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Elder Abuse

Elder Abuse. What Is Elder/Dependent Adult Abuse?. Definitions Vary Most often defined as an action by a person in a position of trust which causes harm to an elderly person or dependent adult. Elder : Any adult age 65 and older.

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Elder Abuse

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  1. Elder Abuse

  2. What Is Elder/Dependent Adult Abuse? • Definitions Vary • Most often defined as an action by a person in a position of trust which causes harm to an elderly person or dependent adult

  3. Elder: Any adult age 65 and older Dependent Adult: Any adult age 18-64 with physical or mental impairments that restrict ability to carry out normal activities or to protect their own rights Target Population

  4. Domestic Abuse vs. Institutional Abuse • Domestic Abuse • occurs in the home • perpetrator has a special relationship with the elder • Institutional Abuse • occurs in SNF, B&C • perpetrator has legal or contractual obligation to provide care.

  5. Campaign Against Elder Abuse • Timeline • Began in 1965 with enactment of Older Americans Act (OAA) of 1965, advocated the rights of elderly population and provide funding for abuse prevention programs • 1973 established the Area Agency on Aging (AOA) • 1986 Institute of Medicine published recommendations for preventing elder mistreatment

  6. Campaign Against Elder Abuse • Timeline • 1990 elder abuse task force formed by the Secretary of the US Department of Health and Human Services (DHHS) • 1991 National Institute on Elder Abuse (NIEA) was created to organize the campaign and provide a headquarters • 1996 National Center on Elder Abuse (NCEA) funded to research the incidence of domestic elder abuse in the US

  7. Types of Abuse • Physical abuse/sexual abuse • Financial abuse • Psychological abuse (not mandated to report) • Neglect • Self-neglect • Abandonment • Isolation

  8. Physical abuse assault, battery, or force likely to produce injury sexual assault prolonged or continual deprivation of food or water punitive/inappropri-ate physical or chemical restraint- Financial abuse Taking, hiding, or misappropriating of elder’s money or property for personal use or gain in violation of the elder’s trust Definition of Abuse

  9. Psychological abuse subjecting an elder to serious emotional distress through threats, harassment, or other forms of intimidating behavior Neglect failure of caregiver to exercise a reasonable degree of care e.g., failure to: help provide food, clothing, shelter, personal hygiene help elder obtain needed medical care protect from health and safetyhazards prevent malnutrition Definition of Abuse

  10. Self-Neglect the inability of an individual to perform essential self-care tasks, resulting in a great risk to his/her health or safety Abandonment The desertion or willful forsaking of an elder by anyone having the care or custody of that person under circumstances under which a reasonable person would continue to provide care Definition of Abuse

  11. Isolation Violation of personal rights, such as false imprisonment or restraint preventing delivery of mail, telephone calls, visiting, etc. REMINDER Mandated to Report Welfare Institutions Code Penal Code 368 failure to report is a misdemeanor punishable by 6 months in jail and/or $1000 fine 12 months in jail and/or $5000 fine if abuse results in death or severe bodily harm Definition of Abuse

  12. Types of Abuse • Neglect • Physical • Financial • Emotional • Sexual • Other

  13. Ages of Elder Abuse Victims

  14. Ethnicity of Elder Abuse Victims

  15. Ability to Care For Self Physically

  16. Mental Status of the Victims

  17. Perpetrators of Elder Abuse

  18. Who Are the Victims? • Advanced age • elders 80 and above are abused and neglected 2-3 times more • Female • abused at a higher rate than males • Physical and/or mental impairments • almost 1/2 substantiated abuse cases elders were physically unable to care for themselves • Isolated

  19. Who Are the Abusers? • SAVED • Stress • Alcoholism • Violence history • Emotional disturbance • Dependency (e.g. financial)

  20. Age of Perpetrators of Elder Abuse, The “Sandwich Generation”

  21. How Can We Uncover Elder Abuse? • Screening • History and Physical Examination • Assessment • Intervention

  22. Screening Questions • Has anyone at home ever hurt your? Or touched you without your consent? • Has anyone made you do things you didn’t want to do? Taken anything that was yours without asking? • Has anyone ever scolded or threatened you? • Have you ever signed any documents that you didn’t understand?

  23. Screening Questions • Are you afraid of anyone at home? • Are you alone a lot? • Has anyone ever failed to help you take care of yourself when you needed help?

  24. The History and Physical Examination • First line of entry • May be only close contact

  25. Physical Examination • Diagnostic Physical Findings • features of physical abuse • multiple injuries in various stages of evolution • injuries without explanation or implausible explanation • Most common • bruises, lacerations, abrasions, head injuries, fractures • Less common • burns, sprains

  26. Physical Examination • Diagnostic Physical Findings • features of neglect • the elder displaysgross inattention to • nutrition • hygiene • established medical needs and • has a caregiver

  27. Physical Examination • Suggestive clinical presentations • Lacerations healing by second intention • Healed but misaligned fractures • Severe malnutrition/dehydration • Disparity in histories between the patient and caregiver • Implausible or vague explanations • Frequent ER visits

  28. Documentation • Urgency of Adult Protective Services (APS) Investigation • likelihood of imminent harm • Description of suspected mistreatment • medical or psychiatric consequences • other pertinent medial/psychosocial problems • Legible/no alterations • Pertinent positives and negative findings • Report facts objectively • Use patient’s own words

  29. Documentation • Source of information • family member • caregiver • collateral contact • Dates, names and times • Draw what you see (body diagram) • characteristics of injuries • size, shape, location, color changes, swelling, tenderness

  30. Documentation • Note: • abrasions • bite marks • bruises • burns • hematomas • punctures • scratches

  31. Dating Bruises swollen, tender 0-2 days red-blue 0-5 days green 5-7 days yellow 7-10 days brown 10-14 days Photodocumentation use good camera far away and close include face identifier (name plate) Documentation

  32. Level of safety Cognitive status MMSE Emotional status Geriatric Depression Scale (GDS) Health & functional status ADL’s and IADL’s Social and financial resources Frequency, severity andintent Implement safety plan safe home, protective order, hospital admission Provide assistance rehab programs, respite care, home health homemaker services, referrals Educate victim and family frequency and severity over time Assessment & Intervention

  33. How Do We Stop Elder Abuse? • REPORT • REPORT • REPORT • Domestic Abuse • Adult Protective Serv. • 877 4-R-Seniors • Institutional Abuse • Local Ombudsman, a patient advocate for those in nursing homes and assisted living facilities

  34. ADULT PROTECTIVE SERVICES (APS) Program dedicated to prevent and remedy abuse, neglect or exploitation of elder and dependent adults Maintain individual safety in their environment and strengthen their own capacity for self-maintenance Provide provision of services or linkage to community based organizations

  35. ADULT PROTECTIVE SERVICES (APS) • Report of alleged abuse/neglect received • Performs investigation within 10 days • Abuse/Neglect is either: • confirmed • inconclusive or • unfounded

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