Recognizing Elder Abuse

Question 1

what is elder abuse

Answer 1

single or repeated act or lack of appropriate action, occurring w/i relationship in which there is an expectation of trust, that causes harm or distress to older people

Question 2

what is a limitation with screening for elder abuse

Answer 2

no gold standard screening tool

Question 3

what are the 6 main risk factors for elder abuse

Answer 3

1. functional dependence
2. cog impairment
3. financial vulnerability
4. advanced age
5. female
6. racial/ethnic minorities

Question 4

what are some examples of psych/emotional abuse

Answer 4

threatening to place in nursing home
ridiculing (ie for incontinence)
disrespect (ie treat like child assuming lack of understanding)
bullying

Question 5

what are some indicators of psychological abuse

Answer 5

individual becomes uncommunicative/unresponsive
evasive or isolation
lack of interest in social contact
anxiety/depression
difficulty sleeping
behavior mimicking dementia (rocking, mumbling)

Question 6

what are examples of physical abuse

Answer 6

hitting
slapping
pushing
pinching
restraints

Question 7

what are indicators of physical abuse

Answer 7

unexplained cuts, bruises, burns, bleeding
sprains or fx
maxillofacial fx on L side
- perp is R handed
frequent ED visits
refuse to go to same ED
dismissive statements ab injuries
caregiver refusal to leave pt alone w provider

Question 8

what are the 6 domains of needs that need to be fulfilled in order to not be considered neglect

Answer 8

essential med care
nutrition
hydration
hygiene
clothing
shelter

Question 9

why is neglect a gray area and why is this significant

Answer 9

difficult to substantiate and prove as intentional

often underreported as a result bc people hesitant to call it neglect unless obvious

Question 10

what are examples of caregiver neglect

Answer 10

withholding appropriate attention
failure to provide proper nourishment, adequate food, appropriate clothing
isolating individuals from society and human contact
failure to provide safe living conditions
use of sedatives to control workload

Question 11

what are indicators of neglect

Answer 11

poor personal hygiene
- oral health often suffers
skin breakdown or rashes
exacerbation of chronic dz despite care plan
difficulty sleeping
sudden wt loss
worsening dementia
meds not filled

Question 12

abuse vs neglect

Answer 12

abuse - do something that may cause harm

neglect - don’t do something that may prevent harm (passive omission)

Question 13

what is the difference w self-neglect

Answer 13

self-neglectors often cognitive intact
- neglected elders often not

Question 14

how common is self-neglect

Answer 14

60% of reported cases

Question 15

what is procedural neglect

Answer 15

failings in care that fall short of objective and observable institutional and professional standards
- violation of institutional procedure

Question 16

what is caring neglect

Answer 16

failings in care that are below threshold of being proceduralized, but lead to pts, family, and public to believe that staff are unconcerned ab physical and emotional well being of their pts

Question 17

what is the difficulty w caring neglect

Answer 17

very gray area
- difficult to detect

Question 18

what are common causes of procedure and caring neglect

Answer 18

factors like high workload and organizational failure

Question 19

what is the least prevalent abuse among elders

Answer 19

sexual

Question 20

what are examples of sexual abuse

Answer 20

unwanted touching
forced nudity
rape, sodomy
making person look at porn

Question 21

what are indicators of sexual abuse

Answer 21

torn or bloody undergarments
bruises in genital area
vaginal or anal bleeding
panic attacks, PTSD

Question 22

what are 3 recommended screening tools as there is no gold standard

Answer 22

elder abuse suspicion index (EASI)
hwalek-sengstock elder abuse screening test (H-S/EAST)
elder assessment instrument (EAI)

Question 23

EASI: advantage, disadvantage, purpose

Answer 23

advantage - 6 items, easy to admin
disadvantage - must be cog intact

purpose - use to prompt a referral

Question 24

H-S/EAST: advantages, disadvantages

Answer 24

advantages
- 15 item test
- can be used various settings
- multiple domains of abuse covered

disadvantages
- poorly studied
- longer test
- too detailed and difficult as a PT
- low validity

Question 25

EAI: advantage, disadvantage

Answer 25

advantage - assess field of negligence

disadvantage - designed for ED and inpatient use

Question 26

what are the 2 main things we can do as PTs to manage this

Answer 26

1. report suspected cases of abuse or neglect
2. interact w team members to establish norms for behavior and quality of care

Question 27

what are important things to remember when we report suspected cases

Answer 27

purpose: trigger response to be connected w resources and promote health/wellness
- doesn’t mean being charged, jail, or removal from home

suspected victim can refuse adult protect services visit or any assistance