Download 10 Violence and Elder Mistreatment Lecture Note PowerPoint Presentation

10
Lecture Note PowerPoint Presentation
Violence and Elder
Mistreatment
LEARNING OUTCOME 1
Discuss current trends in elder mistreatment, including
incidence and prevalence.
ELDER ABUSE IS
The least addressed,
 Underreported
 Under-recognized crime
 Only 1 out of every 14 cases of abuse in the
domestic settings are reported to authorities.

ACCORDING TO THE 2004 SURVEY OF
STATE ADULT PROTECTIVE SERVICES
(APS)
19.7 % increase in total reported elder abuse and
neglect and a 15.6% increase in proven elder
abuse and neglect since the 2000 survey
 Majority of abuse and neglect (89.3%) occurred in
the domestic setting (-elder's home -caregiver's
home)

TABLE 10-2
ELDER MISTREATMENT CHARACTERISTICS
ONE SURVEY OF NURSING HOME STAFF
MEMBERS REVEALED THAT
36% had witnessed at least one incident of
physical abuse by another staff member in the
previous year
 81% had observed at least on incident of
psychological abuse

THE PANEL TO REVIEW RISK AND
PREVALENCE OF ELDER ABUSE AND
NEGLECT (2002)
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Defined abuse types
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Physical abuse
Sexual abuse
Emotional / psychological abuse
Neglect
Abandonment
Financial / material exploitation (management)
Self-neglect
Sexual abuse
THREE BASIC CATEGORIES OF ELDER
MISTREATMENT:
A- Domestic mistreatment generally occurs within the
older adult’s home by a significant other
 B- Institutional mistreatment occurs when an older
adult has a contractual arrangement and suffers abuse
 Elder abuse can occur in a domestic setting, such as
one’s home or the home of a caregiver, or in an
institutional setting, such as a nursing home, board
and care home, or other health care or residential
facility.
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THREE BASIC CATEGORIES OF ELDER
MISTREATMENT:

C- Self-neglect occurs when older adults who are
mentally competent enough to understand the
consequences of their own decisions engage in
behaviors that threaten their own safety.
LEARNING OUTCOME 2
Review key reasons why elder mistreatment occurs.
COMMON CHARACTERISTICS OF THE
ABUSER
Likely to be male
 History of substance abuse, mental illness
 History of violence
 Lack a strong social support network
 Dependent on the care recipient for financial or
other needs

THEORIES OF THE ETIOLOGY OF ELDER
ABUSE
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“Psychopathology of the abuser”
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Caregivers who have preexisting conditions that
impair their capacity to give appropriate care
“Transgenerational violence”

Part of the family violence continuum

is based on the belief that violence is a learned behavior
pattern. A child observes violence as an acceptable
reaction to stress and then internalizes this as an
acceptable behavior. In cases of elder abuse, violent
behavior becomes cyclical: the abused – the child becomes the abuser of the parent.
THEORIES OF THE ETIOLOGY OF ELDER
ABUSE

“Situational theory,” also know as “caregiver
stress


Care burdens outweigh the caregiver’s capacity
“Isolation theory”

Mistreatment is prompted by a dwindling social
network
LEARNING OUTCOME 3
Conduct clinical assessment for screening and detection
of elder mistreatment.
CHARACTERISTICS OF VICTIMS OF ABUSE
Older than age 75 years
 Female
 Live with abusers
 Suffer from chronic, debilitating illnesses
impairing function creating heavy care needs

CAREGIVERS FOR OLDER ADULTS SHOULD
BE ASSESSED
For caregiver stress
 For substance abuse
 For a history of psychopathology
 Using the Caregiver Strain Index (CSI), which
may aid in assessment
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The Caregiver Strain Index (CSI) is a tool that can be used
to quickly identify families with potential caregiving
concerns. It is a 13-question tool that measures strain
related to care provision. There is at least one item for each
of the following major domains: Employment, Financial,
Physical, Social and Time.
SEPARATE INTERVIEWS SHOULD BE
CONDUCTED FOR THE CAREGIVER AND
THE PATIENT

Inconsistencies might increase the suspicion of
abuse
ASSESSMENT SHOULD INCLUDE
Awareness of differences based on culture
perceptions of mistreatment
 An interdisciplinary team
 A nonjudgmental environment

POTENTIAL SIGNS OF MISTREATMENT
Physical abuse
 Unexplained signs of injury such as bruises,
welts, or scars, especially if they appear
symmetrically on two side of the body
 Broken bones, sprains, or dislocations
 Report of drug overdose or apparent failure to
take medication regularly (a prescription has
more remaining than it should)
 Broken eyeglasses or frames
 Signs of being restrained, such as rope marks on
wrists
 Caregiver’s refusal to allow you to see the elder
alone

Emotional abuse
 In addition to the general signs above,
indications of emotional elder abuse include
 Threatening, belittling (‫)االستهانة‬, or controlling
caregiver behavior
 Behavior from the elder that mimic dementia,
such as rocking (ّ‫)الهز‬, sucking, or mumbling (‫)غمغم‬
to oneself
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NEGLECT BY CAREGIVERS OR SELFNEGLECT
Unusual weight loss, malnutrition, dehydration
 Untreated physical problems, such as bed sores
 Unsanitary living conditions: dirt, bugs, soiled
bedding and clothes
 Being dirty or unbathed
 Unsuitable clothing or covering for the weather
 Unsafe living conditions (no heat or running
water; faulty electrical wiring, other fire hazards)
 Desertion of the elder at a public place
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Financial exploitation
Significant withdrawals from the elder’s accounts
Sudden changes in the elder’s financial condition
Items or cash missing from the senior’s household
Suspicious changes in wills, power of attorney, titles, and
policies
Addition of names to the senior’s signature card
Unpaid bills or lack of medical care, although the elder has
enough money to pay for them
Financial activity the senior couldn’t have done, such as an
ATM withdrawal when the account holder is bedridden
Unnecessary services, goods, or subscriptions
Sexual abuse
 Bruises around breasts or genitals
 Unexplained venereal disease or genital infections
 Unexplained vaginal or anal bleeding
 Torn, stained, or bloody underclothing

TESTING TO CONFIRM ABUSE
Laboratory findings that supporting the presence
of dehydration and malnutrition without medical
causes.
 Papanicolaou smear
 Cultures for sexually transmitted disease


The Papanicolaou test (also called Pap smear, Pap
test, cervical smear, or smear test) is a screening test
used in gynecology to detect premalignant and malignant
(cancerous) processes in the ectocervix
TESTING TO CONFIRM ABUSE

Radiological testing
Have students perform a complete history, including
assessment for mistreatment of a patient.
 Have students administer a caregiver stress
inventory.
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LEARNING OUTCOME 4
Create a nursing care plan for the ongoing well-being of
older patients.
NURSES SHOULD PLAN FOR
EDUCATIONAL INTERVENTIONS FOR
THE CAREGIVER
Disease management
 Aging changes
 Maximizing healthcare services
 Respite (‫ أمهل‬,‫ أرجأ‬,‫)مد‬services:
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Short-term, temporary care provided to an individual in their
home or outside their home
Designed to give the primary caregiver(s) a break from their care
giving duties
Respite may be just a few hours or several days in length
depending on the plans of the caregiver
Respite may be planned in advance or may be made available to
assist in a crisis/emergency situation
Behavioral management
 Caregiver support groups

LEARNING OUTCOME 5
Summarize key resources for elder mistreatment
information.
ELDER MISTREATMENT RESOURCES
National Elder Abuse Study
 National Center On Elder Abuse
 Worldbridges
 Association For The Protection Of The Elderly
 National Center For Victims Of Crime
 American Bar Association

ELDER MISTREATMENT RESOURCES
National Committee for the Prevention of Elder
Abuse
 Elder Justice Center
 Elder Abuse in Long-Term Care Facilities
Website
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