ADULT & ELDER III – Exam 3 Review
Weeks 9-12
Elder Abuse and Mistreatment (week 9)
“Intentional actions that cause harm or create serious risk of harm to a vulnerable elder by a caregiver or other person who
stands in a trust relationship to the elder”
“Failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm
Legal definitions may vary from state to state
An outcome of the actions of abuse, neglect, exploitation, or abandonment
Types of Elder Mistreatment
•Physical • Caregiver Neglect (intentional or non-intentional)
•Sexual •Abandonment
•Emotional/Psychological •Self-Neglect
Financial Abuse/Exploitation
Theories of Elder Mistreatment
Situational Theory
Result of caregiver strain/stress
Psychopathology Theory
Stems from perpetrator’s own psychological issues
Exchange Theory
Related to victim-perpetrator long term relationship and dependency
Social Learning Theory
How abuse was learned
Political Economy Theory
Focuses on challenges faced by older adults in society
Dementia and Elder Mistreatment
~47% of older adults with dementia are victims of some type of elder mistreatment
Elder mistreatment may occur in long-term care settings by caregivers of older adults w/ dementia & chronic conditions
Challenges:
Older adults with dementia are not often able to provide a detailed history
Lack of objective assessment and policies on elder mistreatment screening and management
Risk Factors for Elder Abuse
•Functional impairment •Social isolation
•Dependency on others • Lack of support system
•Cognitive impairment •Low socioeconomic status
History of childhood trauma or abuse, substance
abuse, depression, other mental health disorders
Perpetrator Characteristics
• Family member in 80%-90% of cases • Dependency on the victim/older adult
• Long history of conflict with the victim/older adult • Lack of support system
• Living with victim for an extended time frame •Social isolation
• Caregiver strain/stress •Poor housing
• Recent financial stress and/or job loss •Low socioeconomic status
• History of substance abuse, gambling issue,
depression, or other mental health disorder
Elder Mistreatment Screening
Elder Assessment Instrument (EAI)
Used in inpatient and outpatient clinics
Relies on objective assessment by the clinician such as general appearance, evidence of dehydration, and physical
and psychological indicators
Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST)
Self-report instrument that focuses on older history
If positive screen is noted, a comprehensive history and physical assessment should be completed to validate
possible mistreatment Caregiver Strain Screening
Modified Caregiver Strain Index
A reliable instrument that may be used to assess caregiver stress/strain
Elder Abuse Assessment
Overview Questions
Interview older adult and caregiver separately (even if the caregiver is not the suspected perpetrator)
Has anyone ever tried to hurt you in any way?
Have you had any recent injuries?
Are you afraid of anyone?
Has anyone ever touched you or tried to touch you without your permission?
Have you ever been physically restrained or tied down?
Note: It may take multiple visits to develop trust and obtain detailed information
Overview
Overall appearance and hygiene
Clothing and footwear appropriate, clean
Overall hydration and nutrition status
Skin appearance
Physical assessment
Lab tests and results
Diagnostic tests and results
Physical Abuse-Related Questions
For suspected evidence of physical abuse (i.e., black eye):
Please describe what happened
How did it get there?
When did it occur?
Did someone do this to you? If yes, who?
Are there other areas on your body like this?
Has this ever occurred before? If yes, by the same person?
Physical Abuse
oBruises oRepeated falls
Assess for stage(s) of healing oSuspected sexual abuse
Assess for signs of grabbing (i.e. o Repeated emergency department (ED)
oupper arms, thighs bilaterally) visits, not necessarily same ED
Injury o Exhibiting anxiety behavior, especially
oBurns towards perpetrator
Lacerations
Fractures
Psychological Abuse-Related Questions
Are you afraid of anyone?
Has anyone ever yelled at you or threatened you?
Has anyone been insulting you and/or using degrading language? o
Do you live in a household where there is stress and/or frustration? o Does anyone care for you or provide regular assistance to you?
o Are you cared for by anyone who abuses drugs or alcohol?
o Are you cared for by anyone who was abused as a child?
Psychological Abuse
o Anxiety
o Agitation o
Dementia o Depression
o Delirium (acute change in mental status) o Change in usual behaviorMood
o Affect
o Willingness to communicate
o Report from older adult victim about verbal
or psychological mistreatment Neglect-Related Questions o Are you alone a lot?
o Has anyone ever failed you when you needed help?
o Has anyone ever made you do things you didn’t want to do?
o Do you live in a household where there is stress and/or frustration? o Does anyone care for you or provide regular assistance to you?
o Are you cared for by anyone who abuses drugs or alcohol?
o Are you cared for by anyone who was abused as a child?
Self-Neglect Related Questions
How often do you bathe?
Have you ever refused to take prescribed medications?
Have you ever failed to provide yourself with adequate food, water, and/or clothing?
Neglect
oPoor hygiene o Change in medication adherence
oInappropriate clothing, footwear oPressure ulcers
oDehydration and/or malnutrition oRepeated falls
o Change in usual bowel habits oUrine odor
oDecreased function o Basic needs not being met
oContractures o Report from older adult victim
Exploitation-Related Questions o Who pays your bills?
o Do you ever go to the bank with him/her?
o Does this person have access to your account(s)? o Does this person have power of attorney?
o Have you ever signed documents you didn’t understand? o Have you ever given money to a phone solicitor/caller? o
Are you cared for by anyone who gambles?
o Are any of your family members exhibiting great interest in your assets?
o Has anyone ever taken anything that was yours without asking?
o Has anyone ever talked with you before about this?
Financial Abuse/Exploitation
Misuse of older adult’s assets
Change in ability to pay usual bills, afford medications, pay for life essentials
Older adult report someone demanding money, threatening in exchange for money, caregiving in exchange for
money or purchases
Phone solicitation
Older adult victim report of “missing money”, unexplained loss of social security checks, pension funds
Abandonment
Left home alone long periods of time
Left home unsafely o
Caregiver withdrawal
Report from older adult victim
Interventions
How safe is the person to be in current setting and/or return home?
Do caregivers need assessment and management?
Use of interprofessional teams and meetings
Consider roles of interprofessional team members
Need for institutional guidelines for responding to elder mistreatment cases
Education
Ethics committee
Referral for services
Develop a trusting relationship
Follow up
Weeks 9-12
Elder Abuse and Mistreatment (week 9)
“Intentional actions that cause harm or create serious risk of harm to a vulnerable elder by a caregiver or other person who
stands in a trust relationship to the elder”
“Failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm
Legal definitions may vary from state to state
An outcome of the actions of abuse, neglect, exploitation, or abandonment
Types of Elder Mistreatment
•Physical • Caregiver Neglect (intentional or non-intentional)
•Sexual •Abandonment
•Emotional/Psychological •Self-Neglect
Financial Abuse/Exploitation
Theories of Elder Mistreatment
Situational Theory
Result of caregiver strain/stress
Psychopathology Theory
Stems from perpetrator’s own psychological issues
Exchange Theory
Related to victim-perpetrator long term relationship and dependency
Social Learning Theory
How abuse was learned
Political Economy Theory
Focuses on challenges faced by older adults in society
Dementia and Elder Mistreatment
~47% of older adults with dementia are victims of some type of elder mistreatment
Elder mistreatment may occur in long-term care settings by caregivers of older adults w/ dementia & chronic conditions
Challenges:
Older adults with dementia are not often able to provide a detailed history
Lack of objective assessment and policies on elder mistreatment screening and management
Risk Factors for Elder Abuse
•Functional impairment •Social isolation
•Dependency on others • Lack of support system
•Cognitive impairment •Low socioeconomic status
History of childhood trauma or abuse, substance
abuse, depression, other mental health disorders
Perpetrator Characteristics
• Family member in 80%-90% of cases • Dependency on the victim/older adult
• Long history of conflict with the victim/older adult • Lack of support system
• Living with victim for an extended time frame •Social isolation
• Caregiver strain/stress •Poor housing
• Recent financial stress and/or job loss •Low socioeconomic status
• History of substance abuse, gambling issue,
depression, or other mental health disorder
Elder Mistreatment Screening
Elder Assessment Instrument (EAI)
Used in inpatient and outpatient clinics
Relies on objective assessment by the clinician such as general appearance, evidence of dehydration, and physical
and psychological indicators
Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST)
Self-report instrument that focuses on older history
If positive screen is noted, a comprehensive history and physical assessment should be completed to validate
possible mistreatment Caregiver Strain Screening
Modified Caregiver Strain Index
A reliable instrument that may be used to assess caregiver stress/strain
Elder Abuse Assessment
Overview Questions
Interview older adult and caregiver separately (even if the caregiver is not the suspected perpetrator)
Has anyone ever tried to hurt you in any way?
Have you had any recent injuries?
Are you afraid of anyone?
Has anyone ever touched you or tried to touch you without your permission?
Have you ever been physically restrained or tied down?
Note: It may take multiple visits to develop trust and obtain detailed information
Overview
Overall appearance and hygiene
Clothing and footwear appropriate, clean
Overall hydration and nutrition status
Skin appearance
Physical assessment
Lab tests and results
Diagnostic tests and results
Physical Abuse-Related Questions
For suspected evidence of physical abuse (i.e., black eye):
Please describe what happened
How did it get there?
When did it occur?
Did someone do this to you? If yes, who?
Are there other areas on your body like this?
Has this ever occurred before? If yes, by the same person?
Physical Abuse
oBruises oRepeated falls
Assess for stage(s) of healing oSuspected sexual abuse
Assess for signs of grabbing (i.e. o Repeated emergency department (ED)
oupper arms, thighs bilaterally) visits, not necessarily same ED
Injury o Exhibiting anxiety behavior, especially
oBurns towards perpetrator
Lacerations
Fractures
Psychological Abuse-Related Questions
Are you afraid of anyone?
Has anyone ever yelled at you or threatened you?
Has anyone been insulting you and/or using degrading language? o
Do you live in a household where there is stress and/or frustration? o Does anyone care for you or provide regular assistance to you?
o Are you cared for by anyone who abuses drugs or alcohol?
o Are you cared for by anyone who was abused as a child?
Psychological Abuse
o Anxiety
o Agitation o
Dementia o Depression
o Delirium (acute change in mental status) o Change in usual behaviorMood
o Affect
o Willingness to communicate
o Report from older adult victim about verbal
or psychological mistreatment Neglect-Related Questions o Are you alone a lot?
o Has anyone ever failed you when you needed help?
o Has anyone ever made you do things you didn’t want to do?
o Do you live in a household where there is stress and/or frustration? o Does anyone care for you or provide regular assistance to you?
o Are you cared for by anyone who abuses drugs or alcohol?
o Are you cared for by anyone who was abused as a child?
Self-Neglect Related Questions
How often do you bathe?
Have you ever refused to take prescribed medications?
Have you ever failed to provide yourself with adequate food, water, and/or clothing?
Neglect
oPoor hygiene o Change in medication adherence
oInappropriate clothing, footwear oPressure ulcers
oDehydration and/or malnutrition oRepeated falls
o Change in usual bowel habits oUrine odor
oDecreased function o Basic needs not being met
oContractures o Report from older adult victim
Exploitation-Related Questions o Who pays your bills?
o Do you ever go to the bank with him/her?
o Does this person have access to your account(s)? o Does this person have power of attorney?
o Have you ever signed documents you didn’t understand? o Have you ever given money to a phone solicitor/caller? o
Are you cared for by anyone who gambles?
o Are any of your family members exhibiting great interest in your assets?
o Has anyone ever taken anything that was yours without asking?
o Has anyone ever talked with you before about this?
Financial Abuse/Exploitation
Misuse of older adult’s assets
Change in ability to pay usual bills, afford medications, pay for life essentials
Older adult report someone demanding money, threatening in exchange for money, caregiving in exchange for
money or purchases
Phone solicitation
Older adult victim report of “missing money”, unexplained loss of social security checks, pension funds
Abandonment
Left home alone long periods of time
Left home unsafely o
Caregiver withdrawal
Report from older adult victim
Interventions
How safe is the person to be in current setting and/or return home?
Do caregivers need assessment and management?
Use of interprofessional teams and meetings
Consider roles of interprofessional team members
Need for institutional guidelines for responding to elder mistreatment cases
Education
Ethics committee
Referral for services
Develop a trusting relationship
Follow up
