Elder Mistreatment: Abuse

1
Elder Mistreatment Abuse Neglect

• Edward J Kramer, M.A. , CTRS.
• New York University
• College of Nursing
• Geriatric Education Center
• October 2008

2
Todays Learning Objectives

• 1.Describe the prevalence and types of elder
  abuse
• 2.Recognize the risk factors
• 3.Discuss assessment and treatment approaches
• 4.Discuss ethical dimensions
• 5.Discuss best practices for health care
  professionals in working with elder abuse

3
The Facts

• 44 million older adultsgtage 60
• 293,000 cases reported in NYS by APS
• Many not reported ( Most)
• 1.1 million in the U.S.
• 2005 data

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Who are the Abusers

• FAMILY, FRIENDS, NEIGHBORS, PROFESSIONAL
  CAREGIVERS,
• NO RACE BOUNDARIES
• NO INCOME STATUS
• NO EDUCATION STATUS

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Abuse

• PHYSICAL
• SEXUAL
• PSYCHOLOGICAL
• FINANCIAL

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Indicators of Physical Abuse

• UNEXPLAINED BRUISES OR WELTS
• SCALDING OR CIGARETTE BURNS
• CONCURRENT OLD INJURIES
• FRACTURES
• COMPLAINTS FROM ELDER
• ABNORMAL LAB RESULTS AS MED LEVELS,ANEMIS,
  ELECTROLITES

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Indicators of Sexual Abuse

• WALKS OR SITS WITH DIFFICULTY
• STAINED , BLOODY OR TORN UNDERGARMENTS
• GENITALIA BRUISED OR BLOODY
• ITCHING OR BURNING WHEN URINATING
• STD
• DESCRIBED FORCED ACTS

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Indicators of Psychological Abuse

• COMPLAINTS
• ANXIETY,AGITATION, ANGER
• BITING, SUCKING, ROCKING
• ISOLATION AND WITHDRAWAL
• CONFUSION
• OVER REACTION TO STIMULI

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Indicators of Financial Abuse

• MISUSE OF ELDER CHECKS AND CREDIT CARDS
• STEALING CASH, SS CHECKS, HOUSEHOLD GOODS
• FORGERY OF SIGNATURES
• IDENTITY THEFT
• THE WON A PRIZE SCAM
• THE CHARITY SCAM
• THE INVESTMENT SCAM
• THE HOME REPAIR SCAM
• NOT PROVIDING HEALTHCARE BUT CHARGING FOR IT
  DURABLE GOODS
• MEDICARE AND MEDICAID FRAUD
• THE DRUG SCAM
• PHONY REMEDIES

10
Am I all alone or is it my Fault

• THE PURE PROFESSIONAL APPROACH
• PERP AND PUNISHMENT
• VICTIM AND RESCUE AND TREATMENT
• THE WHOLISTIC ZEN APPROACH
• PERP PUNISHMENT AND REHABILITATION AND
  REUNIFICATION IF POSSIBLE
• VICTIM RESCUE, TREATMENT, AND EMPOWERMENT, AND
  CHOICES

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Family Risk Factors

• MENTAL ILLNESS,DEMENTIA,SUBSTANCE ABUSE
• FAMILY HISTORY OF VIOLENCE
• DEPENDENCY
• ISOLATION
• STRESS
• LIVING ARRANGEMENTS
• CAREGIVER SELF PERCEPTION

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Assessment

• TECHNIQUES
• SPEAK TO PERSON ALONE
• ASSURE CONFIDENTIALITY
• NEVER USE A FAMILY MEMBER AS A INTERPRETER
• FRAME YOUR QUESTION FOR COMFORT
• SENSITIVE TO CULTURAL BARRIERS
• INTERJECT COMPASSION STATEMENTS
• DEAL WITH FEAR AND DENIAL
• THE HEALTHCARE PROFESSIONAL SHOULD
• LOOK
• HEAR
• CONFIRM
• REFER
• FOLLOW UP
• THE ASSESSMENT INSTRUMENT
• TONE SETTING
• FIRST VIEW
• SMALL TALK
• HYGIENE

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INTERVENTIONS

• SOCIAL CASEWORK
• ADVICE,ADVOCACY,COORDINATION
• REFERRALS
• APS, POLICE, MEDICAL, SOCIAL SERVICE, FAMILY
  VIOLENCE
• PURCHASED SERVICES
• THIRD PART PAYEE, EMERGENY SHELTER
• LEGAL INTERVENTIONS
• REMOVAL, RESTRAINING ORDER, GUARDIANSHIP,PROSECUTI
  ON

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Community Resources

• SENIOR CENTER
• APS
• DFA
• FAITH
• POSTAL WORKERS
• STORES
• ETHNIC CLUBS
• HOSPITAL/CLINICS
• POLICE
• DOCTORS OFFICE