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ELDER ABUSE

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is the maltreatment of older adults by family members or caregivers. It may include physical and sexual abuse, psychological abuse, neglect, financial exploitation, and denial of adequate medical treatment.

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 Estimates

are that 500,000 elders are abused or neglected in domestic settings, and that as many as five unreported incidents of abuse or neglect occur for each one reported. Nearly 60% perpetrators are spouses, 20% are adult children, and 20% are others such as siblings, grandchildren, and boarders.
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 Most

victims of elder abuse are 75 years or older 60 % to 65% are women. Abuse is more likely when the elder has multiple, chronic mental and physical health problems and when he or she is dependent on others for food, medical care, and various activities of daily living.

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Elder are often reluctant to report abuse, even when they can, because the abuse usually involves family member whom the elder wishes to protect. Victims also often fear losing their support and being moved to an institution.
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CLINICAL PICTURE
The

victim may have bruises or fractures; lack needed eyeglasses or hearing aids; be denied food, fluids, or medications; maybe restrained in a bed or chair.
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May May Or

 Careful

ASSESSMEN T

assessment of elderly persons and their care giving relationships is essentials in detecting elder abuse. nurse should suspect abuse if injuries have been hidden or untreated or are incompatible with the explanation provided.
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The

Such injuries can include cuts, lacerations, punctured wounds, bruises, welts, or burns. Burns can be cigarette burns, scalding, acid, or friction burns of the wrists or ankles caused from being restrained by rope, clothing, or chain. Signs of physical neglect include a pervasive smell of urine or feces, dirt, rashes, sores, lice, or inadequate clothing. Dehydration or malnourishment not linked with a specific illness also strongly indicates abuse.
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Possible indicators of emotional or psychological abuse include an elder who is hesitant to talk openly to the nurse or is fearful, withdrawn, depressed, and helpless. The elder also may exhibit anger or agitation for an apparent reason. He or she may deny any problems, even when the facts indicate otherwise.

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Possible indicators of self-neglect include inability to manage money, inability to perform activities of daily living, and changes in intellectual function. Other indicator of self-neglect include sign of malnutrition or dehydration, rashes or sores in the body, an odor of urine and feces, or failure to keep needed medical appointments. For self-neglect to be diagnosed, the elder must be evaluated as unable to manage day-to-day life and take care of himself or herself. Self-neglect cannot be established based solely on family members beliefs that the elder 3/25/12

 Warning

of financial exploitation or abuse may include numerous un paid bills, unusual activity in bank accounts, checks signed by someone other than the elder, or recent changes in a will or power of attorney when the elder cannot make such decisions. The elder may lack amenities that he or she can afford such as clothing, personal products or a television. The elder may report losing valuable possessions and report that he or she has no contact with friends or relatives.
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 The

nurse also may detect possible indicators of abuse from the caregiver. The caregiver may complain about how difficult caring for the elder is, incontinence, difficulties in feeling, or excessive costs of medication. He or she may display anger or indifference toward the elder and try to keep the nurse from talking with the elder alone. Elder abuse is more likely when the caregiver has a history of family violence or alcohol or drug problems.
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 Some

states have mandatory reporting laws for elder abuse; others have only voluntary reporting laws. Nurses should be familiar with the laws or statutes for reporting abuse in their own state. Many cases remain unreported. The local agency on aging can provide procedures for reporting abuse in accordance with state laws.
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TREATMENT
Elder

abuse may develop gradually as the burden of care giving exceeds the caretakers physical or emotional resources. Relieving the caregivers stress and providing additional resources may help to correct the abusive situation and leave the care giving relationship intact. In other cases, the neglect or abuse in intentional and designed to provide personal gain to the caregiver such as access to the victims financial resources. In these situation, removal of elder or caregiver is necessary. 3/25/12

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PHYSICAL ABUSE INDICATORS

Frequent,

POSSIBLE INDICATORS OF ELDER ABUSE

unexplained injuries accompanied by a habit of seeking medication assistance from various locations to seek medical treatment for injuries, or denial of their existence or grogginess indicating misuse of medication3/25/12

Reluctance

Disorientation

POSSIBLE INDICATORS OF ELDER ABUSE

PSYCHOLOGICAL OR EMOTIONAL ABUSE INDICATOR
Helplessness Hesitance Anger

to talk openly or depression

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or agitation

Withdrawals

POSSIBLE INDICATORS OF ELDER ABUSE

FINANCIAL ABUSE INDICATOR

Unusual or inappropriate activity in bank accounts on checks that differ from the elders change in will or power of
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Signatures Recently

POSSIBLE INDICATORS OF ELDER ABUSE

NEGLECT INDICATORS
Dirt,

fecal or urine smell, or other health hazards in the elders living environment sores, or lice on the elder has an untreated medical condition or is malnourished or dehydrated not related to a known illness clothing
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Rashes, Elder

Inadequate

POSSIBLE INDICATORS OF ELDER ABUSE

INDICATORS OF SELFNECLECT
Inability

to manage personal finances, such as hoarding, squandering, or giving away money while not paying bills to manage activities of daily refusing needed medical 3/25/12 living

Inability

Wandering,

POSSIBLE INDICATORS OF ELDER ABUSE WARNING INDICATORS FROM CAREGIVER

Elder

is not given opportunity to speak for self, to have visitors, or to see anyone without the presence of the caregiver of indifference or anger toward the elder
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Attitudes