Elder Abuse and Neglect

Course Outline:

● Identifying those at risk of elder abuse.
● Types of elder abuse.
● Signs of physical abuse.
● Signs of emotional abuse.
● Signs of neglect.
● Legal duty of healthcare providers to report suspected elder abuse and neglect.

Course Material:

No clear statistics on this but sources have indicated that 5 to 10% of the elderly experience some form of abuse. In more than 2/3 of all reported elder abuse, the abuser is a family member.

Definition of Terms:

Abuse- Intentional infliction of non-therapeutic injury, pain, or physical injury that can lead to mental or emotional distress. For elderly care, since many are also unable to take care of their own finances, financial abuse has also been included in this definition.

Neglect- is when the caregiver does not do the things necessary to meet the needs of the elderly (or a child).

  • Active Neglect – The caregiver has been educated andinformed on the necessary interventions to care for the  patient and does not want to comply.
  • Passive Neglect – The caregiver advocates for the patient but unintentionally overlooks other aspects of care and causes harm to the patient.
  • Domestic elder abuse – happens in the patient’s home.
  • Institutional elder abuse- occurs in nursing homes or long-term care settings.

Even if a caregiver is trying to help, it can be considered abusive if they use enough force to cause unnecessary pain or injury to an elderly patient.

Elders (in Domestic abuse) don’t always report the abuse because they are:

1. Caregiver (abuser) not allowing the patient to speak privately or preventing interviews.
2. Caregiver has signs of abusing drugs or alcohol
3. Unexplained injuries or bruises.
4. Frequent ER visits.
5. Caregiver showing signs of emotional instability.

Who is most at risk for elder abuse?

1. The patient is physically or mentally impaired.
2. The patient is isolated from other family members or friends.
3. The patient is totally dependent on care from the caregiver.
4. The caregiver has a history of drug or alcohol abuse.

Signs of Physical Abuse:

  •  Burns, including cigarette or hot water burns
  •  Unexplained bruises, especially bruises in the shape of belts or fingers.
  • Multiple bruises that are at different stages of healing (New bruises are red, then they turn blue, then black purple, then may turn yellow.)
  •  Frequent trips to the ER.
  •  Multiple cuts, scrapes, or bite marks.
  •  Black eye or broken eyeglasses.
  •  Signs of sexual assault, such as bruises in the genital area, unexplained vaginal bleeding, and bloody or torn underwear.
  • Spots where hair appears to have been pulled out.
  •  Rope marks in the wrist and ankle areas.
  • Unexplained sexually transmitted disease.

Emotional abuse (more common than physical) includes:

  • Insults
  •  Threats
  • Intimidation
  • Harassment
  • Yelling or screaming
  •  Treating the elderly like an infant
  • Not allowing patients to make choices
  • Constant criticism
  •  Humiliating the patient like laughing when the patient wets the bed
  •  Not allowing the patient to see some family or friends

Signs of emotional abuse:

  • The patient becomes withdrawn when visitors are present.
  • The patient complains of being very tired or sleeping all the time.
  • Appetite changes or the patient all of a sudden refuses to eat.
  •  Significant weight loss
  •  The patient talks about being helpless and expresses suicidal ideations.

Financial Abuse –

includes theft or misuse of someone’s money or property by a trusted individual. This includes: using the patient’s ATM card, forging checks, transferring money, or transferring property (real estate or car) title.

Signs of Neglect:

  • The environment is unkempt, dirty, and has a foul smell upon entry.
  •  Home with safety hazards, no air/heat or running water.
  • Patients have rashes, lice, or pressure ulcers
  •  Patient is emaciated.
  • The patient has worn-out clothes with holes.
  •  Patients do not have prescribed medications.
  •  No food in the refrigerator.

Self -Neglect/Noncompliance –

is the term used for mentally competent patients who refuse to follow the recommendations of their healthcare providers. Example: A hemodialysis patient who is non-compliant with his/her dialysis schedule.

Signs of Self-Neglect:

  • Reports from the MD clinic of missed appointments.
  • Expired full medication bottles.

What to do if Abuse or Neglect is Suspected (All healthcare
providers are mandatory providers):

  • Is the patient in immediate danger or need of emergency medical treatment? If the patient is in immediate danger and needs to be pulled out of the current living situation, call the police and the patient’s family
  • If you suspect abuse or neglect but are not sure about it, reach out to a social worker or Adult Protective Services (APS). Reporting to APS does not mean that abuse or neglect has occurred but that the situation warrants an investigation. Caregivers of non-compliant patients who are self-neglecting can be proactive and consult with social services or APS so they will not be later accused of neglecting the patient. It is not a HIPAA violation for a caregiver to give information to people or agencies investigating the abuse or neglect allegation.

ALWAYS:

  •  Follow the patient’s care plan and make sure all basic needs are met.
  •  Report anyone you see mistreating a patient, even your
  • co-workers. Do not cover co-workers.
  •  Know your limits and request relief if you are stressed out.
  •  Report to your supervisor if the patient refuses to participate in care, like refusing to eat, hygiene, or
    nutrition.

Never:

  • Never ignore a patient’s request for water, food, or bathroom needs (unless they are contra-indicated per MD orders).
  • Keep quiet when you witness a co-worker abuse a patient.
  • Threaten or make fun of the patient and do not let your co-workers do it either.
  • Take your personal problems out on the patients.

References:

National Institute of Aging. (n.d.). Elder Abuse. https://www.nia.nih.gov/health/elder-abuse/elder-abuse

U.S. Department of Justice. (2024, December 9). About elder abuse.   https://www.justice.gov/elderjustice/about-elder-abuse

California Department of Social Services. (n.d.). Adult protective services. https://www.cdss.ca.gov/inforesources/adult-protective-services

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