Elder Mistreatment:Abuse & Neglect by cbtms2B9

VIEWS: 13 PAGES: 14

									   Elder Mistreatment: Abuse &
              Neglect
Edward J Kramer, M.A. , CTRS.
New York University
College of Nursing
Geriatric Education Center
October 2008
  Today’s 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
                The Facts
•   44 million older adults>age 60
•   293,000 cases reported in NYS by APS
•   Many not reported ( Most)
•   1.1 million in the U.S.

• 2005 data
     Who are the Abusers
FAMILY, FRIENDS, NEIGHBORS,
 PROFESSIONAL CAREGIVERS,

NO RACE BOUNDARIES
NO INCOME STATUS
NO EDUCATION STATUS
              Abuse
•   PHYSICAL
•   SEXUAL
•   PSYCHOLOGICAL
•   FINANCIAL
    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
   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
    Indicators of Psychological Abuse
•   COMPLAINTS
•   ANXIETY,AGITATION, ANGER
•   BITING, SUCKING, ROCKING
•   ISOLATION AND WITHDRAWAL
•   CONFUSION
•   OVER REACTION TO STIMULI
    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
 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
       Family Risk Factors
• MENTAL ILLNESS,DEMENTIA,SUBSTANCE
  ABUSE
• FAMILY HISTORY OF VIOLENCE
• DEPENDENCY
• ISOLATION
• STRESS
• LIVING ARRANGEMENTS
• CAREGIVER SELF –PERCEPTION
                                         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
•     WEIGHT
•     HAIR
•     CLOTHES
•     NAILS
•     SKIN
SPECIFICS:
BRUSING
LACERATIONS
FRACTURES
ULCERS
DEHYDRATION
DIARRHEA, URINARY INCONTINENCE
DEPRESSION
MALNUTRITION
MONEY ISSUES
ABANDOMENT ISSUES
        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,PROSECUTION
         Community Resources
•   SENIOR CENTER
•   APS
•   DFA
•   FAITH
•   POSTAL WORKERS
•   STORES
•   ETHNIC CLUBS
•   HOSPITAL/CLINICS
•   POLICE
•   DOCTORS OFFICE

								
To top