Neglect and Abuse in Older Adults

Question 1

What is meant by self neglect in COTE patients?

Answer 1

Lack of self care to the extent that it threatens personal health and safety.
Inability to avoid harm as a result of lack of self care
Failure to seek help or access services to meet health and social care needs.
May include: personal hygiene, hoarding, unsafe living conditions, inappropriate nutrition

Question 2

What are some potential causes of self-neglect particularly in COTE patients?

Answer 2

1. Mental/neurological disorder such as brain injury or dementia
2. Physical illness affecting ability or energy levels
3. Medication side effects
4. Adverse life events e.g loss of a loved one
5. Loneliness or lack of support from family/friends
6. Not feeling they need support or not wanting to bother anyone.

Question 3

What are some different types of neglect/abuse that may be seen in patients?

Answer 3

1. Neglect - ignoring medical, emotional or physical needs including withholding access.
2. Psychological - emotional, threats, humiliation, abandonment
3. Physical abuse - assault, misuse of meds, NAI
4. Domestic abuse
5. Discriminatory abuse - based on protected characteristics
6. Sexual abuse - not consented or lacks capacity to do so
7. Financial/economi - stealing/withholding money or pressuring to use in a certain way
8. Organisational abuse - institution or care setting
9. Modern slavery - forced labour or human trafficking

Question 4

What are some warning signs of neglect/abuse in older people?

Answer 4

1. Appearing unkempt or dehydrated
2. Bruising/injuries with varying degrees of healing
3. Old fractures of high impact
4. Withdrawn or sudden changes in behaviour
5. Appear frightened or confused without a medical indication
6. Partner/person not allowing patient to speak - always answering for them
7. Signs of over-medication or not receiving medication properly
8. Recent changes to banking/spending habits

Question 5

How can we help patients suffering from abuse?

Answer 5

1. Escalate to senior/safeguarding team
2. Documentation - objective and factual
3. Carefully discuss with patient/family
4. Assess patients mental capacity
5. OT involvement - home assessment - can fund cleaning
6. Age UK - advise on raising concerns and signposting patients to support
7. Counselling/psychological therapies
8. If crime suspected or immediate risk of danger - contact police.