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Elderly Abuse

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Every man, woman and child in the society has a right to be treated with respect and care. Abuse and neglect of the elderly in the society is a critical health care issue that has caught the attention all stakeholders in healthcare and policy makers. The elderly are defined as anyone over the age of 65. This group, whether living at their homes with relatives or in long-term care institutions are at a high risk of abuse. Nurses can provide higher quality care if they are aware of the contributing factors, screening questions, the symptoms to look out for, and available resources in the community. Nurses should, therefore, be equipped with the right knowledge and clinical skill application to deal this critical issue.

Federal law defines abuse as "the infliction of injury, unreasonable confinement, intimidation, or punishment, with resulting physical harm, pain, or mental anguish" (Aronovitz, 2003, p. 21).  Another form of abuse is when a caregiver deprives an older adult of goods or services that are critical in maintaining physical and mental well-being. There is increasing awareness, among healthcare providers as well as the public, about elderly abuse and neglect. Almost all states have put laws in place that require healthcare providers to report any suspected cases of elderly abuse. According to the US Department of Health and Human Services, Administration and Aging (2016), an estimated 36 million people in the United States are aged 65 and above with an approximated 600, 000 in need of assisted living. As of 2015, the US has 15, 600 certified nursing homes with 1.4 million residents (KFF.org, 2016).

Unfortunately, older citizens are subjected to intentional abuse and neglect not only in nursing homes but also in their homes. Research shows that more than 1 million adults over the age of 65 are subjected to exploitation, mistreatment and may even be injured by their caregivers (Band-Winterstain, 2015). Nurses are well placed to play an influential role in the identification, handling, and prevention of abuse of the elderly because they maintain regular contact with the elderly.  In addition, nurses have the unique capabilities to carry out physical and psychological evaluations, run relevant diagnostic tests like x-rays and blood tests, and also collaborate with physicians and protective services. Nurses also have the authority to recommend services such as home health care, or hospitalization in order to allow further investigation by the concerned local agencies.

In the environment nurses work in, there are numerous opportunities detect and intervene in cases of elderly abuse. In the institutional setting, a nurse can observe patient health and also interview the patient on their health history, and evaluation of physical, psychological, sexual, and financial abuse that is important in eliciting reports, unearthing or preventing abuse, and also intervening for the safety of the patient (Blundell, & Gordon, 2015).  Nurses can collaborate with various other healthcare providers to form an interprofessional team that whose role is to ensure positive outcomes and the safety of elderly patients. Abuse can also occur in nursing homes and other assisted living facilities. All stakeholders who are involved in providing services, including nurses, institutional medical directors, and private practitioners, therefore, have a responsibility to identify, treat, and prevent all cases of mistreatment.

Mistreatment may be perpetrated by a staff member, a fellow patient, a visitor at the facility or a family member. Abuse can occur in the form of failure to implement a treatment plan, unauthorized use of both physical or chemical restraints, and isolation as a way to punish them or for staff convenience. Here, the nurse should have knowledge about patient diagnosis, MOST (medical order for scope of treatment), and appropriate medications including  possible side effects, so as to be able to identify any suspicious event that might need further investigation or to be reported to the supervisors (Corbi et al., 2014). However, it is important to note that a majority of the cases of abuse occur at home and are perpetrated by a family member.

Nurses should have knowledge about maltreatment as well as how to identify suspicious injuries in order to be effective in detecting elderly abuse. People involved in caring for older adults, including their family members and social workers, should be taught the definitions as well as signs and symptoms of these injuries. Some abused and neglected older adults may not be able to clearly communicate this, the perpetrators may attribute their bruises to the process of aging, while others may be afraid to report maltreatment. Any signs of bodily harm should warrant further investigation into other types of maltreatment like sexual molestation by the healthcare providers.

Many elderly people are at a higher risk of maltreatment because they have additional vulnerabilities. The elderly under care in nursing homes are typically dependent and may have chronic illnesses that affect their cognitive, visual, and auditory abilities. Furthermore, elderly people are likely to be frailer as compared to other patients and may also not be visited regularly by family members who can check on their mental status, physical condition or healthcare. Each vulnerability an older adult has increases their risk to abuse. Elderly patients heal slower from injuries and may also experience greater trauma from a physical injury as compared to a younger patient. They have more brittle bones while their tissue can easily bruise, get abraded, and lacerated (Lachs, & Pillemer, 2015). There are huge differences between older adults and the younger population in terms of how they physically and psychologically respond to injuries or any other form of abuse. 

Almost half of all the residents of in long-term care facilities are diagnosed with dementia (Lachs, & Pillemer, 2015). This, among other cognitive impairments, causes elderly patients to behave in a resistant manner towards caregivers. Other factors such as insufficient resources, poor staffing, inadequate supervision and poor training, when coupled with cognitively impaired patients increase the risk of abuse and neglect of the elderly.  In addition lack of awareness about the right standards for quality care in the society and acceptance of abuse of neglect by the victimized older adults can lead to underreporting and an increase in the cases of elderly abuse.

One of the ways to deal with elderly abuse is to incorporate routine questions about possible abuse and neglect into the daily nursing practice (Corbi et al., 2014). Although they may experience diminished cognitive abilities, the elderly can still describe cases of abuse. It is, therefore, important that nurses always enquire about abuse or neglect. They can also conduct mental examinations to evaluate the patient's cognitive status. Investigations into elderly abuse should include both the victim and the caregiver. Nurses should first interview and examine the victim in a private and separate setting from the individual suspected of maltreatment (Corbi et al., 2014).

All clinical facilities should establish a protocol for detecting and assessing elderly abuse. The protocol should be comprised of a narrative, checklist, or standardized forms that make it possible to conduct rapid screening for elderly abuse. Protocols should also provide guidelines for effective documentation that can help reveal patterns of abuse that can be used as evidence in a court of law. Assessment should include basic demographic questions that can disclose the patient's family composition, as well as their socio-economic status. The interview should start with general questions about the patients well being and then delve deeper to questions targeting specific kinds of abuse (Du Mont et al., 2015).

The healthcare provider does not have to provide evidence that an older adult has been abused. They only need to screen and document suspicious physical and verbal signs that are suspicious and write a recommendation that could be just simply stating that the patient showed signs of health and personal problems that and should be assisted (Blundell, & Gordon, 2015). Proper documentation includes drawings of the injuries on a body diagram or photographs that can be used as support for written reports. The war against elderly abuse can only be won through educating people about abuse and proper use of the knowledge by all the stakeholders.

Elderly abuse is a significant problem that might go unnoticed or unreported. It can be physical, emotional, psychological or sexual. A victim can be helped through immediate care, home delivered food, and provision of either overnight accommodation or long term care. This issue can easily be resolved but once neglected can have severe and life-threatening outcomes. The more knowledge the nurse and other healthcare providers have, the better positioned they are to implement strategies to prevent and manage the issue. The nurse has a duty to perform assessments and following the established protocols, take the necessary action.

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