Elder Abuse/Child Protection Flashcards
What is the statistics of elder abuse in nz?
1/10 people over 65
Whats the definition of elder abuse?
A single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person
“can be physical, psychological or emotional, sexual or financial in nature”.
“can be the result of intentional or unintentional neglect”
What % is psychological abuse?
79%
What % is financial abuse?
54%
What % is physical abuse?
19%
What % is neglect?
17%
What % is sexual abuse?
1%
What fraction of abuse cases go unreported?
3/4 cases go unreported
What are Red flags for possible abuse?
- anxious for no obvious reason
- irritable or angry
- disturbed sleep, poor appetite
- helpless, hopeless or sad
- reluctant to talk openly or defers to caregiver
- avoids eye contact or recoils when touched
- lack of spending on self ‐ necessities / socially
- depleted savings / missing possessions
- fear of bathing or toileting
What are possible caregiver behaviors of concern?
- blaming the older person for their behaviour e.g., wandering or incontinence
- insisting on being present when the older person is interviewed
- shopping around for medical attention
- over concerned or unconcerned
- ‘shifty’ – evading questions
What are risk factors for abuse and neglect?
MAY raise suspicion ‐
* the abused lives with the abuser
* history of family conflict (cycle of abuse)
* increasing dependence on others
* presence of alcohol or substance abuse
* poor literacy or awareness of rights
* cognitive impairment e.g. dementia
What % of abused people live with their abuser?
42%
What is an example of psychological abuse?
Behaviour that results in mental anguish or despair
- Intimidation
- Harassment or humiliation
- Threats of harm to an older person, there family pets etc.
- Withholding affection
- Verbal abuse
- Ignoring
- Treating the older person like a child
- Saying hurtful things
Whats an example of financial or material abuse?
Illegal or improper exploitation and or/ use of funds or other resources
- Withdrawing money from bank accounts
- Misuse of EPOA
- Failing to repay loans
- Withholding money from older person
- Deciding what they can or can’t spend there money on
What are signs of Financial abuse?
- signs of misuse of an EPOA, with control over an older person’s money and decisions
- signatures on documents not resembling the older person’s
- little spent on necessary aids e.g., glasses, hearing aids, meds
- little spent on social, cultural stimulation
- absence of basic hygiene / inappropriate clothing
Why does elder abuse occur?
Carer stress
Relationship dynamics- power and control
Social isolation
Vulnerability of older people
Ageist attitudes
What act is relevant to elder abuse
Crimes amendment act
What is the purporse of the Crimes amendment act
“Anyone who has actual care or charge of a vulnerable adult is under a duty to provide that person with necessities and take responsible steps to protect them from injury”
” Anyone who has care or charge of a vulnerable adult or is a staff member of a hospital may be criminally liable if their conduct is likely to have caused suffering, injury, adverse effect to health”
What is the Family violence intervention guidelines Elder abuse and neglect?
Applies to hospital, ARC and community
Inter‐agency protocols and government legislation try to protect victims and empower health professionals
ALL health professionals have a responsibility to screen for abuse
What are the 6 steps approach for caregivers when screening for abuse
(1) Identify
(2) Support and Empower
(3) Assess Risk
(4) Plan Safety
(5) Document
(6) Refer
What does it mean to Identify (Abuse screening)
Questions
Patient
- Are you afraid of anyone?
- Do you ever feel worried about your safety?
- How do you spend your days?
- How do you feel your caregiver is managing?
- Do you have everything you need to take care of yourself?
- Have you had things go missing?
- Has anyone ever made you do anything that you didn’t want to do?
Carer
◦ How has life changed for you since becoming a caregiver?
◦ How has if affected your relationship?
◦ Do you get enough time for a break for yourself?
◦ Are you ever worried that you might hurt somebody?
What does it mean to Support and empower (Abuse screening)
Listen to the person’s story
Acknowledge what has happened ‐ “that must have been terrifying” .. “you are very strong to have survived that”
Reinforce that this is not their fault and they are not alone
Validate that you will support them and get help
Reinforce that violence is not OK and is a CRIME, not just a private family matter
The older person’s willingness to accept help and make choices will affect intervention options
If you suspect abuse but the individual denies it, leave the door open for further contact
Provide them with the details of support agencies
What does it mean to Assess risk (Abuse screening)
Your FIRST priority is immediate risk – may need to police or security
May be risk of self harm or homicide
Appropriate referral to SPECIALIST abuse services is recommended
Telephone advice may be useful during preliminary risk assessment
NOTE, evidence of abuse is NOT required for referral
Whos more Risk of SELF HARM
Older men have a greater risk of suicide than older women
Warning signs for extra concern in seniors
* previous attempts
* a well‐developed plan
* access to the means of implementing it
* planning for suicide (e.g., putting affairs in order, having final catch‐ups)
Any person expressing suicidal ideation should be assessed by a mental health clinician before being discharged home (NZGG, 2003a).
What does it mean to plan safety (Abuse screening)
Requires an MDT approach including colleagues trained in elder abuse response and intervention
Decide what action to take – ideally the least disruptive
- Will the action cause further harm?
- What services are available?
- Who needs to be notified?
The older person has the right to make an informed decision about WHAT action is taken and WHEN
MUST respect self‐determination and the RIGHT TO REFUSE assistance at this time
Leave the door open for future contact with contacts for specialist services
Most cases of elder abuse and neglect are not crisis situations
What does it mean to Document (Abuse screening)
Document concerns ‐ incident form
In suspected physical or sexual abuse, a thorough examination is required, including lab tests and X‐rays
Confidentiality and privacy
Record ethnicity and primary language and cultural considerations
Use the person’s own words (verbatim) as much as possible
If known, state the identified abuser’s name or relationship to the older person
Note actual / suspected cause of any injuries, and when they allegedly occurred
Mark the site(s) of old and new injuries on a body injury map
Date / sign / designation etc
What does it mean to Refer (Abuse screening)
Referral relationships and inter‐agency protocols need to be in place
The point at which to make a referral will require professional judgement, influenced by:
* the urgency of safety concerns
* the readiness of the person to disclose information / accept referral
* the complexity of the physical, social and mental health needs
Referral of the abuser may also be appropriate e.g., to alcohol and drug services
Referral for older Māori, Pacific or ethnic communities ‐ requires knowledge of groups within the local
community who hold the necessary knowledge and skills
