
• Financially or psychologically dependent on the victim
• Often male, most often spouse (physical abuse)
• Adults abused as children 20x likely to abuse
• Hx aggressive episodes
• Feelings of powerlessness, vulnerability, dependency

Question 20

How do we assess telling behaviors of abuse?

Answer 20

• Interactions
• Tone of conversation (e.g. patient suddenly quiets when abuser is present, but is normally lively and talkative)
• Reactions (e.g. anxiety, withdrawn, when abuser present)

Question 21

What is the nurses roles in elder abuse?

Answer 21

• Education (to prevent elder abuse) (e.g. teaching caregivers expected behaviors, trajectory of illness)
• Assessment (documentation)
• Intervention (patient safety)

Question 22

What are some assessment questions we can ask while we are alone with the patient?

Answer 22

• Did someone hurt you? Hit you?
• Has anyone ever touched you without your consent?
• Does anyone slap you, pull your hair, touch you in a rough way or threaten to do these things to you?

Question 23

What questions can we ask to the caregiver and patient?

Answer 23

• Be creative in approach, and appear curious without directly placing blame. Assess to see if abuser answers, stories are consistent, etc.
• When did incident occur?
• Who was involved in incident?
• How did it happen?
• How often do these incidents happen or have happened in the past?

Question 24

What do we document?

Answer 24

• Document all objective /subjective data gathered
• “Quote” patient’s and caregiver’s explanations of injuries
• Note discrepancies in stories
• Body map injury sites/identify type
• Photo-document

Question 25

What are some interventions for elder abuse?

Answer 25

• Facility’s policy i.e. emergency response team
• Elder Abuse protective services:
• BC Center for Elder Advocacy and Support
• BC Victim’s Information Line: 1-800-563-080
• Long-term care programs/Office of Public Trustee (financial abuse/neglect investigation)
• Law Enforcement