Abuse and Neglect


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Help take care of elderly


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Elder Abuse and Neglect : 

Elder Abuse and Neglect Brenda Holmes MSN/Ed, RN

Slide 2: 

Elderly abuse is not often reported because the abusers usually are people the victims

Definition : 

Definition Elder abuse is a general term used to describe harmful acts toward an elderly adult, such as physical abuse, sexual abuse, emotional or psychological abuse, financial exploitation, and neglect, including self-neglect.

Types of Abuse : 

Types of Abuse Passive and Active Neglect: With passive and active neglect the caregiver fails to meet the physical, social, and/or emotional needs of the older person. The difference between active and passive neglect lies in the intent of the caregiver. With active neglect, the caregiver intentionally fails to meet his/her obligations towards the older person. With passive neglect, the failure is unintentional; often the result of caregiver overload or lack of information concerning appropriate caregiving strategies.

Types of Abuse : 

Types of Abuse Physical Abuse: Physical abuse consists of an intentional infliction of physical harm of an older person. The abuse can range from slapping an older adult to beatings to excessive forms of physical restraint (e.g. chaining).

Types of Abuse : 

Types of Abuse Violations of Basic Rights: Violations of basic rights is often concomitant with psychological abuse and consists of depriving the older person of the basic rights that are protected under state and federal law ranging from the right of privacy to freedom of religion.

Types of Abuse : 

Types of Abuse Self Neglect: The older person fails to meet their own physical, psychological, and/or social needs. Usually seen in those with Alzheimer or some form of dementia

Types of Abuse : 

Types of Abuse Sexual Abuse: Sexual abuse consists of any sexual activity for which the older person does not consent or is incapable of giving consent. The sexual activity can range from exhibitionism to fondling to oral, anal, or vaginal intercourse.

Types of Abuse : 

Types of Abuse Psychological Abuse: Psychological or emotional abuse consists of the intentional infliction of mental harm and/or psychological distress upon the older adult. The abuse can range for insults and verbal assaults to threats of physical harm or isolation

Types of Abuse : 

Types of Abuse Material/Financial Abuse: Material and financial abuse consists of the misuse, misappropriation, and/or exploitation of an older adults material (e.g. possessions, property) and/or monetary assets

Potential Indicators of Abuse : 

Potential Indicators of Abuse Below are some potential indicators for each type of elder abuse. Please be aware that this does not represent a definitive listing. Passive and active neglect Evidence that personal care is lacking or neglected Signs of malnourishment (e.g. sunken eyes, loss of weight) Chronic health problems both physical and/or psychiatric Dehydration (extreme thirst) Pressure sores (bed sores)

Potential Indicators of Abuse : 

Potential Indicators of Abuse Physical Abuse Overt signs of physical trauma (e.g. scratches, bruises, cuts, burns, punctures, choke marks) Signs of restraint trauma (e.g. rope burns, gag marks, welts) Injury - particularly if repeated (e.g. sprains, fractures, detached retina, dislocation, paralysis) Additional physical indicators - hypothermia, abnormal chemistry values, pain upon being touched Repeated "unexplained" injuries Inconsistent explanations of the injuries A physical examination reveals that the older person has injuries which the caregiver has failed to disclose A history of doctor or emergency room "shopping" Repeated time lags between the time of any "injury or fall" and medical treatment

Potential Indicators of Abuse : 

Material or Financial Abuse Unusual banking activity (e.g. large withdrawals during a brief period of time, switching of accounts from one bank to another, ATM activity by a homebound elder) Bank statements (credit card statements, etc.) no longer come to the older adult Documents are being drawn up for the elder to sign but the elder can not explain or understand the purpose of the papers The elders living situation is not commensurate with the size of the elder's estate (e.g. lack of new clothing or amenities, unpaid bills) The caregiver only expresses concern regarding the financial status of the older person and does not ask questions or express concern regarding the physical and/or mental health status of the elder Personal belongings such as jewelry, art, furs are missing Signatures on checks and other documents do not match the signature of the older person Recent acquaintances, housekeepers, "care" providers, etc. declare undying affection for the older person and isolate the elder from long-term friends or family Recent acquaintances, housekeeper, caregiver, etc. make promises of lifelong care in exchange for deeding all property and/or assigning all assets over to the acquaintance, caregiver, etc. Potential Indicators of Abuse

Potential Indicators of Abuse : 

Potential Indicators of Abuse Psychological Abuse Psychological Signs: Ambivalence, deference, passivity, shame Anxiety (mild to severe) Depression, hopelessness, helplessness, thoughts of suicide Confusion, disorientation Behavioral Signs: Trembling, clinging, cowering, lack of eye contact Evasiveness Agitation Hypervigilance

Potential Indicators of Abuse : 

Potential Indicators of Abuse Sexual Abuse Trauma to the genital area (e.g. bruises) Venereal disease Infections/unusual discharge or smell Indicators common to psychological abuse may be concomitant with sexual abuse Violation of basic rights Caregiver withholds or reads the elder1s mail Caregiver intentionally obstructs the older person1s religious observances (e.g. dietary restrictions, holiday participation, visits by minister/priest/rabbi etc.) Caregiver has removed all doors from the older adult's rooms. As violation of basic rights is often concomitant with psychological abuse the indicators of basic rights violations are similar indicators as those for psychological abuse.

Potential Indicators of Abuse : 

Potential Indicators of Abuse Additional Indicators of Abuse or Neglect Elder is not given the opportunity to speak without the caregiver being present. Caregiver exhibits high levels of indifference or anger towards the older adult Overmedication or over sedation

Interventions : 

Interventions Notify staff immediately on recognition of any problems that might indicate abuse and/or neglect.

Video of Elder Abuse : 

Video of Elder Abuse

Questions? : 


Slide 20: 

Reference Woolf, L. M. Ph.D., Webster University Concise Dictionary of Modern Medicine. (2002) McGraw-Hill. http://medical-dictionary.thefreedictionary.com/elder+abuse

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