This document discusses stress, coping, and elder abuse in elderly patients. It defines stress as mental tension caused by problems, and coping as processes to overcome difficulties. Many factors can influence coping in elderly, including health, social support, and resources. Poor coping may be caused by poor health, weak social support, or lack of skills. The document also defines elder abuse and lists its main types. Elder abuse cases are often invisible, and risk factors include impaired cognition or aggressive behaviors. Comprehensive nursing assessment is needed to identify stressors, coping abilities, and potential abuse in elderly patients.

1. Stress and coping in elderly –
Elderly abuse
ABDELRAHMAN AL KILANI
MSN – 15906012

2. Objectives
By reading the end of this seminar, you’ll be able to:
 Define stress and coping
 Identify age-related changes that affect psychological
function
 Discuss the factors that influence coping in older adults
 Describe the risk factors that may lead to poor coping
 Explain the coping strategies for the psychosocial challenges
of older adulthood
 Discuss the nursing care provided to elder people with
stress.

3. Objectives
 Define elder mistreatments
 Review international elderly abuse statistics
 Describe the types of elder abuse
 Discuss the risk factors for elder abuse and neglect
 Discuss the nursing care provided to elder people with abuse
or neglect.

4. Stress and coping
 Stress: is a state of mental tension and worry caused by
problems in your life, work, etc.
 Coping: is the process of contending with life difficulties in
an effort to overcome or work through them.

5. Age-related changes affecting
psychological function
1. Retirement:
 Loss of income
 Loss of identity/role
 Loss of status/authority
 loss of purpose in life
 loss of peer contacts
2. Death of friends:
 loss of companions
 threats to own mortality
 loss of social activities

6. Age-related changes affecting
psychological function
3. Widowhood:
 loss of helper
 loss of companion
 loneliness, grief
 changes in responsibility
 dependency on others
4. Relocation from family
homestead:
 loss of space
 changes of neighborhood
 move from friends

7. Age-related changes affecting
psychological function
5. Chronic illnesses
 functional impairments
 sensory decline
 medications
 dependency
 loss of money
6. Ageist stereotypes
 devaluation
 negative attitudes
 age-determined
expectations
 stereotypes and myths

8. Factors that influence coping in
older adults
 Religion and spirituality
 widely recognized as major coping resources that have a
positive effect on many aspects of psychosocial function
for older adults.
 Cultural considerations:
 Definition of mental health and mental illness
 Belief about the causes of mental health and illness
 Expression of symptoms or clinical manifestations of
mental health and illness

9. Risk factors that may lead to poor
coping
 Poor physical health
 Weak social supports
 Lack of economic resources
 Narrow range of coping skills
 The occurrence of unanticipated events
 The occurrence of several major life events in a short duration

10. Coping strategies
1. Retirement:
 Develop new skills
 Use time for hobbies and
personal pursuits
 Become involved with
meaningful volunteers
activities
2. Death of friends:
 Allow yourself to grieve
appropriately
 Establish new
relationships
 Renew old friendships.

11. Coping strategies
3. Ageist stereotypes
 Develop a firm self-
identity
 Challenge the myths
 Question any behaviors
that are based on age-
determined expectations
4. Relocation from family
homestead
 Appreciate the relief from
the responsibilities of
home ownership

12. Coping strategies
5. Changes in cognitive skills
 Take advantage of
educational opportunities
 Enroll in classes
 Keep mentally stimulated
 Join a discussion group
6. Declining physical health
 Maintain good health
practices (nutrition
exercise, rest)

13. Recent study
 Title: Caregiver Coping Strategies Predict Cognitive and
Functional Decline in Dementia: The Cache County Dementia
Progression Study
 Author: Tschanz, J. , at el.
 Design: Longitudinal, prospective cohort study. (6 years)
 Sample: A total of 226 persons with dementia, and their
caregivers
 Tool: Ways of Coping Checklist–Revised, Mini-Mental State
Examination (MMSE), and Clinical Dementia Rating (CDR).
 Conclusion: Caregiver coping strategies are associated with
slower dementia progression.

14. Nursing process for patients with
stress
Nursing assessment
 Because psychosocial function encompasses a broad range of
social, cognitive, and emotional aspects, a comprehensive
assessment is needed.
Nursing diagnosis
 Usually covers the self-esteem disturbance, the social
interaction, ineffective coping, sometimes about spiritual
well-being, and other diagnoses according to situation.

15. Nursing process for patients with
stress
Nursing planning and interventions:
Usually the plans will be directed to:
 Enhance self-esteem
 Promote a sense of control
 Involve the older adults in decision making
 Address role less
 Encourage life review and reminiscence
 Foster social support
 Address spiritual needs

16. Elder abuse and neglect
According to the national research council:
 Elder mistreatments: are intentional actions that cause harm
or create a serious risk of harm, whether or not intended, to a
vulnerable elder by a caregiver or other person who stands in
a trust relationship to the elder

17. Elder abuse and neglect
According to National Center on Elder Abuse, 2016
 Average number of elderly abuse cases each year: 2,150,000
in USA (9.5% of elderly population)
Neglect 58.5 %
Physical Abuse 15.7 %
Financial Exploitation 12.3 %
Emotional Abuse 7.3 %
Sexual Abuse 0.04 %
All other types 5.1 %
Unknown 0.06 %

18. Types of elder abuse
1. Physical abuse: use of physical force that may result in
bodily injury, physical pain, or impairment.
2. Sexual abuse: nonconsensual sexual contact of any kind
with an elderly person
3. Emotional abuse: infliction of anguish, pain, or distress
through verbal or non-verbal acts

19. Types of elder abuse
4. Neglect: refusal or failure to fulfill any part of a person’s
obligations or duties to an elderly person
5. Abandonment: desertion of an elderly person by an
individual who has assumed responsibility for providing care
for the elder, or by a person with physical custody of the
elder.
6. Financial or material exploitation
7. Self-neglect: behavior of an elderly person that threatens
his own health and safety.

20. Risk factors for elder abuse and
neglect
1. Invisibility of the problem (majority of cases are not
reported)
 Older people have less contact with community
 Older people are reluctant to admit to being abused or
neglected.
 Vulnerability if the older person:
 Dementia, depression, and mental illness
 Absence of close relatives

21. Risk factors for elder abuse and
neglect
2. Psychological factors
 Impaired cognitive function
 Dementia or impaired judgment increase the risk for
self-neglect, psychological and physical abuse
 Aggressive behavior of the person with dementia or
depression.
3. Caregiver factors
 Personality characteristic of caregiver
 Caregiver’s anxiety

22. Nursing process of abused or
neglected adults
Assessment
 Elder abuse is not much assessed as it detected.
 Assessment begins with a suspicion about its existence
 If it is suspected, the immediate assessment focus on the
safety of the older person.
 After basic life-sustaining needs are addressed, we can
consider the other needs:
Physical health, activities of daily living, psychological function, and
others.

23. Nursing process of abused or
neglected adults
Nursing diagnosis:
 Because elder abuse and neglect is so broad and complex,
various nursing diagnoses are applicable depending on
situation.

24. Nursing process of abused or
neglected adults
Planning and interventions:
The nursing interventions are made to:
 Improve the quality of life
 Abuse cessation, protection, recovery status
 Risk control
 Family coping and social support

25. Summary
 Stress is a state of mental tension and worry caused by
problems in your life, work, etc.
 Coping is the process of contending with life difficulties in an
effort to overcome or work through them.
 There are many factors influence coping in older adults as
there are some lead to poor coping.
 Comprehensive nursing assessment is required for optimum
nursing care.

26. Summary
 Elder mistreatments are intentional actions that cause harm
or create a serious risk of harm, whether or not intended, to a
vulnerable elder by a caregiver or other person who stands in
a trust relationship to the elder
 It has several types; physical, sexual, emotional, neglect,
abandonment, and financial.
 The main risk factor for abuse in elderly is the invisibility of
the problem.
 The main purpose in nursing assessment is to detect the
existence of abuse or neglect.

27. Conclusion
 Comprehensive and careful nursing assessment is an
important part in caring of elderly patient to identify the
stressors and the possible existence of abuse.

28. References
 Miller, C. (2012). Nursing wellness in Older Adults. Wolters Kluwer Health.
 Merriam-Webster online dictionary: http://www.merriam-
webster.com/dictionary/stress retrieved on 04/11/2016
 LeMone, P., & Burke, K. M. (2008). Medical-surgical nursing: Critical thinking
in client care. Upper Saddle River, NJ: Pearson/Prentice Hall.
 Statistic brain. (2016). Elderly abuse statistics. Retrieved from
http://www.statisticbrain.com/elderly-abuse-statistics/ on 17/11/2016
 JoAnn, T., Fauth, E., Norton, M. C., & Rabins, P. V. (2013). Caregiver Coping
Strategies Predict Cognitive and Functional Decline in Dementia: The Cache
County Dementia Progression Study.