Elder Abuse

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Elder Abuse

• Nancy V. Karp, Ed.D., P.T.
• nvkarp_at_gmail.com

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Abuse Module

• This presentation will
• Examine the demographics of elder abuse.
• Define elder abuse and list the types of abuse.
• Outline the screening procedures a PT should use
  for detecting elder abuse.
• Describe correct PT documentation procedures for
  elder abuse.
• Explain the ways that a PT can intervene for a
  patient when elder abuse is suspected.

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Elder Abuse and Neglect Categories

• Physical abuse
• Sexual abuse
• Emotion/psychological abuse
• Neglect
• Abandonment
• Financial/material exploitation
• Self-neglect

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Family Violence Prevention and Services Act

• Passed in 1992
• Mandated national study of abuse
• Provided insight into the characteristics of the
  abused, self-abused, and abusers.

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National Elder Abuse Incidence Study

• Published September, 1998
• Found that 5.3 times more abuse than is reported.
• Abuse in domestic settings
• 50 neglect
• 35 emotional/psychological abuse
• 30 financial exploitation
• 25 physical abuse
• 4 abandonment
• lt1 sexual abuse
• Note totals gt100 because of the possibility of
  multiple abuses.

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Elder Victim Characteristics

• Abuse increases with age gt50 over age 80.
• Average income of victims 5000-9000/yr (1996
  dollars)
• 60 female
• Victim demographics
• 50 unable to care for themselves
• 30 somewhat able to care for themselves
• 60 exhibit confusion
• 45 exhibit signs of depression

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Self-Neglecting Elders Characteristics

• 65 women
• Self-neglect increases with age 45 gt 80 years
  old
• 75 demonstrate confusion
• 50 demonstrate depression

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State Statutes on Elder Abuse

• All states have elder abuse statutes.
• GA requires that PTs must report suspected abuse
  to specific, designated agencies.
• PTs are in a critical position to identify elder
  abuse and intervene because patients view PTs as
  advisors, educators and confidantes.

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Elder Abuse and Neglect Categories
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Physical Abuse

• Definition The use of physical force which may
  result in bodily injury, physical pain or
  impairment.
• Mechanisms
• Chemical and physical restraints
• Incorrect positioning
• Force feeding
• Improper medication use
• Physical punishment of any type
• Providing physical therapy which is unwanted or
  at an inappropriate intensity level to maximize
  reimbursement

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Physical Abuse

• Lesser-known manifestations
• Wound locations inconsistent with patients
  explanation
• Evidence of unused prescribed medicines
• Unwillingness to communicate
• Changes in demeanor or activity level
• Caregivers refusal to allow visitors to see an
  elder alone

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Sexual Abuse

• Definition Nonconsensual sexual contact of any
  kind with an elder person. Includes sexual
  contact with any individual incapable of giving
  consent.
• Manifestations
• Bruises around breasts, genitals, or inner thighs
• Unexplained venereal disease or genital
  infections
• Unexplained anal bleeding
• Torn, stained, or bloody underclothing
• Difficulty in walking or sitting without evidence
  of musculoskeletal disease
• Reports of being sexually assaulted or raped

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Sexual Abuse

• Many elders were raised in a time when sexual
  matters were not discussed openly.
• Many elders view sexual abuse as the worst form
  of lost dignity.

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Emotional/Psychological Abuse

• Definition The infliction of anguish, emotional
  pain, and distress through verbal or non-verbal
  acts.
• Manifestations
• Emotional upset or agitation
• Depression
• Anxiety
• Passivity
• Evasiveness
• Fear

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Neglect

• Definition The refusal or willful failure to
  fulfill any part of a persons obligations or
  duties to an elderly person.
• Mechanism
• Active neglect
• The refusal or willful failure to provide for
  food, water, shelter, clothing, personal hygiene,
  medicine, comfort, personal safety, and other
  essentials included as a responsibility or an
  agreement.
• Passive neglect
• The non-willful failure of a caregiver to
  fulfill fiduciary functions and responsibilities
  due to inadequate knowledge or understanding of
  the need for prescribed services. Includes lack
  of compliance with clinical regimens and failure
  to provide safety precautions.

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Neglect

• Manifestations
• Dehydration Malnutrition
• Hypo/hyperthermia Decubitus ulcers
• Poor personal hygiene Misuse of meds
• General deterioration of health
• Unattended or untreated health problems
• Misuse of medications
• Failure to provide prosthetics, glasses,
  dentures, etc.
• Hazardous or unsafe living conditions
• Unsanitary or unclean living conditions
• Reports of being neglected

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Abandonment

• Definition The desertion of an elderly person
  by an individual who has physical custody of the
  elder or a person who has assumed responsibility
  for providing care for the elder.
• Manifestations
• Desertion of an elder at a hospital, nursing
  facility or other similar institution
• Desertion of an elder at a shopping center or
  other public location
• Reports of abandonment

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Financial/Material Exploitation

• Definition The illegal or improper use of an
  elders funds, property, or assets.
• Mechanism
• Cashing checks without authorization or
  permission
• Forging signatures
• Misusing or stealing an elders money or
  possessions
• Coercing or deceiving an elder into signing a
  document
• Providing and billing for PT services without
  informed consent of the patient or power of
  attorney.

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Financial/Material Exploitation

• Manifestations
• Inclusion of additional names on an elders bank
  signature card
• Unexplained, sudden transfer of assets to a
  family member or someone outside the family
• Sudden appearance of previously uninvolved
  relatives claiming rights to the elders affairs
  and possessions
• Provision of services that are not necessary

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Self-Neglect

• Definition
• Behaviors by an elderly person that threaten the
  elders healthy or safety. Does not include
  situations in which mentally competent elders
  make conscious and voluntary decisions to engage
  in acts that threaten their health or safety.

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Self-Neglect

• Mechanism
• The inability, due to physical or mental
  impairments, to perform tasks essential to caring
  for oneself, including obtaining essential food,
  water, clothing, shelter, personal safety,
  personal hygiene, medical care, and goods and
  services necessary to maintain physical health,
  emotion well-being, and general safety, and to
  manage financial affairs.

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Screening
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ScreeningPart of PT Assessment

• Physical therapists who suspect elder abuse
  should incorporate questions and examinations
  related to elder abuse into their daily practice
  to assist in further investigation by the
  appropriate authorities.

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ScreeningPart of PT Assessment

• Environment - the environment selected to screen
  elders when abuse is suspected should facilitate
  open communication.
• Examples
• Keep instructions short and simple
• Keep voice and mannerism calm
• Asking clear questions
• Allow ample time for hearing, understanding,
  answering
• Assess non-verbal cues

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ScreeningPart of PT Assessment

• Evaluating decision-making capacity
• Is the patient able to make and express choices
  regarding an intervention?
• Is the person able to provide reasons for
  choices?
• Do the persons reasons make sense?
• Is the person able to understand potential harm
  from choices?
• Is there a need for psychological assessment?

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ScreeningPart of PT Assessment

• Interviewing Technique
• Every clinician should have an interview
  protocol for the detection and assessment of
  elder abuse.

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Direct Questions for Interview

• What sort of difficulties have you experienced
  recently, either at home or somewhere you go
  regularly?
• Has anyone made you do anything or sign anything
  you didnt want to?
• How are you eating at home?
• Do you take any medications?
• Do you depend on anyone to help you?
• Does that person give you the help you need?

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Indirect Questions for Interview

• Tell me what you think the problem is here?
• What type of care does the elder require?
• Do you have any emotional support?
• Does the elder manage his/her own finances?

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Validating

• Many elders who have been abused have stated
  that the most helpful thing anyone can do is
  listen to them, believe them, and take them
  seriously.

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PT Validating Points

• Express the following
• You are concerned about the elders safety and
  well-being.
• You understand how difficult it is for the elder
  to make the necessary changes.
• The elder is not alone.
• The violence the elder is experiencing is not the
  elders fault, and only the abuser can stop the
  abusive behavior.
• No one deserves to be abused, there is no excuse
  for abusive behavior, and the elder deserves
  better.
• There are options and resources available.

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The Right to Refuse Help

• Despite your best efforts to identify elder
  abuse and offer assistance, the suspected victim
  may refuse help. Whether abused or not, adults
  have the legal right to refuse medical and social
  services.

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Documentation
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Documentation

• It is the PTs responsibility to carefully
  document any injuries that are suspected or known
  to have resulted from elder abuse.
• Treatment records may provide important evidence
  in legal proceedings.

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Clinical Examples of Elder Abuse- Review of
Systems -

• Cardiovascular/Pulmonary system
• Edema in extremities
• Dehydration (reduces blood volume and bp)
• Integumentary system
• Patients hygiene
• Skin turgor as a sign of dehydration
• Skin lesions
• Bruises, burns, pressure ulcers
• Scalp abnormalities

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Clinical Examples of Elder Abuse- Review of
Systems -

• Musculoskeletal system
• Abused patients show pain or fear of movement
• Contractures
• Muscle weakness patient is unable to perform ADL
• Fractures not consistent with reported injury
• Neuromuscular system
• Slow response to commands without a pathological
  condition
• Fear or apprehension
• Unexplained communication problems
• Somulence or slurred speech
• Incoordination

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Note

• A patient may exhibit some of the signs of abuse
  but these may be related, instead, to depression,
  dementia, medication reactions, or undiagnosed
  medical conditions. It may not be abuse.

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Interventions
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PT Responsibilities

• If elder abuse is suspected, the PT should
• Document the elder abuse
• Report suspected elder abuse
• Prevent elder abuse via patient and caregiver
  education
• Develop a plan-of-care to promote functional
  independence

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Promoting Functional Independence

• As independence in ADL increases, abuse of
  geriatric patients decreases.
• Functional activities should be taught to every
  geriatric patient or client.

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PT Documentation Highlights

• Record the abuse in the patients own words.
• Record the caregivers explanations in the
  caregivers own words.
• Use a body template or body map to record abuse.
• Provide detailed descriptions and measurements of
  injuries in objective terms. Do not use
  judgmental or emotional terminology.

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PT Documentation Highlights

• With patients permission, take photographs to
  document abuse.
• Document place photo taken
• Document date, time, name of photographer
• Document name of witness to photographic session
• Facilities may have a protocol for taking
  photographs. This may be done by medical records
  personnel, nurses, or others.

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Reporting Abuse

• It is the therapists responsibility to know the
  applicable state laws and appropriate state
  agencies for reporting abuse.
• Elder abuse is usually reported to Adult
  Protective Services. Look up the number for your
  county or local area. In Georgia, the listing is
  usually under
• Georgia State GovernmentFamily and Children
  Services, Adult Protective Services
• Report suspected abuse immediately.

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Adult Protective Services

• Georgia State GovernmentDepartment of Family
  and Children Services Augusta, GA 30901
• Phone [phone] 
• After Hours, Columbia County 115 Davis
  RdAugusta, GA 30907-2383
• Phone [phone] 

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In A Facility

• The protocol in a specific facility may require
  that you contact social services, first, rather
  than reporting the abuse directly to Adult
  Protective Services.
• However, it is your responsibility to insure
  that there is a follow-up.

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References

• This information in this powerpoint presentation
  is taken from two sources
• American Physical Therapy Association,
  Guidelines for Recognizing and Providing Care for
  Victims of Elder Abuse, APTA, Alexandria, VA,
  2000.
• Little, CD, What every physical therapist should
  know about elder abuse, Gerinotes, 9 (4), p 5-9,
  July, 2002.

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Questions

• If you have additional questions once you have
  gone through this module, feel free to speak to
  me either before or after class or email me.
• nvkarp_at_gmail.com

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Elder Abuse

• The End