Elder Mistreatment Flashcards
Elder mistreatment is a complex syndrome including actions such as?
abuse, neglect, exploitation, and abandonment of an elder person
elders mistreatment in all forms involves what?
trusting relationship between an older person and another individual in which the trust is violated in some way
what are the 4 patterns of abuse
physical, psychological, financial, neglect
What is the epidemiology of Elder Mistreatment
prevalence is in the 2-5%
Estimated that only 1 in 14 domestic abuse cases come to attention of authorities
Elder mistreatment crosses all ethnic and socioeconomic boundaries
what are the 3 main theories of elder mistreatment
trans-generational violence- abuse is learned
dependence theory-stressed caregiver
Psychopathology of the abuse theory- Focus shifts from the victim to the abuser who may have mental health or substance abuse issues
Elder mistreatment risk factors
Very old Female poor mental or physical health cognitive impairment poor social support low income Hx of violence
who are the most common perpetrators in elder mistreatment
spouses and adult children are most common
who is more likely to be an abuser to elders sons or daughters?
they are equally likely
what are some other characteristics of abusers
dependent on victim for financial or living support
substance abuse
mental health conditions
advanced age and poor physical/mental health
abuse in nursing homes
less common now due to increased scrutiny, laws and regulations
resident on resident abuse is more common
residents assaulting employees (dementia)
What characteristics may predict abuse in the nursing home setting
quality of care increases with # of beds
non profit homes superior to for profit
increased nursing home costs=better care
nureses/aides with lower levels of education tend to be more abusive
younger staff= increased negative attitudes towards the elderly
nurses more empathetic than aides
staff with longer time working with elderly have more positive attitudes toward elderly
elder mistreatment patient presentation
difficult clinical challenge
many chronic disease have clinical manifestation that mimc abuse (Fractures, depression, malnutrition)
provider must have heightened awareness
Challenges with elder mistreatment
environment may be a challenge like a hurried ED encounter
caregiver may be present
listen to input from ancillary staff or home healthcare providers
what the easy approach in trying to find elder mistreatment
ask patient do you feel safe in your home
These behaviors from the caregiver should raise an index of suspicion
Loss of control or fears losing control
Presents a contradictory hx that does not explain injury
Project cause of injury onto a third party
Delay in bringing pt in for care
Over/underreact to seriousness of situation
Complain about other issues unrelated to the injury
Refuse consent for procedures or tx
Remove a pt from a facility
what is the management for elderly mistreatment
First and foremost ensure safety for the victim!!
Call 9-1-1 if necessary
- Intervention is critical-Elder mistreatment victims are at a three fold risk of death or nursing home placement
other resources to help with elder management
Adult daycare Financial Manager Legal Guardian Meals on Wheels Support Groups Nursing Home Placement Home Health Care
Intimate partner violence (IPV)
Intentional controlling behavior consisting of physical, sexual, or psychological assaults in the content of an intimate relationship
intimate partner violence stats
silent epidemic
-Available data underscores the magnitude of the problem
-28% of couples reported violence at some point in their relationship
-4% of women reported severe violence
-Est that 4 million women are subjected to violence in US
500,000 require medical tx
does not discriminate
similar in homosexuals
as providers we do a poor job detecting IPV
what may double risk of IPV
pregnancy
IPV diagnosis
may present with direct or indirect S/S of abuse
thorough hx
what are red flags for IPV
-delay in seeking care
-illogical explanation of injury
-black eyes are not caused by door knobs
-multiple somatic complaints- fatigue, HA, chest pain
-depression and anxiety
-1 out of 10 attempt suicide
-pregnancy
-substance abuse
-recent dx of HIV
FHx of IPV
-overbearing partner
IPV physical exam findings
Inappropriate behavior- fright crying, no eye contact
Multiple injuries-more extensive than trauma from a true accident
Injuries tend to occur to the center of the body:
Head, neck, chest, Abdomen, breasts
Injury to upper arms from fending off attacks
Bruises, lacerations, burns, bites, and Fractures
Injuries at different stages of healing
screening for IPV ask difficult questions the right way
What happens when you have a fight with your partner?
Do you feel safe at home?
Do you ever feel afraid of your partner
Does your partner ever abuse your children?
If answers are vague or evasive more direct questioning is needed
Be supportive and non judgmental
what are the 5 basic task for IPV Tx?
-Validate the problem Assess patient safety Document clearly and completely Provide information and appropriate referrals Reporting requirements
IPV pitfalls
Do not try to control the victim’s behavior-Terminating relationship
Do not recommend couples therapy
Do not use the word alleged-perceived as not believing victim
Do not ask what provoked the violence
IPV barriers for providers
Lack of provider training
Lack of institutional support
Lack of time
Provider discomfort
IPV barriers for patients
fear economic psychological social support lack of options
mandatory reporting
In MA-Depends on the mechanism of injury
Firearms, knife wounds or burns
In NH-Only if victim of GSW
