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  1. 1. Elder abuse: mistreatment of older Americans on the rise<br />By: Arlene Orhon Jech, RN<br />November 4, 2002<br /><br />
  2. 2. Purpose<br />This training is to inform you about elder abuse and the measures you can take to help prevent it.<br />
  3. 3. Topic Objectives<br />When you complete this training, you will be able to:<br />Identify the four types of elder abuse<br />Describe steps nurses can take to prevent elder abuse<br />Discuss domestic elder abuse and name the most frequent perpetrators<br />
  4. 4. introduction<br />Elder Abuse: Mistreatment of Elder Americans<br />
  5. 5. The U.S. population is aging. In 2000, about 35 million Americans, or 12.8% of the population, were older than 65. By 2050, more than 80 million people, or 20 percent of the population, will be older than 65 (1). <br />+45 Million<br />
  6. 6. Americans also are living longer. At the beginning of the 20th century, life expectancy was 47 years; by 2000, it had increased to an all-time high of 76.9 years (2). <br />+ 29.9 Years<br />
  7. 7. The increasing number of older Americans has been accompanied by a disproportionate increase in the prevalence of elder abuse. <br />Between 1986 and 1996, when the elder population increased 10 percent, reports to Adult Protective Services of suspected domestic elder abuse increased 150 percent.<br />+15 times<br />
  8. 8. In 1996 alone, more than 550,000 older people experienced some form of abuse or neglect in the domestic setting (3).<br />
  9. 9. Abuse significantly increases an elder’s chance of dying. Only 9 percent of mistreated elders and 17 percent of self-neglected elders in one study survived during a 13 year period, compared with 40 percent of elders with no history of mistreatment or neglect (4).<br />
  10. 10. Elder Abuse defined<br />Elder Abuse: Mistreatment of Elder Americans<br />
  11. 11. Elder abuse is defined as:<br />the mistreatment, neglect, or exploitation of an elderly person. <br />The abuse can be:<br /><ul><li>Physical
  12. 12. Psychological
  13. 13. Financial (5).</li></li></ul><li>Physical abuse is defined as: <br />the use of physical force that can cause bodily injury, physical pain or impairment. <br />
  14. 14. Evidence of physical abuse includes:<br />Striking<br />Shoving<br />Shaking<br />Beating<br />Slapping<br /><ul><li>Kicking
  15. 15. Pinching
  16. 16. Burning
  17. 17. Restraining
  18. 18. Improper feeding (5).</li></li></ul><li>Elders who have been physically abused may have:<br /> Bruises<br />Welts<br />Lacerations<br />rope marks<br />black eyes<br />Wounds<br />Cuts<br />Untreated injuries <br /><ul><li>Dislocations
  19. 19. Sprains
  20. 20. internal injuries
  21. 21. broken eyeglasses or frames
  22. 22. medication overdoses or under-doses </li></li></ul><li>Other signs are:<br />Withdrawal<br />Anxious or depressed behavior<br />Fearfulness around a family or caregivers<br />Change in the elder’s behavior. <br />Another red flag is a caregiver’s refusal to let the elder have visitors without the caregiver being present (5).<br />
  23. 23. Sexual abuse is defined as: <br />Nonconsensual sexual contact of any kind with an elderly person (5).<br />
  24. 24. Sexual Abuse includes:<br />Unwanted touching<br />Sexual assault or battery<br />Rape<br />Coerced nudity<br />Sexually explicit photographing (5). Bruising around the breasts or genital area, venereal disease, vaginal or anal bleeding and torn or bloody undergarments are signs of sexual abuse (5).<br />
  25. 25. Evidence of sexual abuse includes:<br />Bruising around the breasts or genital area<br />Venereal disease<br />Vaginal or anal bleeding <br />Torn or bloody undergarments (5).<br />
  26. 26. Psychological abuse is defined as:<br />The infliction of emotional distress, anguish, or pain through verbal or nonverbal acts (5).<br />
  27. 27. Evidence of psychological abuse includes:<br />Verbal assaults<br />Insults<br />Threats<br />Intimidation<br />Humiliation<br />Harassment<br />
  28. 28. Other examples of psychological abuse are:<br />Isolation of the elder from family, friends, or regular activities and ignoring or giving the elder “the silent treatment”. <br />Treating an older person as if he or she were an infant is also a form of psychological abuse (5). <br />
  29. 29. Psychologically abused elders may appear:<br />Agitated<br />Emotionally upset<br />Withdrawn<br />Non-communicative<br />Unresponsive<br />As well as unusual behavior such as biting or rocking also can be caused by psychological abuse<br />
  30. 30. Neglect is defined as:<br />The failure to provide needed care for an elder. <br />
  31. 31. Neglected elders may be being denied:<br />Food<br />Water<br />Clothing<br />Personal hygiene<br />Shelter<br />Medicine<br />Comfort<br />Personal safety<br />
  32. 32. Neglect also can take the form of:<br />Failure to fulfill an obligation to an elder, such as failing to pay for necessary home care services or the failure of an in-home caregiver to provide necessary care (5). <br />
  33. 33. Elders who have been neglected may also:<br />Appear dehydrated and malnourished<br />Have untreated bedsores<br />Lice or flea infestation<br />Urine or fecal smell<br />Be inadequately clothed<br />Live in hazardous, unsafe or unsanitary conditions.<br />
  34. 34. Financial abuse is defined as:<br />The illegal or improper use of an elder’s funds, property or assets (5). <br />
  35. 35. Financial abuse can include:<br />Cashing an elder’s checks without permission<br />Forging an elder person’s signature<br />Stealing money or possessions<br />Coercing or deceiving the elder into signing a contract or will<br />Improperly using the power of attorney, guardianship, or conservatorship (5).<br />
  36. 36. Indications of the Financial Abuse of Elders can include:<br />The disappearance of financial papers, checkbooks and legal documents<br />Sudden change in banking or a bank<br />Withdrawal of large sums of money by a person who accompanies the elder<br />Unauthorized use of an ATM or credit card<br />The unexplained disappearance of funds or possessions <br />Substandard care even though financial resources are available also can be caused by financial abuse. <br />
  37. 37. Other signs of financial abuse include:<br /> The sudden appearance of previously uninvolved relatives claiming a right to the elder’s possessions<br />Unexplained transfer of assets to a family member or person outside the family<br />Provision of unnecessary services <br />The elder’s report of being financially exploited (5).<br />
  38. 38. Self-neglect is defined as:<br />The behavior of an elderly person that threatens his or her safety (5). <br />
  39. 39. Self Neglect includes:<br />An older person’s refusal to provide himself or herself with enough food, clothing, shelter, cleanliness, medications or safety. <br />This definition does not apply to a mentally competent person who makes the elders come in contact with the health care system at some point. <br />Nurses and other health care providers are well placed to detect situations of potential abuse and to connect the patient and family with community resources.<br />
  40. 40. Abuse in the institutional setting<br />Elder Abuse: Mistreatment of Elder Americans<br />
  41. 41. Institutional abuse is defined as:<br />abuse and neglect that occurs in residential facilities that care for the elderly, including nursing homes, foster homes, group homes, and board and care facilities (5). <br />
  42. 42. Examples of abuse in the institutional setting are:<br />Slapping<br />Hitting<br />Isolating<br />Improper feeding<br />Theft of the resident’s property<br />Intimidation and psychological abuse by care providers.<br />
  43. 43. About 17,000 nursing homes in the United States care for 1.6 million residents, a figure expected to quadruple to 6.6 million residents by 2050 (10). <br />+5 Million Residents<br />
  44. 44. But in a recent two-year period, almost one out of every three nursing homes was cited for abuse (10). <br />
  45. 45. Facilities with the highest levels of nursing staff had 60 percent fewer violations for abuse (11). <br />STAFF<br />Abuse<br />
  46. 46. Nursing home staff often are poorly paid and overworked, have high stress levels and feel stretched beyond their limits. <br />
  47. 47. Nine out of ten U.S. nursing homes are understaffed, according to a recent government study (10).<br />
  48. 48. Legislation:<br />Citing insufficient levels of staff as the cause of poor care, a U.S. House of Representative committee introduced the nursing Home Staffing Improvement Act, HR 4715, in May 2001 (10). <br />
  49. 49. The bill helps the elderly by:<br />Establishing minimum staffing levels for nursing homes<br />Requires that all nursing home residents receive at least four hours of nursing care each day<br />And provides the funding to pay for the increased nursing staff (10). <br />Note: As of this writing, the bill has yet to be introduced to the full House of Representatives and the Senate.<br />
  50. 50. Report Violence Immediately:<br />Instances of one resident hitting another and suspected or resident reported caregiver abuse of residents are abuse and must be reported immediately to local law enforcement, Adult Protective Services or the long-term care ombudsman (11).<br />In most states, Adult Protective Services is the public agency responsible for investigating reports of elder abuse and for providing victims and families treatment and protective services (5).<br />
  51. 51. prevention<br />Elder Abuse: Mistreatment of Elder Americans<br />
  52. 52. Nurses who admit elders to emergency rooms, hospitals, and nursing homes should be alert for the signs of abuse, neglect, and self-neglect. <br />
  53. 53. Abuse can be detected by:<br />Obtaining a detailed history from the patient and caregiver in a nonjudgmental manner (9). <br />Interviewing the patient privately, preventing him or her from being inhibited by the caregiver’s presence (9). <br />
  54. 54. You can also:<br />Perform an assessment, it should include a thorough physical exam for signs of physical injuries, as well as testing for neurological and cognitive status. <br />The assessment should be documented with careful notes, drawings and photographs (9). <br />
  55. 55. After your assessment, If you suspect abuse:<br />Report it to local law enforcement or county Adult Protective Services, following the facility, state, and county reporting requirements (6).<br />
  56. 56. Seeking assistance for caregivers:<br />Stressed caregivers can be put in contact with social and support groups for referrals for adult day health care, delivered meals, and respite care. Finding helpers, attendants and home health aides to help with care giving can be a lifesaver. <br />
  57. 57. Caregiver assistance can be obtained from:<br />An area’s Agency on Aging (in the city or county section of the telephone directory under “Aging Services” or “Social Services”) and the Eldercare Locator can help (8).<br />
  58. 58. Nurses can help caregivers by:<br />Teaching caregivers to recognize situations that cause them stress<br />
  59. 59. Nurses can also:<br />Teach caregivers appropriate ways to handle difficult care receiver behaviors such as violence, combativeness, and verbal abuse (8).<br />
  60. 60. An ombudsman is defined as: <br />An advocate for residents of nursing homes, board and care homes and assisted living facilities (11). <br />
  61. 61. The federal Older Americans Act requires that:<br />Every state have an ombudsman program to handle complaints and advocate for improvements in long-term care (11). <br />
  62. 62. To find your area’s long-term care ombudsman, contact:<br />The State Ombudsman’s office or the National Long-Term Care Ombudsman Resource Center online (11).<br />
  63. 63. Summary<br />Elder Abuse: Mistreatment of Elder Americans<br />
  64. 64. By being aware of the signs of elder abuse, nurses can help protect the safety of some of our most vulnerable citizens. <br />When we suspect elder abuse, we can accurately document our observations and notify the appropriate authorities to investigate. <br />When we see domestic care situations at high risk for becoming abusive, we can refer the care providers to agencies for help to relieve their stress. <br />Nurses working in long term care should be ever vigilant and help relieve situations of care provider stress that can give rise to institutional elder abuse.<br />
  65. 65. Topic Objectives<br />Having completed this training you should be able to:<br />Identify the four types of elder abuse<br />Describe steps nurses can take to prevent elder abuse<br />Discuss domestic elder abuse and name the most frequent perpetrators<br />
  66. 66. Sources<br />Elder Abuse: Mistreatment of Elder Americans<br />
  67. 67. Citation<br /> <br />Administration on Aging. Older Population by Age: 1900 to 2050. [Online]. Available:<br /> <br />National Center for Health Statistics. Deaths: preliminary Data for 2000,2001. [Online]. Available:<br /> <br />Administration on Aging. Elder Abuse Prevention, 2001. U.S. Department of Health and Human Services. [Online]. Available: [Aug.26,2002]<br /> <br />National Institute on Aging, national Institutes of Health. (1998). Abuse Associated With Increased Risk of Death for Older People. [Online]. Available: [Sept. 2,2002]<br />National Center on Elder Abuse. (2002) The Basics: What is Elder Abuse? [Online]. Available: [Aug. 30,2002]<br /> <br />
  68. 68. Citation (cont.)<br /> <br />Administration on Aging (1998) The National Elder Abuse Incidence Study; Final Report, September 1998. [Online]. Available: [Sept. 2,2002]<br /> <br />National Center on Elder Abuse. (2002). Fact Sheet on Caregiver Stress and Elder Abuse. [Online]. Available: [Sept. 2, 2002].<br /> <br />National Center on Elder Abuse. (2002). Preventing Stress from Becoming Harmful: A Guide for Caregivers. [Online]. Available:<br /> <br />Hoban, S., Kearney, K. (2000). “Elder abuse and neglect. It takes many form- if you’re not looking, you may miss it.” American Journal of Nursing, 100(11), 49-50.<br /> <br />United States House of Representatives Committee on Governmental Reform-Minority Office. (2002). Special Investigations-Nursing Homes. [Online]. Available: [Sept. 2,2002].<br />
  69. 69. Elder Americans Quiz<br />