Transcript Elder Mistreatment and Abuse

Elder Mistreatment and
Abuse
Tammy Garcia RN
Ferris State University
Nursing 314-Spring 2012
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“According to the best available estimates,
between one and two million Americans
age 65 or older have been injured,
exploited, or otherwise mistreated by
someone on whom they depended for
care or protection (Hartford Institute for
Geriatric Nursing, 2011).”
Background
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Types of abuse and neglect
◦ Physical-when a person makes physical contact with
the intent to do harm
◦ Emotional/Psychological-when a person causes pain
or fear through verbal or nonverbal means
◦ Sexual abuse-sexual contact without consent or with
someone unable to provide consent
◦ Financial abuse/exploitation-use of another's
resources without authorization or for unauthorized
reasons
Elder Mistreatment and Abuse
◦ Caregiver neglect-failure to provide for the
needs-safety, personal care, and comfort-of
someone under one’s care
◦ Self neglect-failure to take care of oneself in
personal, living, safety needs
Types of abuse and neglect
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Caregiver stress
Childhood trauma
Cultural sanctions against seeking help to care for elderly
Delirium
Dependency of abuser on victim for housing and finances
Dependency of elder on caretaker for assistance with activities
Family history of violence
Financial strain
Increased age
Isolation of the caregiver or victim
Lack of close family ties
Mental illness in family members/caretakers
New, worsening, or prolonged depression
New, worsening, or prolonged physical impairment
Poverty/lack of financial resources
Progressing dementia
Shared living arrangement
Substance abuse in family members/caretakers
Unsafe living situation
◦ (Hartford Institute for Geriatric Nursing, 2011)
Risk Factors
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Interview the patient and caregiver
separately
◦ Assess for:
 Physical abuse
◦ Has anyone ever tried to hurt you?
◦ Has anyone touched you without your permission?
◦ Is there anyone your afraid of?
◦ Any recent injuries?
◦ Restrained without permission?
◦ Is there physical evidence of abuse?
 If present-dig deeper. Any other injuries like this? How
did this happen? Did someone do this to you?
Assessment and Intervention of
Elder Abuse and Mistreatment
◦ Emotional/psychological abuse
 Have you been threatened? Verbally, physically?
 Is there stress and violence happening where you
live?
 Who provides care for you?
 Are you afraid of anyone?
 Any history of abuse in the background of
caregivers?
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Sexual abuse
◦ Have you ever been touched without
permission?
◦ Does anyone in your house abuse drugs or
alcohol?
◦ Have you ever been made to do things you do
not want to?
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Financial abuse/exploitation
◦ Who pays the bills?
◦ Does anyone have access to your bank
accounts?
◦ Who has power of attorney for you?
◦ Have you ever had to sign paperwork you did
not understand or were forced to sign?
◦ Has anyone stolen from you?
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Caregiver Neglect
◦ Are you left alone frequently?
◦ Does the person/persons caring for you provide
for your needs?
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Self Neglect
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Do you take your medications as ordered?
How frequently do you bathe?
Do you eat and drink enough?
Have enough clothing?
Indicators of Abuse Screen (IOA)
◦ http://www.uihealthcare.com/depts/med/famil
ymedicaine/research/geriatrics/eledermistreat
ment/indicators.pdf
◦ Risk Assessment Instruments
 http://www.elderabusecenter.org/default.cfm?p=r
iskassessment.cfm
 Caregiver Strain Index (CSI)
◦ http://links.lww.com/A291
Assessment/Screening Tools
Patient
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Decrease risk factors for abuse and/or neglect
Decrease in caregivers stress
Support systems in place
Removal of patient from potential harmful situation
Caregiver
 Stress assessed and decreased
 Respite care if needed
 Treatment of mental health or substance abuse
issues if indicated
Expected Outcomes
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Health Care Provider
◦ Complete documentation, including history,
physical exam, treatments, referrals, and
reporting
◦ Identification of risk factors that may lead to
abuse and neglect
◦ Elder abuse and neglect-alleged or suspectedidentified and reported per state laws
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Institution
◦ Provide education to staff
◦ Policies and procedures in place to deal with
suspected abuse and or neglect that meet Joint
Commission on Accreditation of Healthcare
Organizations (JCHAO) Standards
◦ Identification of potential victims
◦ Evaluation of home environment and caregivers in
the discharge planning process
◦ Cases of suspected abuse and neglect reported to
proper authorities.
◦ List of community agencies for evaluation and
assessment of victims of abuse and neglect
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Follow up Monitoring
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Team collaboration
Patient safety
Caregiver stress
Communication Adult Protective Services (APS)
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Current referral from hospital
◦ Patient living with daughter. Patient became ill and
EMS called. EMS reported to ED staff unsanitary
living conditions. Hospital case management
interviewed patient and daughter. Daughter became
hostile and defensive, refusing to answer questions.
Further investigation revealed daughter had a
recent sub acute rehab stay where patient was left
alone at home. Hospital initialed guardianship
proceedings. Currently awaiting placement of
emergency guardian to admit patient for long term
care.
Trail of Protocal
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Strengths
◦ Detailed assessment tools
◦ Addresses many different forms of abuse and
neglect
◦ Weaknesses
 Assessment tools need to be utilized
 Common sense needs to be applied to
situations that don’t follow a “normal” pattern
 Assessment tools are only as good as the
professional using them
Strengths and Weaknesses of
Protocol
Current employer has abuse and neglect
trraining mandatory for all employees
 Protocals in place for reporting cases of
suspected cases of abuse and neglect
 Care plans for patients and screenings for
abuse and neglect
 Social workers on staff to assist discharge
planning to safe envorinments
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Application and Use in Current
Practice Setting
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Hartford Institute for Geriatric Nursing. (2010).
ConsultGeriRN.org. Retrieved from
http://consultgeririn.org?
References