Elderly abuse and neglect دکتر احمد باقری مقدم متخصص پزشکی ورزشی سرپرست پژوهشی پزشکی قانونی

1. Elderly abuse and neglect دکتر احمد باقری مقدم متخصص پزشکی ورزشی سرپرست پژوهشی پزشکی قانونی

2. مقدمه • روند رو به تزاید جمعیت سالمندان • پدیده جدید • حوزه پیچیده ومشکل

4. در ایران • سال 1375 جمعیت سالمندان 3977000 معادل 6/6 درصد • سال 1385 جمعیت سالمندان 5119000 معادل 7/3 درصد

5. What is elder abuse? • تمام اشکال سوء رفتار با سالمند را سالمند آزاری میگویند • در تعریف دیگر فعل یا ترک فعل آسیب رسان به سالمند را گویند • Elderly abuse was defined as an act or omission which results in harm or threatened harm to the health or welfare of an elderly person.

6. Incidence of elderly abuse • Abuse in institutional settings is difficult to measure, yet is thought to exceed that in community settings. • In the USA,10% of nursing staff in institutional settings admitted committing physical and 40% psychological abuse against residents .

7. میزان گزارش بسیار متغیر است و بستگی به تعاریف دارد • “mistreatment of adults, including abuse, neglect, and exploitation, affects more than 1.8 million older Americans”(Pavlik, Hyman, Festa, Bitondo, andDyer, 2001, p. 45) • self-neglect accounts for one-third to one-half of all abuse cases(Gray-Vickrey, 2000, 2004; Levine, 2003; Paris, 2003) • شایع ترین نوع آن خود غفلتی است self neglect است که تشخیص آن نیز بسیار مشکل است

8. سالمند آزاری فیزیکی در شهر اصفهان پایین است و بیشترین نوع آزار به سالمندان از نوع استفاده از اموال بدون رضایت سالمند می‌باشد.

9. Distribution of Abuse • تقریبا بین زنان و مردان مساوی است ولی برخی تحقیقات نشان داده در مردان بیشتر بوده است. • الگوی آزار بسیار فرهنگی است و در بین جوامع مختلف و محل های مختلف متفاوت است.( خانه یا بیمارستان و شهر های مختلف)

10. Perpetrators of Abuseآزار رسان ها چه کسانی هستند؟ • elder abuse can be perpetrated by nearly anyone including: • paid or volunteer caregivers • medical and long-term care employees, • family members • strangers such as a person who befriends an elderly person for the purpose of exploiting them

11. Who is Committing the Abuse?

13. Risk factors for elderly abuse factor related to the abused elderly: • The intensity of an elderly person’s illness or dementia • Social isolation • The elder’s role, at an earlier time, as an abusive parent or spouse • A history of domestic violence((خشونت خانگی in the home • Dependency

14. factors related to the abuser: • Inability to cope with stress (lack of resilience) • Depression, which is common among caregivers • Lack of support from other potential caregivers • The caregiver’s perception that taking care of the elder is burdensome and without psychological reward • Substance abuse

15. being male being related history of mental illness recent decline in mental health abusing alcohol primary caregiver change in family roles from being cared for to being the care provider prior history of violence Greatest Risk Factors for Causing Abuse

16. Types of elder abuse Abuse by others Frequency • Physical 16% • Sexual 2% • Financial 29% • Neglect 27% • Abandonmentترک 1% • Isolation 2% • Abductionربایش 0.2% • Psychological 24%

17. Physical abuse Physical abuse means at least one act of physical violence against the elderly

18. Direct beatings Hitting Slapping Cutting Burning shaking Unreasonable physical restraints Maltreatment of medical conditions Sexual assault Prolonged deprivation of food or water. Forms of physical abuse

19. Sings of physical abuse • bruises • Broken bones, sprains, or dislocations • Report of drug overdose or apparent failure to take medication regularly • 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

21. Bruising • A bruise, or contusion, occurs when blunt forces distort soft tissues to an extent sufficient to result in disruption and leakage of blood vessels • Escape of blood from blood vessels produces discoloration

22. When is bruising suspicious trauma versus accidental trauma? Which looks more like abuse: A or B? B A

23. Accidental or Inflicted? You decide

24. Accidental or Inflicted? You decide

25. Bruising Study con’t

27. Location of Bruises Caused by Abuse

28. Patterned Injury • An injury that possesses features or configuration with objects or surfaces that produced it

29. Bruising • Physically abused older adults had significantly larger bruises than those in comparison group who were not abused and more knew the cause of their bruises

30. Patterned Injury • Grip marks around arms or neck • Rope marks or welts on wrists or ankles • Imprints from belts, belt buckles, straps, cords, hangers, hairbrushes, combs, cigarettes and cigarette lighters • Handprints, fingerprints, knuckle prints and footprints • More on strangulation… • More on burns…

31. Fracture • Broken bones • Includes severing of the bone or compression of intact bone

32. Avulsion • The tearing away of a structure or part; often seen as a partial avulsion

33. Abrasion • A wound in which the outermost layer of the skin is removed by a compressive or sliding force

34. Laceration • Blunt force injuries resulting from tearing, ripping, crushing, overstretching, pulling apart, bending and shearing soft tissue. • Lacerations are usually found over a bony surface and are ragged or irregular in appearance

35. Incision • Incision, known as a cut, is a wound made by a sharp instrument or object, such as a scalpel, knife, razor or paper coming against the skin with pressure to cause an injury

36. Stab Wound • Result whenever a sufficiently sharp and narrow object is forced upward • Unlike a cut, depth exceeds width in stab wounds

37. Mechanical Restraints • Means of controlling behavior, especially in hospitals and nursing facilities • Only acceptable reason for temporarily restraining someone is to prevent significant harm

38. Sexual abuse is unwanted sexual contact with an elder including touching, sexual assault, and rape or sodomy

39. Sexual Abuse • Sexual abuse is unwanted sexual contact with an elder including: • touching , Fondling نوازش کردن • sexual assault(rape or sodomy) • Verbal or suggestive behavior • Unnecessary help with dressing/hygiene

40. Signs of sexual abuse • Signs Bruises around breasts or genitals • Unexplained venereal disease or genital infections • Unexplained vaginal or anal bleeding • Torn, stained, or bloody underclothing

41. Neglect The failure of a designated caregiver to meet the needs of an elderly person, and withholding of physical, material, or emotional necessities of physical and mental health, whether intentionally or unintentionally.

42. This includes failure to assist in personal hygiene or the provision of clothing for an elder, failure to provide medical care for the physical and mental health needs of an elder, and failure to protect an elder from health and safety hazards.

43. NEGLECT • Denial of care: • food, water, shelter • personal hygiene, clothing, bedding • medical care, medicines, assistive devices • Isolation: • control of time, activities, contacts • disinformation tactics • false imprisonment

44. Minimal personal care

45. Passive Neglect • ناتوانی غیر عمدی به انجام تعهدات مراقبت • اعمال دیسترس بدون قصد آگاهانه و یا عمدی

46. Active Neglect • شکست عمدی به تعهدات مراقبت، اعمال استرس جسمانی یا عاطفی و یا آسیب • رها کردن، محرومیت از غذا، دارو، بهداشت شخصی

47. SELF-NEGLECT • Basic activities of daily living are neglected, threatening personal health and safety: • hygiene • food, water • clothing and bedding • shelter and surroundings • finances • health care

48. Signs of neglect • Malnutrition, dehydration • Lack of personal care • Inadequate heating • Unclean clothes or bedding • Lack of needed medications, eye glasses, hearing aids, or dentures • Contractures, decubitus ulcers, wasting and muscle atrophy

49. Psychological abuse or emotional abuse • Psychological abuse is more difficult to define and operationalize. • Usually defined as an act carried out with the intention of causing emotional pain or distress. • Psychological abuse often accompanies physical abuse. Emotional abusers can use verbal and non verbal to inflict elder damage.

50. Psychological Abuse • Humiliationتحقیر • Isolationانزوا • Intimidationارعاب • Threatsتهدید • Removal of decision making powers • Verbal insults, yellingتوهین کلامی، فریاد