Scope and Nature of Elder Mistreatment

Module 3

Nurse Responses to Elder Mistreatment

An IAFN Education Course

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Case Analysis: Mrs. Kennedy

1. What are the issues in this case? 2. What do you currently know to

help you address these issues? 3. What do you think you still need

to know to respond to these issues?

Intentional acts by a caregiver or “trusted other” that cause harm or serious risk of harm to a vulnerable older adult and/or omission of acts wherein a caregiver or trusted other fails to meet basic needs of a vulnerable older adult

Impairments can increase vulnerability to mistreatment

Typically not one-time event

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Elder Mistreatment

Types Suspected and Clues

Emotional/psychological abuse? Neglect? Physical abuse? Sexual abuse? Abandonment? Financial exploitation? Violation of personal rights?

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Clues?

It can sometimes be difficult to distinguish elder mistreatment (EM) from problems that occur due to progression of aging, disease or chronic conditions and/or medication changes

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Module 3 Topics

Incidence, prevalence and risk factors of EM

Signs of possible EM Common age, disease-, chronic condition-

and medication-related changes that may mimic possible EM

Family violence in later life, elder mistreatment in institutional settings and elder sexual abuse

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Prevalence and Misconceptions

What misconceptions about extent and nature of EM have nurses seen held as truth in their work settings or in their communities?

How do these misconceptions impact interactions between patients and health care providers and subsequent interventions?

www.coaottawa.ca/elderabuse/documents/10Myths.pdf

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Prevalence Estimates

1 to 2 million Americans age 65+

2 to 10% of 65+ populationDrawn from National Center on Elder Abuse, Elder Abuse Prevalence and Incidence

http://www.elderabusecenter.org/pdf/publication/FinalStatistics050331.pdf

Additional Data…

Rates of reporting Who are victims? Who are perpetrators? Risk factors

o Caregiver stress? Intentionality of mistreatment?

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One Sign Doesn’t Indicate EM

A pattern of physical, behavioral and environmental signs point to a need to question whether mistreatment occurred

National Center on Elder Abuse, Frequently asked questions Center for Substance Abuse Prevention, Out of the shadows: , Uncovering substance use and elder abuse,

2004

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Signs of EM

Emotional/psychological abuse Neglect Physical abuse Sexual abuse Abandonment Financial exploitation Violation of personal rights

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Health Changes and Functional Effects in Older Adults

Skin Cardiovascular system Musculoskeletal system Neurological System Sensory System Gastrointestinal system Hormonal system Also, medication effects…

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Focus on…

Family violence in later life Institutional elder

mistreatment Elder sexual abuse

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Questions to Consider…

For each case, what is alleged perpetrator’s relationship with victim? Where did EM occur (community or institution)? What types of mistreatment do you think occurred? How does perpetrator use victim’s vulnerabilities to control or exploit? Is victim able to reach out for help?

What are challenges that nurses might face when presented with these different types of cases?

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Abuse in Later Life Wheel

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National Clearinghouse on Abuse in Later Life, 2006 Based on the Power and Control/Equality wheels developed by the Domestic Violence Intervention Project, Duluth, MN

Pattern of Controlling Tactics

Wheel shows pattern of controlling behaviors that make it very difficult for victim to leave abusive relationship

Perpetrators often use victims’ vulnerabilities to maintain control

National Clearinghouse on Abuse in Later Life, Interactive training exercises on domestic abuse in later life, 2003

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Who are the Perpetrators?

Spouse/intimate partnero Domestic violence grown oldo New life partnership/marriage in

later lifeo Late onset abuse

Adult child, grandchild, or other family member (e.g., sibling)

B. Brandl & D. Horan, Domestic violence in later life: An overview for health care providers, Women and Health, 2002

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Health Care Providers

Domestic violence at any age may be criminal

Assist victims in making their own decisions

Dangerous to believe abuser accounts Don’t medicate patients rather than

identify abuse Make safety/support options available

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Health Care Providers

Don’t blame victim or collude with batterer

Don’t minimize potential danger to patients or health care providers

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Family Violence in Later Life

Strangulation/suffocation Homicide-suicide

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Institutional EM

Research suggests that vulnerable individuals living in licensed nursing homes and other residential care facilities, on any given day, are at much higher risk for abuse and neglect than older persons who live at home

C. Hawes, Elder abuse in residential long-term care settings: What is known and what information is needed?, in R. Bonnie & R. Wallace (Eds.), Elder

mistreatment, abuse, neglect and exploitation in an aging America, 2003

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One study of 80 residents in 23 nursing homes in Georgia

44 % reported being abused 48 % reported being treated roughly 38 % reported seeing other residents being

abused 44 % reported seeing other residents being

treated roughly 95 % reported they had been neglected or

witnessed other residents being neglectedAtlanta Long-Term Care Ombudsman Program ,

The silenced voice speaks out: A study of abuse and neglect of nursing home residents, 2000

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Flags: Resident Examples

Signs/symptoms out of proportion to current problem/resident’s history

Unexplained injuries or injuries from improbable causes

Behavior changes after resident has visitors or a particular staff member is in room (crying, depression, etc.)

L. Phillips, Issues in Identification of Mistreated Elders (Slide presentation)

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Offenders: Institutional Settings

Staff Family of residents Other visitors to facility

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Underreporting

Health care professionals Residents and family Ombudsmen

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Sexual Abuse

Continuum can include:o -Forcing victim to view pornography or listen

to explicit sexual accounts or commentso -Coerced nudity/sexually explicit

photographingo -Sexualized kissing and fondlingo -Oral-genital contact/digital penetrationo -Vaginal rape/anal rapeo -Rape by objects/attacking victim’s genitals

with blows or weapons o K. Vierthaler, Addressing Elder Sexual Abuse: Developing a Community Response, 200526

Sexual Abuse

How do older persons react to/cope with sexual abuse?o Emotionallyo Physically

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Offenders: Elder Sexual Abuse

Vast majority are male Husband/intimate partner with

domestic violence history Adult son or grandson Caregiver in home Caregiver in facility

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Underreporting

What are barriers to self-reporting sexual abuse for older persons, in addition to those discussed already?

Barrier or healthcare providers to reporting elder sexual abuse?

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Closing Assessment

What one important thing did you learn in this module that you can apply in your practice setting?

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