Elder Abuse

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According to the United States Department of Justice, elder abuse is dramatically underreported, with only 1 in 23 cases reported to Adult Protective Services. Cognitive decline is a risk factor for elder abuse, particularly financial exploitation. Abused elders are at greater risk for nursing home placement than their nonabused counterparts. One in 10 senior citizens is abused each year, and abused seniors are three times more likely to face mortality than nonabused seniors (United States Department of Justice, n.d.). Elder abuse is a problem that crosses all socioeconomic and sociodemographic strata with a higher incidence in populations with increased vulnerability factors. These factors include: community-dwelling minority elders, individuals with cognitive and physical impairment, and those with psychosocial distress. Victims of Alzheimer's disease are 4.8 times more likely to experience elder abuse than those without cognitive impairment (Dong, 2015). Elder abuse is a complex issue that can be related to many causes, such as family dynamics, caregiving stress, and cultural factors. Home healthcare clinicians providing care to community-dwelling seniors are well positioned to assess and identify elders at risk and those suffering from abuse during routine home healthcare visits. Clinicians often feel they need convincing evidence to report a suspected case of abuse, but this is not the case. Most states have mandatory reporting for healthcare professionals; this reporting requires only a reasonable suspicion of abuse. Early detection and intervention can often prevent elder abuse by facilitating important community-based support services, and managing a variety of underlying problems and stressors.
Some cultural and societal norms actually contribute to elder abuse and limit the ability of well-intended providers to identify and assist the abused. Members of some cultures may be of the belief that what goes on in the home or behind closed doors is a private or family matter. There may also be an attitude of disrespect or insignificance for the elder member in the family. The older person may experience shame and embarrassment, making it difficult for them to seek help and reveal these painful circumstances in their family, as this would shame the family. The abused elder may fear losing their living environment and be unable to manage financially and emotionally on their own due to language barriers, recent immigration status, and emotional and financial resources (American Psychological Association, 2017).
Elder abuse can take many forms: physical, sexual, emotional/psychological, neglect, and financial. Each is detrimental to the patient's health, but the presentation may change based on the type of abuse. Home healthcare clinicians play an important role in assessing all patients for signs of potential abuse.
Physical abuse occurs when someone causes actual bodily harm by pushing, slapping, kicking, spitting, hitting, misusing medications, force feeding, and using restraints. These physical acts may cause bruising, cuts, lacerations, sprains, hair loss, missing teeth, fractures, burns, and other traumatic injuries. Sexual abuse is rape, or acts that have not been consented to, or the individual is unable to consent to, or has been forced/compelled to consent. These victims may suffer from trauma around the rectum, vagina, breasts, and mouth.
Emotional/psychological abuse can include any of the following: humiliation, intimidation, ridicule, disregard, threatening, yelling, creating fear, bullying and blaming, controlling, harassment, coercion, isolating or withholding social contact, denial of basic rights, or incidences of overprotective behavior. Individuals suffering emotional abuse often display feelings of demoralization, depression and withdrawal, apathy, hopelessness, tearfulness, confusion, ambivalence toward the perpetrator, insomnia, loss of appetite, unexplained paranoia, agitation, and fear.
Neglect is a form of abuse that occurs when a caregiver ignores the elder's needs or fails to respond to needs.
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