Elderly Mistreatment Flashcards
Estimated that __-__% of elderly are abused yearly
5-10 (probably underestimated)
It’s estimated that up to ___% of cases of elderly mistreatment go unreported
80
_______ is defined as Intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes of creates a risk of harm to an older adult
Elder abuse
Example of elder abuse
Withholding food, water, medications
How do EM and self-neglect impact the risk of death?
Elevate it (independent of chronic illness, functional status, etc.)
Screening for EM is done as apart of an initial nursing assessment in what healthcare setting?
ED
Risk factors for EM
- Cognitive impairment of patient or caregiver
- Excessive dependency (caregiver on pt. or pt. on caregiver)
- Family conflict
- FH of abusive behavior, alcohol or drug misuse, mental illness, cognitive impairment
- Financial stress
- Isolation of pt. or caregiver
- Inadequate living arrangements
- Stressful events (e.g. death, loss of employment)
90% of abusers are
Family members
About half of abusers are the patient’s
Children (~47%)
Interview patient & caregiver
Separately & privately
What are the two EM screening tools?
EASI (FP clinic)
H-S/EAST (ER or OP clinic)
Types of abuse
- Physical
- Psychological/emotional
- Sexual
- Medical
- Financial
- Rights violation (speech, privacy, restraints, choice of physician)
Most common type of abuse
Self-neglect
Examples of self-neglect
- Hoarder
- Uncleanliness (refusal to bathe)
- Noncompliance with med regimen
Second most common type of abuse
Neglect
Most common physical sign of abuse
Bruising
Characteristics of suspicious bruises
- Various stages of healing
- Location: inner thigh, bilateral or inner arms
Signs & sx of physical abuse
- Anxiety or nervousness in presence of caregiver
- Deference to caregiver
- Fractures
- Burns (cigarette, chemical)
- Lacerations (face, lip, eyes)
- Head injuries
- Genital abnl discharge, injury
- Delay in seeking treatment, inconsistent f/u, consistently switching HCP
Signs & sx of psychological abuse
- Impatience, demeaning statements by caregiver
- Ambivalence of pt. to caregiver or anger
- Unexpected depression or withdrawal
- Lack of adhere to treatment regimens or frequently cancelled appointments
- Frequent request for sedative meds
_______ is defined as intentional or unintentional withholding of food, medication, or other necessity resulting in the older person’s failure to thrive
Neglect
S&S of neglect
- Contractures
- Dehydration/malnutrition
- Depression
- Diarrhea, fecal impaction, urine burns
- Failure to respond to obvious disease
- Inappropriate medication use
- Pressure ulcers
- Repeated falls
- Repeated hospital admissions
Signs of financial exploitation
- Disparity of pt living conditions & apparent assets
- Poor accounting of money and property
- Demands for money or goods in exchange for care
- Unexplained loss of social security/pension
Signs of abandonment
- Pt. is left alone without adequate arrangements for care
- Sudden withdrawal of care by caregiver
How do we manage self-neglect
- Assess pt. understanding of consequences
- HCP MUST honor the pt. right to autonomy and self-determination
Causes of institutional mistreatment
Aggravated by
- Poor working conditions
- Low salaries
- Inadequate staff training and supervision
- Prejudiced attitudes
- Behavior by the older adult
Who is responsible for investigations, balancing the rights of staff with the rights of patients?
State departments of health
Sometimes the older adult serves as a _____ for EM
Trigger (the relationship may be mutual abusive)
Factors governing the course of action
- The nature & degree of EM
- The ability or willingness of the pt. AND caregiver to cooperate
_______ are required to assess & report suspected EM
Clinicians
Barriers to reporting EM
- Cognitive impairment
- Fear of violence/retaliation
- Embarrassment
- Fear of placement > fear of abuse
- Family/ friends may not be aware of situation/how to recognize it
- “Not my business”
- Do not want to cause trouble
- Fear of retaliation
- Belief that their actions will not make things better
