Gero Exam2: Elder Abuse – Flashcards

*Adult children* opposed to spouses or other family members

Caregiver Private nurse's aid Guardian Telemarketer Power of attorney Family friend

The failure to provide for one's self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caretaker to provide such goods or services.

Extremely thin and malnourished Little or no food in cupboards No utilities operating/bills unpaid No personal hygiene Unsanitary living conditions Hoarding Isolation from others Home disrepair

Yes.

Person 65+ years or older

Person older than 14 who by reason of age or physical or mental disease, defect, or injury is substantially unable to protect himself from harm or to provide food, shelter, or medical care for himself.

By act: Intentionally Knowingly Recklessly With criminal negligence By Omission: Intentionally Knowingly Recklessly Causes: Serious bodily injury, Serious mental deficiency, impairment, or injury; or Bodily injury.

*Intentionally or knowingly* cause *SBI or SMD* by individual or owner, operator, or employee of group home

*Recklessly* cause *SBI or SMD* by individual or owner, operator, or employee of group home

*Intentionally or knowingly* cause *BI* by individual or BI or exploitation by owner, operator, or employee of group home

*INTENTIONALLY*-Actions with respect to the nature of his conduct or to a result of his conduct when it is his *conscious objective to desire to engage in the conduct or cause the result.* *KNOWINGLY* -Actions with respect to the nature of his conduct or to circumstances surrounding his conduct when he is *aware of the nature of his conduct or that the circumstances exists*...with respect to a result of his conduct when he is aware that his conduct is reasonably certain to cause the result. *RECKLESSLY* -Actions with respect to circumstances surrounding his conduct or the result of his conduct when *he is aware of but consciously disregards a substantial and unjustifiable risk * that the circumstances exist or the result will occur. -*note*: risk must be of such a nature and degree that its disregard constitutes a gross deviation from standard of care that an ordinary person would exercise under all circumstances as viewed from actor's standpoint. *CRIMINAL NEGLIGENCE* -Actions with respect to circumstances surrounding his conduct or result of his conduct when he ought to be aware of a substantial and unjustifiable risk that circumstances exist or result will occur. -*note*: Risk must be of such a nature and degree that failure to perceive it constitutes a gross deviation from the standard of care than an ordinary person would exercise under all circumstances as viewed from actor's standpoint.

If the result would not have occurred but for his conduct, unless the concurrent cause was clearly sufficient to produce the result and the conduct of the actor clearly insufficient.

Intentionally/ Knowingly: kick hit slap poison starve Recklessly/ with criminal negligence: -Leaving individual alone ties in a chair

Intentional physical, psychological, or sexual mistreatment which violates a person's rights, caused by someone in a caregiving or trusting relationship

Nurses

-Use of physical force that results in bodily injury, pain, or impairment -Includes acts of violence such as striking, pushing, shaking, slapping etc., inappropriate use of chemical/physical restraints, force-feeding, physical punishment -Signs include any unexpected injury, bruises, or change in behavior -Bruises resulting from abuse are likely found on the face, lateral aspect of arms, and posterior torso and are > 5 cm and person will be unable to offer a reasonable explanation for the injury

-Infliction of anguish, pain, or distress through verbal or nonverbal acts -Include insults, threats, intimidation, humiliation, treating person like a child, enforced social isolation, etc. -May be a deliberate effort to dehumanize the person to mitigate guilt of providing poor care

-Nonconsensual sexual contact of any kind with an elderly person, including with those persons unable to give consent -Unwanted touching, rape, sodomy, coerced nudity, explicit photographing -Injuries may be observed by healthcare providers -Behaviors may be revealing: fear of certain people, resistant to touch in genital area, reports of sexual contact

*Illegal or improper use of an elder's funds, property, or assets* -Can be done with force - demand a person sign checks with threat of withholding care -Can be done with deceit, misrepresentation, or fraud - cashing checks w/o permission, forging signatures -Signs include changes in banking practices, failure to pay bills, unexpected changes in wills, finding personal valuables missing *Undue influence* - one person uses their role and power to exploit the trust, dependency or fear of another to gain psychological control over the weaker person's decisions, usually for financial gain *Exploitation of Elderly* A person commits an offense if the person intentionally, knowingly, recklessly causes the exploitation of an elderly individual. -"Exploitation" means the illegal or improper use of an elderly individual for monetary or personal benefit, profit, or gain. -3rd degree felony *Theft of Elderly* -Unlawfully appropriates property with intent to deprive the owner of the property. Must be conduct done w/o the owner's consent. -Punishment is a value ladder and enhanced one penalty level if the victim is an elderly individual.

*Refusal or failure of a person to fulfill the obligation or duties of providing care or assistance to an elder dependent on the person* Most common form of elder mistreatment! *Caregiver Neglect*: act of omission or withholding needed goods and services (food, meds, treatment). Passive neglect (ignoring or not attending to needs) most common *Self-Neglect:* failure to provide for one's self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caretaker to provide such goods or services. May be indicated by failure to thrive, untreated medical conditions, neglected grooming, malnutrition, dehydration Includes withholding needed goods and services - food, medication, treatment, personal care, etc. May be due to caregiver stress or feeling overwhelmed by responsibilities of caregiving. Can be deliberate or malicious. Passive neglect most prevalent - ignoring or not attending to needs

-Desired treatment is withheld. -A particular problem in the elderly is pain under-treatment which can be considered a form of medical neglect -Abandonment: The desertion of an elder by an individual who had assumed the responsibility of providing care or assistance.

-Typical abused elder is a white, single woman over age 75 -Frailty, confusion, and depression also risk factors -The more dependent the elder, the more they are vulnerable to abuse. -The majority of caregiving and the majority of abuse occur within the family -Typical abuser is a male or female family member, single or divorced, age 35 - 50, unemployed and lazy, addicted to drugs/alcohol/gambling -Particular attention should be paid to a caregiver who is alone w/o support from others or opportunities for respite

-Vision and hearing problems. -Decubitus ulcers; unexplained bruises, burns, skin tears. -Pain. -Mobility vs. restrains (physical, drugs) -Nutritional status: thirst, dehydration. -Urinary and/or bowel incontinence. -Over/under-medication. -Infections: URI, UTI, etc.

-Exteremely thin and malnourished, little or no food in cupboards, no utilities operating/bills unpaid, no personal hygiene, unsanitary living conditions, hoarding, isolation from others, home desrepair -Treating the elder like a child -Isolating the person from his family, friends or regular activities -Fear of certain people, resistance to touch in genital area -Finding personal items missing, failure to pay bills, unexpected will changes -Poor personal hygiene: clothing appearance. -Residential appearance (interior). -Social withdrawal: loneliness, despair, anger/hostility, fear

-When a capacity to make healthcare decisions is called into question the nurse must determine if the incapacity is truly due to impairment or if inconsistencies with the nurse's own expectations is interpreted as a lack of capacity -Nurse has a responsibility to protect the patient from neglect or exploitation from all sources

-Thorough assessment with precise documentation . (What is the cause of injury ? Was it: Self-imposed or Criminal responsibility of another) -Collection and preservation of physical evidence (Bruising, Pressure sores, Medications, Cognitive orientation, Malnutrition, Dehydration, Delay in seeking medical attention) -Social services consultation -Implement safety plan if elder is in immediate danger -Mandatory report to appropriate agency on the suspicion of abuse or neglect

*Bruising* -color -stages of healing -location -consistent with facts *Pressure sores* -causes -mobility status of pt -nutrition *Medications* -over medication -under medicated -chemical restraints -use of drug levels *Cognitive orientation* -alertness -level of confusion -onset of dementia *Malnutrition* *Dehydration* *Delay in seeking medical attention*

Fear of retaliation Fear of placement Embarrassment Abandonment Helplessness/resignation Confusion Denial

Build rapport Non threatening Repeat victim's answers as part of next question Indirect approach Have documents to show them

Nurses are required to report suspicions of abuse, usually to APS (adult protective services). Nurse should notify police if elder is believed to be in immediate dange

Standard for reporting is reasonable belief that a vulnerable person is likely to be abused, neglected, or exploited; actual knowledge is not required

Physically frail but *mentally competent* elders *can refuse * agency intervention and cannot be removed from harmful situations without their permission

-Look at all folks: caregiver, private nurse's aid, guardian, telemarketer, power of attorney, family friend -Nurses may not be able to prevent abuse in some situations but can* make sure potential victims know how to get help if needed* and what resources are available and offer support and encouragement -Situations of caregiver stress: find respite services; give caregiver permission to give up the role; refer to support groups; teach use of crisis hotlines, professional consultation, victim support groups, etc.; provide thoughtful and compassionate care for victim and perpetrator -Gero nurses can* familiarize *themselves *with laws * affecting older adults in their state to assist elders in seeking representation and selecting the least-restrictive problem-solving approaches -* Advocacy - * nurse's role is to ensure that the patient is protected and that the patient's voice is not lost when they cannot express themselves

-Enacted in 2010. -Part of the health care reform bill and known as Patient Protection and Affordable Care Act; -Authorizes Elder Justice Coordinating Council to make recommendations on coordination of on federal, state, and local activities relating to elder abuse, neglect and exploitation

Volunteer or paid staff who *advocates for vulnerable elders in institutions* An ombudsman is usually appointed by the government or by parliament but with a significant degree of independence, who is charged with representing the interests of the public by investigating and addressing complaints of maladministration or violation of rights