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Chapter 23: Abuse and Mistreatment of Older Adults


Title: Chapter 21: The gerontological nurse as manager Author: jimmauk Last modified by: Molly Created Date: 7/7/2005 1:57:03 PM Document presentation format – PowerPoint PPT presentation

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Title: Chapter 23: Abuse and Mistreatment of Older Adults

Chapter 23 Abuse and Mistreatment of Older
Learning Objectives
  • Distinguish between elder abuse and self-neglect.
  • Describe several categories of the mistreatment
    of older adults.
  • Recognize risk factors for elder abuse.
  • Identify characteristics of perpetrators of

Learning Objectives (contd)
  • Recognize signs that an older adult is being
  • Discuss strategies to prevent the mistreatment of
    older adults.
  • Synthesize interventions in various cases of

(No Transcript)
  • Elder abuse is a single, or repeated act, or
    lack of appropriate action, occurring within any
    relationship where there is an expectation of
    trust which causes harm or distress to an older
    person or the mistreatment of an older adult
    that threatens his or her health or safety (WHO)
  • National Center on Elder Abuse (2010) 1 in 10
    older adults experience some form of abuse but,
    of those, less than 1 in 5 report it. under
    recognized problem.

Types of Elder Abuse
  • Psychological or emotional neglect (P. 812)
  • Psychological or emotional abuse
  • Violation of personal rights
  • Financial abuse
  • Physical neglect
  • Self-neglect
  • Direct Physical Abuse

  • Emotional Abuse Test
  • Do you...
  • feel afraid of your partner much of the time?
  • avoid certain topics out of fear of angering your
  • feel that you can't do anything right for your
  • believe that you deserve to be hurt or
  • wonder if you're the one who is crazy?
  • feel emotionally numb or helpless?
  • Does your partner...
  • humiliate or yell at you?
  • criticize you and put you down?
  • treat you so badly that you're embarrassed for
    your friends or family to see?
  • ignore or put down your opinions or
  • blame you for their own abusive behavior?
  • see you as property or a sex object, rather than
    as a person?
  • have a bad and unpredictable temper?
  • hurt you, or threaten to hurt or kill you?
  • threaten to take your children away or harm them?
  • threaten to commit suicide if you leave?

Case Studies
  • 23-1 65-year-old woman has bruises and small
    burns belligerent son
  • 23-2 80-year-old neighbor with Alzheimers
  • 23-3 Older male neighbor giving money to and
    afraid of young couple that is doing work for him
  • 23-4 Brother borrowing money from elderly
  • 23-5 Woman says she was in car accident
  • 23-6 81-year-old malnourished man with loud wife

Characteristics of Victims (T. 23-1)
  • Lives alone or with another person (shared living
  • Elderly (with financial abuse, between 80 and 89
    years of age)
  • Poor or of limited means
  • Physical disability
  • Significant functional or cognitive limitations
    (such as memory loss or dementia)

Characteristics of Victims (contd)
  • Impaired psychosocial health
  • Female
  • Socially isolated, depressed, or lacking social
  • Substance abuse issues
  • Dependent on others for care or assistance
  • Verbally or physically combative

Characteristics of Perpetrators of Elder Abuse
(T. 23-2)
  • Substance abuse, especially alcoholism
  • Increased stress
  • Lack of social support
  • Depression, anxiety, or other mental health
  • Lack of knowledge or training about caring for an
    older adult

Characteristics of Perpetrators of Elder Abuse
  • Overwhelmed caregiver
  • Poor coping skills
  • History of family violence
  • Maladaptive personality traits
  • Other social, psychological or emotional problems
    of Elder Mistreatment or Abuse

Prevention of Abuse or Mistreatment
  • Nursing interventions in the prevention of elder
    abuse (Table 23-3)

Establish a trusting relationship with the elder. Know about community resources and be able to appropriately refer people for help. Strengthen social supports and networking of older adults. Encourage regular respite for the caregiver. Identify and refer to appropriate caregiver support groups. Identify caregivers who are at high risk to be abusers and target interventions to prevent stress from caregiver burden. Interview the patient and family or caregiver to find out normal patterns for stress management. Identify possible scenarios and facilitate strategies to cope with those. Observe family interactions, dynamics, and body language. Encourage single older adults to remain involved and connected to society. Be aware of risk factors and contributing factors. Perform thorough physical assessments and carefully document findings, including appearance, nutritional state, skin condition, mental attitude and awareness, and need for aids to enhance sensory perception. If abuse is suspected, interview caregivers and other possible informants separately to confirm or refute suspicions. Know the reporting laws for your own state. Encourage the older person to let a trusted person know where valuable papers are stored.
Prevention of Abuse or Mistreatment
  • Suggestions for older adults to reduce the
    potential for abuse (T.23-4, P. 820)
  • Stay activekeep involved in social activities.
  • Have access to a telephone and use of it in
  • Store important contact information in two
    separate places (e.g. in a cellphone and a phone
  • Maintain contact with family and friends.
  • Know your financial situation and when to expect
    deposits and automatic withdrawals.
  • Have a secure, private place where your important
    files are kept.
  • Have a family members or friends visit regularly
    and unannounced.
  • Have an emergency safety plan if you are
    concerned about potential abuse.
  • Let a trusted person know where you are going if
    you are traveling or visiting out of town.

Assessment and Screening (1)
Recognizing the signs and symptoms of elder abuse
or mistreatment (Table 23-5, p. 821)
  • Poor hygiene
  • Unexplained bruises of different stages of
  • Broken bones
  • Malnutrition
  • Dehydration
  • Depressed mood
  • Withdrawn, fearful, agitation, cowering
  • Missing prosthetic devices denture, glasses,
  • Person is brought for treatment by someone other
    than the caregiver
  • Elder expresses feelings of hopelessness,
  • Elder expresses ambivalent feelings toward family
  • History of treatment in a variety of facilities
    and by different physicians

Assessment and Screening (2)
  • - Delays in seeking treatment
  • - Contradictory explanations by the caregiver and
    the patient
  • Bruises, burns, welts, lacerations, restraint
  • - Decubitus ulcers or poor hygiene
  • - Signs of medication misuse
  • - Pattern of missed or cancelled appointments
  • - Frequent changes in healthcare providers
  • - Discharge, bleeding or pain in rectum or vagina
    or sexually
  • transmitted disease

Assessment and Screening
  • Three Rs in detecting and reporting elderly
    abuse Recognize, Respond, Report (T. 23-6, P.
  • The Role of the gerontological nurse in reporting
    elder abuse
  • Clinical practice guidelines Elder abuse
    prevention program is available at

Nursing intervention
  • Alone (not) let the victim to be aware that
    he/she is not alone
  • Believe
  • Confidentiality
  • Documentation
  • Education
  • Safety

  • Elder abuse occurs across many socioeconomics
    groups and settings.
  • All gerontological nurses should be educated in
    the prevention, detection, and treatment of elder
  • Better mechanisms are needed for reporting abuse
    and neglect of older adults.