Elder Abuse

Question 1

What is elder abuse?

Answer 1

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 an informal caregiver?

Answer 3

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 4

What are 7 categories of elder abuse?

Answer 4

Financial
Psychological/emotional
Physical
Neglect
Medication abuse
Sexual abuse
Violation of rights

Question 5

What are 5 theories of elder abuse?

Answer 5

Exchange Theory or Dependency Theory
Political Economic Theory
Situational Theory
Transgenerational (Social Learning)
Pathologic Personality Theory

Question 6

What is the Exchange Theory or Dependency Theory of elder abuse?

Answer 6

Emphasizes care recipient’s dependency on others through physical or mental impairments.

Question 7

What is the Political Economic Theory of elder abuse?

Answer 7

Changing roles via loss of independence and income.

Question 8

What is the Situational Theory of elder abuse?

Answer 8

Care recipient viewed as source of stress to abuser (caregiver).
Unrelenting responsibility of chronically ill older person may trigger abuse.

Question 9

What is the Transgenerational (Social Learning) Theory of elder abuse?

Answer 9

Violence as learned set of behaviours passed from generation to generation.

Question 10

What is the Pathologic Personality Theory of elder abuse?

Answer 10

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

Question 11

What are two sources of primary stressors to informal caregivers?

Answer 11

Concrete manifestations of the caregiving situation

Issues within the caregiver

Question 12

What are some examples of informal caregiver objective stressors: concrete manifestations of the caregiving situation?

Answer 12

Cognitive impairment, problematic behaviour, ADL dependency and resistance

Question 13

What are some examples of informal caregiver subjective stressors: issues within the caregiver?

Answer 13

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

Question 14

What are secondary stressors to informal caregivers?

Answer 14

The extent to which caregiving intrudes into non-care elements of Informal Caregiver’s life.

Question 15

What are some examples of secondary stressors to informal caregivers?

Answer 15

Family conflict, work conflict, financial strain, intimacy, social availability

Question 16

What can occur as a result of primary and secondary stressors to informal caregivers?

Answer 16

Primary and Secondary stressors together can result in a loss of self, loss of competence, a sense of hopelessness and depression.

Question 17

What are some covert manifestations of psychological abuse?

Answer 17

Ambivalence, deference to caregiver.

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

Question 18

What are some overt manifestations of psychological abuse?

Answer 18

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

Question 19

What are some manifestations of physical abuse?

Answer 19

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 20

What are some manifestations of neglect?

Answer 20

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 21

What are some potential profiles/characteristics of the abused?

Answer 21

65 years or older
Living with relatives or informal caregiver
Females
Isolated, lack of social contacts
Physical or mental impairments

Question 22

What are some potential profiles/characteristics of abusers?

Answer 22

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

Question 23

What are some questions that the nurse can ask an elderly patient to assess for elder abuse?

Answer 23

Did someone hurt you? Hit you?
Has anyone every 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 24

What is financial abuse?

Answer 24

This is the improper use of an elderly person’s pension or finances.

Question 25

What are some examples of medication of abuse?

Answer 25

neglecting to give them. Taking their meds themselves instead of giving it to the patient. Over sedating them just to make it easier to care for them

Question 26

What is cachexia?

Answer 26

Muscle wasting from lack of nutrition

Question 27

What kind of interactions between the patient and caregivers might be “telling behaviours” that indicate elder abuse? (What kind of interactions between the patient and their caregiver might make you uncomfortable?

Answer 27

-Defensiveness
-Won’t let you talk to the patient by themselves (this is a big red flag)
-When they talk for the patient even when the patient is very capable of talking for themselves.
-The tone of the conversation. Are they speaking to the patient as if they’re a child? Is it an aggressive tone? Are they passive-aggressive?
(Family members who have dysfunctional communication between them, sometimes aren’t aware that it’s dysfunctional so they interact that way in front of others like the nurse and it can be quite shocking. They aren’t aware that it isn’t normal).
-How gruff a family member is with the patient in physical interactions. Eg. how they transfer them.

Question 28

What is the nurse’s role in dealing with elder abuse? (3 points)

Answer 28

Education - to prevent Elder abuse

Assessment – thorough documentation

Intervention – patient safety

Question 29

What are some telling behaviours that we as nurses can assess for?

Answer 29

Interactions

Tone of conversation

Reactions

Question 30

What are some questions you can ask of the patient and their caregiver when you assess for elder abuse?

Answer 30

When did the incident occur?
Who was involved in the incident?
How did it happen?
How often have these types of incidents happened in the past?

Question 31

What are some important considerations when documenting about possible elder abuse?

Answer 31

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 32

What are some interventions for elder abuse?

Answer 32

Facility’s policy i.e. emergency response team
Elder Abuse protective services:
BC Center for Elder Advocacy and Support
BC Victim’s Information Line: 1-800-563-0808
Long-term care programs/Office of Public Trustee (financial abuse/neglect investigation)
Law Enforcement