Violence and Elder Mistreatment

1. 10 Lecture Note PowerPoint Presentation Violence and Elder Mistreatment

2. LEARNING OUTCOME 1 Discuss current trends in elder mistreatment, including incidence and prevalence.

3. 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.

4. 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)

5. Table 10-2Elder Mistreatment Characteristics

6. 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

7. The Panel to Review Risk and Prevalence of Elder Abuse and Neglect (2002) • Defined abuse types • Physical abuse • Sexual abuse • Emotional / psychological abuse • Neglect • Abandonment • Financial / material exploitation (management) • Self-neglect • Sexual abuse

8. 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.

9. 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.

10. LEARNING OUTCOME 2 Review key reasons why elder mistreatment occurs.

11. 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

12. Theories of the Etiology of Elder Abuse • “Psychopathology of the abuser” • 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.

13. 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

14. LEARNING OUTCOME 3 Conduct clinical assessment for screening and detection of elder mistreatment.

15. 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

16. 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 • 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.

17. Separate Interviews Should Be Conducted for the Caregiver and the Patient • Inconsistencies might increase the suspicion of abuse

18. Assessment should include • Awareness of differences based on culture perceptions of mistreatment • An interdisciplinary team • A nonjudgmental environment

19. 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

20. Emotional abuse • In addition to the general signs above, indications of emotional elder abuse include • Threatening, belittling (الاستهانة), or controlling caregiver behavior • Behavior from the elder that mimic dementia, such as rocking (الهزّ), sucking, or mumbling (غمغم) to oneself

21. Neglect by caregivers or self-neglect • 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

22. 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

23. Sexual abuse • Bruises around breasts or genitals • Unexplained venereal disease or genital infections • Unexplained vaginal or anal bleeding • Torn, stained, or bloody underclothing

24. 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

25. 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.

26. LEARNING OUTCOME 4 Create a nursing care plan for the ongoing well-being of older patients.

27. Nurses Should Plan for Educational Interventions for the Caregiver • Disease management • Aging changes • Maximizing healthcare services • Respite (مد, أرجأ, أمهل)services: • 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

28. LEARNING OUTCOME 5 Summarize key resources for elder mistreatment information.

29. 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

30. Elder mistreatment resources • National Committee for the Prevention of Elder Abuse • Elder Justice Center • Elder Abuse in Long-Term Care Facilities Website