Elder Mistreatment and Family Caregiving Flashcards
Exam 4 (Final)
Definitions:
Elder mistreatment:
What does it include:
Elder mistreatment is a complex phenomenon that includes elder abuse and neglect.
Definitions:
Elder mistreatment:
What is it?
It is the infliction of actual harm, or a risk for harm, to vulnerable older persons through the action or behavior of others (American Psychological Association [APA], 2020).
Definitions
Elder Abuse:
What is it?
Elder abuse is 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.
Elder Abuse:
This type of violence constitutes a violation of what and includes what?
This type of violence constitutes a violation of human rights and includes
physical, sexual, psychological and emotional abuse;
financial and material abuse;
abandonment;
neglect;
and serious loss of dignity and respect.
Key facts
What percent of those older than 60 years of age have been or will be mistreated?
Up to 15.7% of those older than 60 years of age have been or will be mistreated (World Health Organization [WHO], 2020).
Key Facts:
Where are rates of elder abuse high? How many staff reported that they committed abuse in the past year?
Rates of elder abuse are high in institutions such as nursing homes and long-term care facilities, with 2 in 3 staff reporting that they have committed abuse in the past year.
Key Facts:
What is the impact of COVID on elder abuse?
Rates of elder abuse have increased during the COVID-19 pandemic.
Key Facts:
What can elder abuse lead to?
Elder abuse can lead to serious physical injuries and long-term psychological consequences.q
Key Facts:
What is predicted to happen to elder abuse?
Elder abuse is predicted to increase as many countries are experiencing rapidly ageing populations.
Key facts:
What is the global population of people aged 60 and older in 2015 to 2050?
The global population of people aged 60 years and older will more than double, from 900 million in 2015 to about 2 billion in 2050.
Elder Mistreatment :Invisibility and Vulnerability
What happens to the vast majority of cases?
Vast majority of cases go unreported
Elder Mistreatment :Invisibility and Vulnerability
What is associated with vulnerability?
Social, personal, situational, and environmental factors associated with vulnerability
Elder Mistreatment :Invisibility and Vulnerability
How may older adults be?
Older adults may have less contact with the outside world
Older adults reluctant to admit to abuse/neglect
Significant psychosocial limitations (due to dementia, depression, and mental health issues) that reduce the ability to remember or seek help
Elder Mistreatment :Invisibility and Vulnerability
What may there be an absence of for older adults?
Absence of close relatives and other support persons able or willing to provide adequate assistance
Which of the following factors does NOT contribute to the invisibility of elder abuse?
A. Older adults have less contact with the community
B. Older adults are reticent to admit being abused
C. Myths foster denial of problems of vulnerability
D. Most older adults live in long-term care settings
D. Most older adults live in long-term care settings
A very small portion of the older adult population lives in long-term care settings. One of the major risk factors for elder abuse is its invisibility
Elder Abuse and Neglect
Elder abuse/mistreatment is defined by what?
Elder abuse/mistreatment is defined by intentional actions causing harm or create serious risk of harm, whether or not intended to vulnerable older adult by a caregiver or other person who stands in trust relationship, or failure by the caregiver to satisfy older adult’s basic needs or protect from harm
Elder Abuse and Neglect
What are three basic categories?
Domestic elder abuse
Institutional elder abuse
Self-neglect or self-abuse
Self-Neglect
What is it?
A behavior in which people fail to meet their own basic needs in the manner in which the average person would in similar circumstances
Self-Neglect
Who would be considered engaging in self neglect?
Persons who do not maintain a socially acceptable level of self-care would be considered engaging in self-neglect.
Self-Neglect
Persons who do not maintain a socially acceptable level of self-care would be considered engaging in self-neglect.
What is an example?
A refusal or failure to provide adequate safety, food, water, clothing, shelter, personal hygiene, or health care
Self-Neglect
Persons who do not maintain a socially acceptable level of self-care would be considered engaging in self-neglect.
What may is be caused by?
May be caused by diminished capacity or by long-standing lifestyle, homelessness, or substance use
Self-Neglect
What questions exist pertaining to this?
Ethical and legal questions as to how much health care professionals can and should intervene in these situations
Seven Major Types or Forms of EM
(Elder mistreatment)
Physical abuse (2.6%)
Sexual abuse (0.9%)
Emotional or psychological abuse (11.6%)
Neglect (4.2%)
Abandonment
Financial/material abuse/exploitation (6.8%)
Self-neglect
Functional Consequences Associated With Elder Abuse and Neglect
Physical abuse:
Physical abuse: inflicting and threatening to inflict physical pain or injury or depriving a basic need
Functional Consequences Associated With Elder Abuse and Neglect
Sexual abuse:
Sexual abuse: nonconsensual sexual contact of any kind, coercing to witness sexual behavior
Functional Consequences Associated With Elder Abuse and Neglect
Emotional/psychological abuse:
inflicting mental pain, anguish, and distress through verbal or nonverbal acts
Functional Consequences Associated With Elder Abuse and Neglect
Financial exploitation:
illegal taking, misuse, concealment of funds, property, or assets
Functional Consequences Associated With Elder Abuse and Neglect
Neglect:
Neglect: refusal, failure to provide food, shelter, health care, or protection
Functional Consequences Associated With Elder Abuse and Neglect
Abandonment:
Abandonment: desertion by anyone who assumed responsibility for care
Functional Consequences Associated With Elder Abuse and Neglect
Self-neglect:
threats to his or her own health or safety
Slide 10
Risk Factors Associated With any Type of abuse:
Older Adult Factors include:
Physical dependence
Dementia
Problem behaviors
Risk Factors Associated With any Type of abuse:
Perpetrator Factors include:
Mental illness (e.g., history of psychiatric hospitalization)
Substance abuse
Hostility in general or directed toward victim
Financial or housing dependence
Risk Factors Associated With any Type of abuse:
Risks Factors According to Forms of Abuse:
Emotional Abuse
Lack of social support
Physical dependence
Prior traumatic experiences
Risk Factors Associated With any Type of abuse:
Risks Factors According to Forms of Abuse:
Physical Abuse
Substance abuse (perpetrator)
Mental illness (perpetrator)
Unemployment (perpetrator)
Social isolation
Lack of social support for the older adult
Risk Factors Associated With any Type of abuse:
Risks Factors According to Forms of Abuse:
Neglect
Low income
Poor health
Inadequate social support
Risk Factors Associated With any Type of abuse:
Risks Factors According to Forms of Abuse:
Financial
Physical disability
Female sex
African-American race
Risk Factors Associated With any Type of abuse:
Risks Factors According to Forms of Abuse:
Sexual
Low social support
Prior traumatic events
Risk Factors Associated With any Type of abuse:
Risks Factors According to Forms of Abuse:
Self-Neglect
Physical disability
Medical conditions Cognitive impairment Mental illness Inadequate social supports
What is the definition of exploitation, as a form of abuse?
A. Intentional or unintentional refusal or failure to provide goods or services
B. Illegal taking, misuse, or concealment of funds, property, or assets
C. Infliction of mental pain, distress, or anguish through verbal or nonverbal acts
D. Deprivation of a basic need or inflicting physical injury
B. Illegal taking, misuse, or concealment of funds, property, or assets
Neglect is the intentional or unintentional refusal or failure to provide goods or services.
Emotional abuse includes the infliction of mental pain, distress, or anguish.
Physical abuse is the deprivation of a basic need or actual or threatened infliction of physical pain, injury, or violence
Which older adult is most likely to be a victim of elder mistreatment?
A 65-year-old single man with cataracts and diabetes
A 70-year-old widowed woman with moderate hypertension
A 75-year-old man with chronic kidney disease living in a long-term care setting
A 82-year-old woman with Alzheimer’s disease living with family in the community
ANS: D
The most likely victim of elder mistreatment is a woman of advanced age who is physically or mentally frail and dependent on the abuser.
Older adults, particularly those with Dementia , are often marginalized and stripped of their dignity and more likely to be victims of abuse /neglect/ mistreatment.
Assessment –Caregiver
Who should be assessed?
Caregivers of older adults should be assessed
Assessment –Caregiver
Caregivers of older adults should be assessed
For what?
For caregiver stress
For substance abuse
For a history of psychopathology
Assessment –Caregiver
Caregivers of older adults should be assessed
How should interviews be?
Separate interviews should be conducted for the caregiver and the patient
Assessment –Caregiver
Caregivers of older adults should be assessed
Separate interviews should be conducted for the caregiver and the patient
What may inconsistencies indicate?
Inconsistencies might increase the suspicion of abuse
Assessment –Caregiver
Caregivers of older adults should be assessed
Separate interviews should be conducted for the caregiver and the patient
Who is more likely to abuse or neglect?
- Family member
- One with emotional or mental illnesses
- One who is abusing alcohol or other substances
- History of family violence
- Cultural acceptance of interpersonal violence
- Caregiver frustration
- Social isolation
- Impaired impulse control of caregiver
Nursing Assessment of Abused or Neglected Older Adults
Unique aspects of elder abuse assessment:
What should there be an awareness of? Who is involved in assessment? What kind of environment is created?
Awareness of differences based on cultural perceptions of mistreatment
An interdisciplinary team
A nonjudgmental environment
Nursing Assessment of Abused or Neglected Older Adults
Unique aspects of elder abuse assessment:
What is the priority?
Safety *Priority nursing: Assess whether the client is safe in the home environment
Nursing Assessment of Abused or Neglected Older Adults
Unique aspects of elder abuse assessment:
What kind of intervention may be necessary?
Legal intervention
Nursing Assessment of Abused or Neglected Older Adults
Unique aspects of elder abuse assessment:
What is the nurse’s core responsibility?
The nurse’s core responsibility is to report suspected elder abuse, not to confirm the abuse.
The Elder Assessment Instrument (EAI):
What is it?
The Elder Assessment Instrument (EAI), is a 41-item assessment instrument.
The Elder Assessment Instrument (EAI):
What does it do? What is not on the instrument?
that reviews signs, symptoms and subjective complaints of elder abuse, neglect, exploitation, and abandonment.
There is no “score”.
The Elder Assessment Instrument (EAI):
When should a patient be referred to social services?
1) if there is any evidence of mistreatment without sufficient clinical explanation
2) whenever there is a subjective complaint by the elder of EM
3) whenever the clinician believes there is high risk or probable abuse, neglect, exploitation, abandonment
The Elder Assessment Instrument (EAI):
What is the purpose of the instrument?
To be used as a comprehensive approach for screening suspected elder abuse victims in all clinical settings.
In what way does assessment of elder abuse differ from usual nursing assessment?
A. A major focus is to determine whether legal interventions are necessary
B. Realistic goals for the abuse situations are often unlimited
C. Abused elders often seek assistance from health care team
D. The nurse is viewed as a trusted source of assistance
A major focus is to determine whether legal interventions are necessary
realistic goals for elder abuse situations often are quite limited;
cases of elder abuse generally involve some
element of resistance from the older person or caregiver;
the nurse may be viewed as a threat rather than a help;
and legal rights of the person and the caregiver must be addressed
Nursing Assessment of Abused or Neglected Older Adults
could include:
Physical Assessment:
Patterns of injury and info about broader circumstances
Laboratory findings that support the presence of dehydration and malnutrition without medical causes
Nursing Assessment of Abused or Neglected Older Adults
could include: Laboratory findings that support the presence of dehydration and malnutrition without medical causes
What needs to be done by nurses?
Nursing: *need immediate intervention
Nursing interventions to address elder abuse and neglect
What kind of education is provided by nurse to caregivers? When? Why?
Education provided by nurses to help prepare the caregiver for the caregiving role, particularly at the time of discharge from the hospital or nursing home, can help to prevent role strain and lessen burden.
Questions to be addressed with the caregiver include the following
Nursing interventions to address elder abuse and neglect
Questions to be addressed with the caregiver include the following
- What questions do you have regarding care today?
- What questions do you have about care at home?
- How are you doing and what are your needs?
Nursing interventions to address elder abuse and neglect
Nurses should plan for educational interventions for the caregiver, including:
Disease management
Aging changes
Maximizing healthcare services
Respite Care services
Behavioral management
Caregiver issues
support groups
Support Resources:
What do they include:
Support resources include caregivers, friends, relatives, and significant others who influence person’s physical and psychosocial function
Support Resources:
How should support resources be assessed?
Assessment of support resources in terms of both helpful and detrimental
Assessment of barriers to the use of resources
Support Resources:
Who can be perpetrators?
Caregivers can be perpetrators
Threats to Life
What should you assess?
Assess urgency, seriousness of situation with opinion regarding legal interventions justified
Threats to Life
What is the nursing priority assessment? What else should be assessed?
Priority Nursing :
(1)Initial assessment aimed at determining immediate threats to life * is the client safe?
(2) competency / mental capacity
Assess suicide potential
Referrals
What is an important nursing role?
Important nursing role is to initiate and facilitate referrals for various services to improve care for the older adult and decrease burden for the caregiver:
Referrals
What should be assessed?
Assess willingness to accept help
Referrals
What is included?
*Interdisciplinary team consult -Social work
*Interdisciplinary team consult -PT, OT, Speech
*Transportation services
*Medical equipment, supplies, and assistive devices to improve function and safety
*Reputable online resources
Preparedness for Caregiving Scale
What is this? The higher score indicate… Lower score indicates…
Responses are rated on a 5-point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared)
The higher the score the more prepared the caregiver feels for caregiving;
the lower the score the less prepared the caregiver feels.
Interventions in Multidisciplinary Teams
What exists in hospitals:
Hospitals: elder abuse teams
Interventions in Multidisciplinary Teams
What can agencies offer? What are a variety of healthcare professionals available to do?
Agencies offer case management services
Variety of health care professionals available to meet the needs of those in abusive or potentially abusive situations
Interventions in Multidisciplinary Teams
What is done?
Thorough assessments
Interventions in Multidisciplinary Teams
If abuse/neglect is suspects : What is done first? Second?
1st - report to your supervisor
2nd – follow the protocol in your institutions
(activate the elder abuse team)
Interventions in Multidisciplinary Teams
What do nurses need to do if interdisciplinary teams are not in place?
Nurses need to be creative if interdisciplinary teams are not in place
The Three Rs in Detecting and Reporting Elderly Abuse
Recognize
Respond
Report
The Three Rs in Detecting and Reporting Elderly Abuse
Read slide if time:
Recognize
Respond
Report
slide 28
Why would providers not report abuse?
Sometimes healthcare providers do not report abuse because of fear of repercussion, especially if the investigation turns out to be negative.
Legal Interventions and Ethical Issues
Voluntary and involuntary legal interventions
Competency of a person to make decisions
Adult protective services law is limited
Ethical issues: principles of adult protective services
What is the most immediate nursing consideration in determining whether legal intervention is necessary in an abusive situation?
A. Need for assistance
B. Cause of the abuse
C. Threats to life
D. Timing of the abuse
C. Threats to life
The most immediate nursing consideration in determining whether legal interventions are necessary is the assessment of threats to life
Ethical Issues
All adults in America have rights like:
Freedom from intrusion
Right to fair treatment
Freedom from unnecessary restraint
Right to self-determination
Ethical Issues
How can adults right be taken away?
All can be taken away through the use of legal measures —assessment of the patient’s decisional capacity: determining if the patient has or lacks capacity for a particular decision at a particular time
Reporting of Elder Abuse in New York State
New York State requires that…
New York State requires that Adult Protective Services (APS) workers report suspicions of abuse to law enforcement, but there are no laws mandating reporting from other professionals or lay persons.
Reporting of Elder Abuse in New York State
New York State requires that Adult Protective Services (APS) workers report suspicions of abuse to law enforcement, but there are no laws for what?
but there are no laws mandating reporting from other professionals or lay persons.
Reporting of Elder Abuse in New York State
It is the position of the New York State Nurses Association that ___. What is this set forth by?
It is the position of the New York State Nurses Association that the registered professional nurse has the responsibility to safeguard elders from abuse, neglect and maltreatment.
This responsibility is set forth in the American Nurses Association’s (ANA),
Scope and Standards of Practice,
Scope and Standards for Gerontological Nursing Practice and
the Code of Ethics for Nurses with Interpretative Statements.
Mandatory Reporting States with Specific Legislation
Slide 34
How Many Caregivers in the U.S.?
About 34.2 million Americans have provided unpaid care to an adult age 50 or older in the last 12 months. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]
How Many Caregivers in the U.S.?
The majority of caregivers care for how many adults? How many for more adults?
The majority of caregivers (82%) care for one other adult, while 15% care for 2 adults, and 3% for 3 or more adults. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]
How Many Caregivers in the U.S.?
How many adult family care givers care for someone who has alzeimher’s or dementia?
About 15.7 million adult family caregivers care for someone who has Alzheimer’s disease or other dementia. [Alzheimer’s Association. (2015). 2015 Alzheimer’s Disease Facts and Figures.]
How Many Caregivers in the U.S.?
Who are caregivers more? Women or men?
More women than men are caregivers: an estimated 66% of caregivers are female.
How Many Caregivers in the U.S.:
What is the average age of a female caregiver?
the average age of a female caregiver is 48.0. (Sandwich Caregiver)
Caregiver Issues
What instrument is used?
*Instrument: Modified Caregiver Strain Index
Modified Caregiver Strain Index (MCSI):
What is it?
13-question tool that measures strain related to care provision.
Modified Caregiver Strain Index (MCSI):
What items are included?
There is at least one item for each of the following major domains:
Financial, Physical, Psychological, Social, and Personal.
Modified Caregiver Strain Index (MCSI):
What is it used for?
Used to assess individuals of any age who have assumed the caregiving role for an older adult
Modified Caregiver Strain Index (MCSI):
What is scoring?
Scoring is 2 points for each ‘yes’ and 1 point for each ‘sometimes’ response. The higher the score, the higher the level of caregiver strain.
