PPA 419 – Aging Services Administration

1. PPA 419 – Aging Services Administration Lecture 9 – Elder Mistreatment

2. Introduction • Population most at risk appears to be women over 75 years of age who are widows and, in most instances, reside with relatives, one of whom is the abuser. The elder woman is most often white, is of poor to modest financial means and is a Protestant. She is frail and vulnerable. Abused elder will become more vulnerable over time.

3. Introduction • Typical abuser is presumably a caregiver because most victims clearly suffer from a range of physical and mental impairments. Most frequently an adult child. Abuser is middle-aged unless he is a spouse or grandchild.

4. Types of Abuse and Neglect • Physical Abuse and Neglect • Definition • Bodily harm, ranging from scratches, cuts, and bruises, to death. • Conditions are not diagnostic of abuse, but are clues and can be used in assessment. • Failure to thrive • Dehydration and malnutrition • Pressure sores or decubitus ulcers • Other conditions encountered in physical abuse and neglect • Deprivation of appliances (eyeglasses, hearing aids, wheelchairs, walkers).

5. Types of Abuse and Neglect • Psychological abuse and neglect • Can include confusion and disorientation, fearfulness, trembling and fidgeting when talking of certain subjects, changing the subject frequently, cowering in the presence of the caregiver, and referring all questions, even basic ones, to the caregiver. • Indicators can range from ambivalence, deference, obsequiousness, and shame to suicide. • May also include social and financial isolation.

6. Types of Abuse and Neglect • Financial abuse • The misappropriation of the assets of the elderly person. • Indicators include unusual activity in bank accounts, change in address of bank statements, the production of documents that the elder does not understand, care is not commensurate with the size of the estate, lack of amenities, caregiver expresses unusual or sole interest in financial aspects of elder person’s care, personal belongings are missing, etc.

7. Types of Abuse and Neglect • Violation of rights • All Americans have certain inalienable rights under the Federal Constitution, and federal and state laws including: • Right to personal liberty • Right to adequate, appropriate medical treatment. • Right not to have property taken without due process of law. • Right to freedom of assembly, speech, and religion. • Right to freedom from forced labor. • Right to freedom from sexual abuse.

8. Types of Abuse and Neglect • Violation of Rights (contd.) • Right to freedom from verbal abuse. • Right to privacy. Right to a clean, safe living environment. • Right not to be declared incompetent and committed to a mental institution without due process of law. • Right to complain and seek redress of grievances. • Right to vote and exercise all rights of citizens. • The right to be treated with courtesy, dignity, and respect.

9. Types of Abuse and Neglect • Self-neglect and self-abuse. • An individual fails to provide the necessities of life for him- or herself such as food, clothing, adequate medical care, and reasonable management of financial resources. • Ranges from poor grooming and eating habits to disintegration of the body from poor medical care. • Inherent legal problems with inclusion under elder mistreatment.

10. Indicators of Mistreatment • Older person not given an opportunity to speak for self. • Family members or caregivers have an attitude of indifference or hostility to the older person. • Caregiver fails to provide proper assistance or necessary mechanical devices for the frail elder. • Too main “explained”, or inconsistently explained, injuries. • A physical examination reveals that the client has injuries that the caregiver has not disclosed.

11. Indicators of Mistreatment • Client or caregiver has a history of “doctor shopping” and utilizing several different medical practitioners over a period of time. • Prolonged interval between the trauma or illness and presentation for medical care.

12. Indicators of Mistreatment • Caregiver or family withholds security and affection from the elder or teases him or her in cruel ways or threatens with nursing home placement. • Conflicting and implausible accounts of injuries. • Flirtation and coyness, indicating inappropriate sexual relationship.

13. High-risk situations • Unrealistic expectations of an older or ill person requiring punishment from caregiver. • Caregivers with multiple problems including mental illness or substance abuse. • Caregivers forced to provide care or in situations where needs exceed or may soon exceed abilities of caregiver. • Financial dependence of caregiver on older person. • King Lear syndrome.

14. Causes of Elder Mistreatment • Physically and mentally dependent elder. • Conditions causing dependency • Physical conditions. • 50% of all impairment caused by arthritis, rheumatism, and heart conditions. • In 1979, 5% of 65-74, 11.4% of 75-84, and 34.8% of 85+ needed help with at least one ADL. • Mental conditions • Depression (30