Nursing / Clinical Care Management Departments

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1 Nursing / Clinical Care Management Departments Experts suggest that 10% of all older adults are victims of abuse. Authorities believe that the reported cases are just the tip of the iceberg and that for every one that is reported there are five that are unreported. This self-directed learning module contains introductory information you are expected to know in the recognition, prevention and reporting of suspected elder abuse. Target Audience: All Clinical Areas Nursing Personnel Contents Instructions...2 Learning Objectives...2 Module Content...3 Job Aid...9 Posttest...10 Page 1 of 10

2 After completing this module, contact your supervisor to obtain additional information specific to your department. Read this module. If you have any questions about the material, ask your supervisor. Complete the online post test for this module. The Job Aid on page 6 may be customized to fit your department and then used as a quick reference guide. Completion of this module will be recorded under My Learning in PeopleLink Learning Objectives: When you finish this module, you will be able to: Define Elder Abuse Discuss statistics regarding abuse Discuss Cultural Issues related to Elder Abuse Identify types of abuse, risk factors, and indicators of abuse Describe assessment of suspected abuse Discuss preventing abuse Discuss reporting of elder abuse Identify resources to learn more about elder abuse Page 2 of 10

3 I. DEFINITION Elder abuse is the infliction of physical, emotional, or psychological harm on an older adult. Elder abuse also can take the form of financial exploitation or intentional or unintentional neglect of an elder adult by the caregiver. II. STATISTICS In the United States, the number of people age 60 and older is growing rapidly. An estimated 2.1 million of these older Americans are victims of physical, psychological, and other forms of abuse every year. Experts suggest as many as 10% of older adults may be victims of abuse. Reliable statistics are difficult to confirm because many violations go unreported. Approximately 70% of reported cases through Adult Protective Service Agencies are for neglect. About 1/3 of the reported cases involve emotional or psychological abuse. Financial exploitation occurs in approximately 1/3 of elder abuse cases. In addition, abuse is two or three times more prevalent in people over age 80 than in those 60 to 80. III. CULTURAL ISSUES Societal attitudes make it easier for abuse to continue without report or intervention. Factors include devaluation and lack of responsibility for older adults and society s belief that what goes on in the home is a private family matter. Defining what is considered abuse varies across diverse cultural and ethnic communities. When society fails to recognize the importance of assuring dignified, supportive, and nonabusive life circumstances for every older person, it shows a lack of respect which contributes to the violence against older people. Page 3 of 10

4 Religious or ethical belief systems sometimes allow for mistreatment of family members, especially women. Those who participate in these behaviors do not consider them abusive. In some cultures, women s basic rights are not honored, and older women in these cultures may not realize they are being abused. They may not be able to call for help outside the family and may not even know that help is available. Healthcare providers have a responsibility to recognize and report disabled adults at risk for abuse, neglect and exploitation in accordance with North Carolina laws. A disabled individual is identified as an elderly patient who is mentally or physically incapacitated due to advanced age. IV. IDENTIFY TYPES OF ABUSE Abuse takes various forms and a victim maybe subjected to more than one type. The most common types include: Caregiver Neglect typically involves a caregiver s refusal or failure to provide an older person with basic necessities, such as adequate food, clothing, shelter, medicine, and assistance with activities of daily living. If the caregiver has responsibility for paying bills, neglect also can include failure to pay the bills or to manage the elder person s money responsibly. Emotional or psychological abuse can range from name calling or giving the silent treatment to intimidating and threatening the individual. It is the deliberate inflicting of anguish, emotional pain, and distress through verbal assaults, threats, intimidation, humiliation, harassment, and isolation from friends and regular activities. Financial abuse or material exploitation occurs when someone takes an individual s money or belongings without permission. Can range from misuse of an elder s funds to embezzlement. Physical abuse is the use of force, such as punching, slapping, restraining, biting, burning, pinching, pushing, and pulling, which results in pain, impairment, or bodily injury. It can range from slapping or shoving to severe beatings and restraining with ropes or chains. Sexual abuse is nonconsensual sexual contact of any kind. It can range from sexual exhibition to rape. Sexual abuse is not often reported as a type of elder abuse. Page 4 of 10

5 Self-neglect is any behavior that threatens a person s own health and safety. It s most often characterized by a person s refusal or failure to provide food, water, clothing, shelter, medicine, and personal hygiene for him/herself. Abandonment is the desertion of a dependent person by the person or persons responsible for providing care. V. RISK FACTORS Experts suggest that 10% of all older adults are victims of abuse. Authorities believe that the reported cases are just the tip of the iceberg and for every one that is reported there are five that are unreported. Common risk factors that may lead to abuse include: Stressful caregiving circumstances, especially if the older person has a physical or emotional impairment. Caregiver resentment of the older person s dependency On going problems and dysfunctional dynamics of the family, such as a history of violence Isolation Poverty History of dysfunctional personality in the victim or the abuser, such as alcoholism, drug addiction, and emotional or mental disorders. VI. INDICATORS OF ABUSE Many of the symptoms listed below can occur as a result of debilitating conditions or medications. The appearance of these symptoms should prompt further investigation to determine the cause. Physical Abuse o Bruises or grip marks around the arms or neck o Rope marks or welts on the writs and / or ankles o Repeated unexplained injuries o Dismissive attitude or statements about injuries o Refusal to go to same emergency department for repeated injuries Emotional/Psychological Abuse o Uncommunicative and unresponsive o Unreasonably fearful or suspicious o Lack of interest in social contacts o Chronic physical or psychiatric health problems o Evasiveness Page 5 of 10

6 Sexual Abuse o Unexplained vaginal or anal bleeding o Torn or bloody underwear o Bruised breasts o Venereal disease or vaginal infections Financial Abuse or Exploitation o Life circumstances don t match with the size of the estate o Large withdrawals from bank accounts, switching accounts, unusual ATM activity o Signatures on check don t match elder s signature Neglect o Sunken eyes or loss of weight o Extreme thirst o Bed sores o Poor hygiene o Dirty clothes o Matted hair VII. ASSESSMENT OF SUSPECTED ABUSE If you suspect an older patient is being abused, provide a setting where the individual will feel safe talking about the situation. The physical examination and interview should be done apart from the caregiver. Many victims may be reluctant to report abuse because they re ashamed and afraid of abandonment or retaliation. They may react angrily and vehemently deny any suggestions that there is anything wrong. Remember the goal of reporting abuse of an older person is to ensure the safety of the victim. If a patient has dementia or a patient is unable to answer your questions appropriately, you should base your determination on your physical assessment, interview with caregiver, and assessment of their interactions. Possible screening questions might include: Has anyone ever hurt you? Has anyone ever touched you without your consent? Has anyone ever made you do things you didn t want to do? Who cares for you at home? Are you afraid of your caregiver? To identify potential neglect and financial exploitation, you might ask these questions: Are you satisfied with you living situation? What is a typical day like for you? Who gives you your medications? Page 6 of 10

7 Who helps you with dressing, bathing, and preparing meals? Has anyone ever failed to help you take car of yourself when you needed help? Has anyone ever withheld food or medications from you? What happens when you and your caregiver disagree? Are you afraid of anyone at home? Are you left alone a lot? Who manages your finances? Have you ever signed anything that you didn t understand? Has anyone taken anything of yours without asking your permission? To assess an injury, you might ask these questions of the patient and the caregiver separately: When did it happen? How did it happen? How long ago did it happen? How often does this happen? VIII. PREVENTING ABUSE Patient education plays a key role in preventing abuse to an older patient. You can offer these tips to avoid becoming a victim: Stay sociable and active keep in touch with neighbors and friends, and keep up with routine health care Keep your possessions in order open your own mail, arrange for direct deposit of checks, don t leave valuables lying around Consult a lawyer consider designating a power of attorney should you become disabled and don t sign anything until someone reviews it Know whom to ask for help you can contact Adult Protective Services or an elder abuse hotline If you suspect that an older person is being abused or neglected, report your suspicions to Clinical Care Management or the Department of Social Services. NOTE: Clinical Case Management at CMC-Lincoln. IX. REPORTING OF ELDER ABUSE Most states require health care workers to report suspected abuse. Follow your facility s reporting policy if you encounter an older adult in any of the following situations: Page 7 of 10

8 You detect evidence of mistreatment without a reasonable clinical explanation The patient complains of abuse You believe that the risk of abuse and neglect is high Normally, you contact the local Department of Social Services. X. RESOURCES The following contact information is available to learn more about elder abuse and how to report it. National Center on Elder Abuse 1225 Eye Street, NW, Suite 725 Washington, DC (202) Fax: (202) National Association of Area Agencies on Aging and the Center for Aging Policy: information on elder rights, housing, access services, and community and home based services; phone ; web site: U.S. Administration on Aging Eldercare Locator: is sponsored by the Administration on Aging (AoA). If you know the address and ZIP code of the older person being abused, Eldercare Locator can refer you to the appropriate agency in the area to report the suspected abuse ; web site: Selected References: Carolinas Healthcare System, Administrative Policy and Procedures Manual American Psychological Association: Elder Abuse and Neglect: In Search of Solutions. Available online at accessed April 15, Gray-Vickery P. Elder Abuse: Are you prepared to intervene? LPN, 1(2): 38-43, March/April Page 8 of 10

9 JOB AID Elder abuse is the infliction of physical, emotional, or psychological harm on an older adult. An estimated 2.1 million of older Americans are victims of physical, psychological, and other forms of abuse every year. Healthcare providers have a responsibility to recognize and report disabled adults at risk for abuse, neglect and exploitation in accordance with North Carolina laws. Types of abuse include: Caregiver neglect, emotional abuse, financial, physical, sexual, self-neglect, and abandonment Risk factors include: stress, resentment, dysfunctional family, isolation, poverty, and dysfunctional personality Many of the symptoms of abuse can occur as a result of debilitating conditions or medications but should prompt further investigation of cause Remember the goal of reporting abuse of an older person is to ensure the safety of the victim. Patient education plays a key role in preventing abuse to an older patient The Clinical Care Management Department may be contacted for additional information and assistance. (Clinical Case Management at CMC-Lincoln). Page 9 of 10

10 Posttest 1. Elder abuse is the infliction of: a. Psychological abuse b. Emotional abuse c. Physical abuse d. All of the above 2. Signs of elder abuse may include: a. Unexplained bruises b. Bed sores c. Matted hair d. All of the above 3. Type of abuse includes: a. Caregiver neglect b. Self-neglect c. Physical, psychological, and/or financial d. All of the above 4. Who should you contact if you suspect elder abuse in a patient? a. No one, it s a family matter b. Clinical Care Management (Clinical Case Management) or Social Worker c. Your supervisor or nurse manager d. b & c 5. When working with a victim of suspected abuse, you should: a. Ask the patient questions in private surroundings b. Be aware that some illnesses or medications can cause symptoms of abuse c. Confront the caregiver about the abuse d. a & b Name: Date: Circle the correct answer. Page 10 of 10

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