Violence-Elder Abuse Flashcards
Any knowing, intended, or careless act that causes harm or serious risk of harm to an older person-physically, mentally, emotionally, or financially.
Elder Abuse
Living in conditions which present a substantial risk of serious harm
Unsafe/unsanitary; poor hygiene
Lacking medical care, food, unpaid bills, etc.
Physical or mental impairment present
Self-Abuse/Inadequate Self Care
Misuse of resources
Social Security or SSI checks,
abusing a joint checking account
taking property, forgery, scams
Financial Exploitation
refusal or failure to provide necessities food, water, clothing, shelter, medical poor hygiene comfort untreated pressure sores lack of supervision
Caregiver Neglect
the infliction of anguish, pain, or distress through verbal or nonverbal acts.
verbal assaults, insults, threats, intimidation, humiliation, and harrassment;
mind games
Emotional/Psychological Abuse
Non-consensual sexual contact of any kind with an elderly or disabled person
Sexual/pornographic material
Sexual Abuse
The use of physical force that may result in bodily injury, physical pain, or impairment.
Acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning.
Physical Abuse
6 types of harm
Self-Abuse/Inadequate Self Care, Financial Exploitation, Caregiver Neglect, Emotional/Psychological Abuse, Sexual Abuse, Physical Abuse
Fear
3 A’s (anxiety, agitation, anger)
Depression
Isolation, withdrawal
Non-responsiveness, resignation, ambivalence
Contradictory statements, implausible stories
hesitation to talk openly (esp. around caregiver)
Confusion or disorientation
Signs of Abuse by Client
Signs of Abuse from Caregiver
Preventing elder from speaking/seeing visitors
Anger, indifference, aggressive behavior towards elder
Hx of substance use/mental illness
Lack of affection toward elder
Conflicting accounts of incidents
Injuries are always explained as accidents/clumsiness
Caregiver Stress/Overwhelmed
Power and Control (DV Model)
Financial burdens related to an aging parent
Dependency of older adult by caregiver
Emotional and psychological problems of the caregiver
Domestic violence grown old
Possible Causes of Abuse
Abused, Neglected, Exploited, Physical disability
APS (Adult Protective Services) Population
Stop/Prevent Physical Abuse and Neglect
Assist
Safety
Goal of APS
Improve or maintain the quality of life for DE citizens who are Elderly (62+) or at least 18 yr and have a physical or mental disability.
A system of services for impaired adults designed to protect their health, safety and welfare.
Intent: authorize only the least possible restrictions of personal and civil rights.
Title 31 ch 39 Adult Protective Services
As long as adults have the capacity to reach rational decisions he/she can:
choose to live in harm
choose to live self-destructively
right to refuse services regardless of level of risk
right to make bad decisions
Ethical Principles
Client participation Remain at home or in community least restrictive/intrusive action Families and caregivers should help meet needs Legal action is last resort
Basic Principles
Home Visit
Preliminary Investigation (substantiate allegations)
Assess (in-home vs. placement)
Referrals (legal, medical, social, housing, transportation, in-home services, etc)
Assist in obtaining services
Refer for case management and follow-up
Services provided by APS: DE Code: Sect 3905
Ridiculing, demeaning, making derogatory remarks, cursing or threatening to inflict physical or emotional harm, etc
(excludes a mentally competent person who understands the consequences of their decisions; making a voluntary decision to engage in acts)
Psychological Abuse
Ch. 3910
any person having reasonable cause to believe that an adult person is impaired or incapacitated and in need of protective services.
Who has duty to report (obligation)
Elder Abuse is a CRIME 2 million victims yearly 84% is unreported 2/3 of abuse is family members most abuse is intentional
The Facts of Elderly Abuse
Isolation
inconsistent explanations
vulnerable
The Signs of Elderly Abuse
the use of excessive force against other individuals or oneself, often resulting in physical or psychological injuries or death
Violence
are those that increase an individuals risk of violence victimization or perpetration of violence
predisposing factors to violence
increase with individuals risk of being a victim of violence
Vulnerability factors
increase the potential that someone will perpetrate violence on others.
Risk factors
are those that give rise to a specific incident of violence
Precipitating factors
decrease the risk of violence perpetration and victimization
protective factors
for violence include environmental, psychological, cultural and behavioral variables
Predisposing Factors
is violence that occurs with in relationships between family members, intimate partners, acquaintances, or strangers that does not aim to further the goals of a formal group or cause. ie. sexual assault, abusive relationships, or stalking
Interpersonal violence
3 phases:
Violence that occurs in a patterned frequency
Cycle of Violence
an injury to human tissues and organs resulting from the transfer of energy from an external environmental source,
- intentional or unintentional
- host; person or group @ risk of injury
- factors include age, sex, race, economic status, preexisting illnesses and use of substances ie. drugs/alcohol
Trauma
causes injury to a single part or system of the body and is usually treated in a physicians office or ED. ie. fracture of the clavicle, 2nd degree burn, stitches
Minor trauma
involves serious single system injury, ie. resulting from a car crash
Major trauma
occurs when there is no communication between the damaged tissues and the outside environment; usually occurs from motor vehicle crashes, falls, assaults, and sport activities
- deceleration; decrease in speed of moving objects
- acceleration; increase in the speed of a moving object
Blunt trauma
forces occurring across a plane with structures slipping across ea. other, compression and crushing
shearing
occurs when a foreign object enters the body, causing damage to body structures including the brain, lungs, heart, liver, spleen, intestines, and the vascular system. ie., gunshots/stabs
Penetrating trauma
A pattern of behavior that dominates, controls, lowers self-esteem, or takes away freedom of choice. Can include elder abuse, child abuse, intimate partner abuse, and sexual abuse.
Abuse
injury from an act of violence where physical force is used with intent to harm, injure or kill; in homicide, the injury is fatal.
Assault/homicide
The victim has physical and emotional responses to the act of rape.
Rape
taking of ones own life
Suicide
Airway with cervical spine protection Breathing and ventilation Circulation with hemorrhage control Disability and neurological assessment Exposure and environmental control
ABCDE’s Nursing Assessment Trauma Care
Nurses role in trauma starts in this. The process of determining which client needs most urgent medical intervention. Based on the ABCDE’s of trauma care
Triage
physical
emotional
sexual
3 main forms of abuse
the intentional physical, emotional or sexual mistreatment or neglect of an individual 65 years of age or older
Elder Abuse
or sexual violence, “any sexual act that is perpetrated against someone’s will”
Sexual Abuse
the act of inflicting sexual, emotional, or physical harm on a current or previous partner or spouse.
Intimate partner violence (IPV)
Constant hunger/malnutrition Listlessness Poor hygiene social isolation Inapprop. dress for weather chronic fatigue unattended medical needs Poor skin integrity or decubiti Contractures Urine burns/excoriation Dehydration Fecal impaction Bruises and welts Withdrawal Burns Confusion Fractures Fear or Suspicion of caregiver, healthcare providers and family members Sprains or dislocations Lacerations/abrasions Evidence of over sedation Failure to meet financial obligations
Possible signs of Elder Abuse
Risk for Trauma Risk for Self-harm Powerlessness Post-Trauma Syndrome Risk for Sexual Dysfunction Social Isolation
Nursing Diagnosis for Violence/Elder Abuse
self-rule, the right of an individual to make decisions for self. Individuals have the right to self-determination so long as their exercise of that right does not violate the right of others.
Autonomy
The ability and freedom to make decisions without external coercion or restraint.
Decisional autonomy
The ability and freedom to act on this decisional autonomy, to carry out and implement personal choices.
Autonomy of execution
Describes an individual’s ability to make an informed decision, sometimes referred to as “functional competence” or “healthcare decision-making”. No legal meaning and are clinical judgements. An individuals who is exercising decision-making capacity is acting with autonomy.
Decision-making capacity
What are the three phases of the cycle of violence?
Phase I: Tension builds; communication fails
Phase II: Battering; Abuse or threatening incident occurs
Phase III: Honeymoon Period;aggressors show of love and remorse. Victim may feel responsible
