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Gerontological Nursing
Revised by
Dr. Maria Park
Introduction:
• The Aging population: The world issue
• Prevalence and scope of the problem
• Impact of the Baby Boomers
Impact of Aging Population &
Gerontological Nursing Issue:
• Health status of older adults:
• Health Care Expenditure & Use
• Health Care Setting:
– Nursing home, Residential care, home care
Barriers to health care
• Common myths of Aging:
• Ageism
• Attitudes of caregiver and receiver
• Finance
• Transportation: reliance on others
• Health care reform and it impacts on health
care needs for older adults.
Life Transition:
• Role Changes
• Compound losses:
– Widowhood
– Retirement
– Reduced income
– Loss of social prestige
– Social isolation
The Aging Process
• Factors affecting Aging process:
• Heredity
• Past and present illnesses
• Amount of life stress
• Lifestyle - exercise, nutrition, gen. fitness
Theories of Aging:
• Biological Theory:
• Genetic programming/ Longevity
• Somatic DNA Damage theory
• Endocrine, immunological
• Normal Wear/Tear,
• Free Radical, Cross-link theories.
• Psychosocial
Process of Aging:
• Biophysiological Aging
• Psychosocial Aging:
– Personality and socioenvioronmental
– Past coping mechanisms
– adjustment to stressful life event in later life
• Adaptation: More difficult for the elderly:
– Loss likely to occur close together with less
time to adjust to each event.
Process of aging: Psychosocial
• Social support and interaction
• Sexuality and intimacy
• Role transitions and role reverse
Legal/Ethical Issues in
Gerontological Nursing
• Gerontological care issues
• Core ethical concepts in GR
• Patient-based principles: Autonomy- right of
the individual to hold views, make decisions, and
take voluntary actions based on personal
preferences and beliefs.
• Direct vs delegated autonomy
• Competent vs incapacitated autonomy
Legal,Ethical: cont.
• Other dimensions of Autonomy
• Substitute Judgment
• Beneficence and Nonmaleficence
• Paternalism: Weak paternalism and strong
paternalism.
Legal&Ethical : cont..
• Omnibus Budget Reconciliation Act:
• Provision of service requirements:Quality of
care
• Resident Rights
• Do not resuscitate orders
• Advanced Medical Directives
• Legal Tools: living wills
End of life decision diagram
• Person is competent
• Right to self-determination
• Not competent: substitute decision
• Court appointed conservator if needed
• The living will speaks
• Durable power of attorney: non-life support
decisions
• Case law: proof of their wishes
Ethical decision making:
• Encourage pts’ expressions of desires
• Identify significant others who impact & are
impacted.
• Review personal value system -know self.
• Form an ethics committee
• Consult: clinical ethics consultation- mediate
moral conflict.
• Read, discuss, share, evaluate decisions.
Laws governing GN practice:
• Legal risks facing Nurses:
• Legal liability for Nurses:
• Assault and Battery
• Negligence
• False Imprisonment
• Invasion of Privacy
• Defamation of Character
• Larceny
Practice Setting / Competency requirement
• Nursing in the Acute Care Setting
– Specific competency and Expertise
– Critical Care and Trauma Care
– Special Care-related Issues
• Home Care and Hospice
• Community-based Services
The Role of the GN:
• Implementation of the plan of TX:
– The Nurse’s Role
– OASIS : an assessment tool care
– The Role of the Nurses
• OASIS
•
Standard used in
Gerontological Nursing:
• ANA Standard of Practice for GN
• Scope and major roles in GN
• GN practice setting
• Issues concerning GN
ANA Standard of CLINICAL GN Care
• Standard 1: Assessment
• Standard 11: Diagnosis
• Standard 111: Outcome Identification
• Standard 1V: Planning
• Standard V: Implementation
• Standard V1: Evaluation
Introduction to Mental Health
and Illness among Older Adults
Depression
• Incidence: Depression and Suicide
• Major depression and depressive
symptoms affect eldery 20-40% in
U.S.
• Incidence: inc. among women and who
are medically,emotionally ill or in long-
term care.
• Age appropriate assessment and Dx.
Barriers to Mental Health Care
• Attitudes: Do not seek help as needed.
• Finance: Limited income of elders.
• Transportation: Elders rely on others
• Inadequate detection of MI & Tx
Seek GP, not psychiatrist: somatic C/P
results in misdiagnosis.
Differential Diagnosis:Depression
• Differentiating Physical from Mental Illness
• Differential DX between Depression and
Dementia
• PSEUDODEMENTIA: The phenomenon of
depression appears to be demented.
• Drug Interaction and Side Effects: Needs for
drug inventory
•
Assessment of Pt.with Depression
• Health Hx, Medical Illnesses,
• Medication inventory,
• Mental Status Assessment including Risk
for suicide.
• Physical Assessment: Energy level and level of
independence - ADL
• Psychosocial Assessment: Psychosocial
stressors, and Coping ability
• Laboratory and other diagnostic tests: EEG,
ECG, Chem. Profile, CBC, B12 level, CAT, MRI, Serologic
tests, Thyroid panel, urinalysis.
Clues /Warning signs of Suicide
• Verbal Clues:
• Behavioral Clues:
• Situational Clues:
– Recent move ( to a nursing home,
relative’s)
– Death of a spouse
– Diagnosis of terminal illness
Geriatric Depression Scale(GDS)
• GDS: best tool specifically designed to use for
older adults.
• It consists of 30 questionnaire
• Direction: Present questions “VERBALLY”.
Circle answer given by pt. Do not show to pt.
• 21-30= severe depression
• 11-20= mild-mod . 0-10= considered normal
• .* GDS scale available in reserve section.
• GDS scale: limitation: Not applicable for
severely demented pt.
• The GDS is not a substitute for a diagnostic
interview.
• GDS is a screening tool for assessment of
depression in older adults.
Depression
Secondary to Medical Illness
• How prevalent is depression in the
medically ill patient?
• Up to 17% of adults
• ECA study 9.4-12.9% of medically ill
patients experienced depression in
comparison to 5.8-8.9 in a matched control
group of healthy individuals ( wells, et al.
1998).
Under-diagnosis & Under-treatment
• Depression in the medically ill patients are
under-diagnosed and under-treated:
• Only 34.9% of pts with major depressive
disorder were identified and adequately
treated by their primary care physicians(
Coyne et al 1995)
Depression secondary to Medical Illness:
• Characteristics of:
• Older age at onset
• More likely to respond to ECT
• More likely to show “organic” features in
Mental Status Exam.
• Less likely to have SI or commit suicide (18
vs45) * Winokur, ‘90
Common Medical Conditions
Etiologically R/T Depression
• CA
• endocrine disorders
• End stage renal disease and Hemodialysis
• Neurological disorders
Common Medications Assoc
with Depression
• Antihypertensives
• Benzodiazepines ( Anti-anxiety meds)
• Cancer- chemotherapeutic agents
• Contraceptives
• Corticosteroids
• Histamine 2 receptor antagonist:
– Cimetadine(Tagamet)
– Ranitidine(Zantac)
Psychoactive substances Assoc.
with Depression:
• Alcohol
• Amphetamine (withdrawal)
• Anabolic steroids
• Cocaine (withdrawal)
• Opiates
Polypharmacy in the Tx of Older Adults:
• Issues concerning polypharmacy in the
elderly:
• Prevalence
• Prevention strategies
Nursing Care Plan
• Presenting problems and the risks:
• Leading Dx for Older Adults with
Depression, and suicidal tendency:
• Outcome criteria:
• Intervention plan:
TX of Depression in the
Medically ill Pts
• Assessment of pt to identify mimicking problem
• Intervention strategies
• Psychopharmacologic management:
• SSRI’S, NSSRI’s, TCA’S
Treatment of Depression: Elders
• Somatic Tx.:* Consider pharmacodynamic
changes in the Elderly: Adverse drug reactions
&interactions:
• Antidepressants: Use with the lowest level of
anticholinergic effect.
• Second gen. Antidepressants with low
anticholinergic effects: Zoloft and Paxel,
• Mood stablizer: Divalproex NA ( Depakote)
• Benzodiazepines
• ECT
SSRI’s and NSSRI’S
• Sertraline –Zoloft Venlafaxine –Effexor
• Paroxetine- Paxil Mirtazapine –Remeron
• Escitalopram –Lexapro
• Fluvoxamine –Luvox
• Citalopram –Celexa
• * Remeron increases norepinephrine
and serotonin through blockade of inhibitory receptors.
* Fluoxetine – Prozac is not commonly prescribed to older
adults because of long half-life.
Psychosocial Approach:Depression
• I:l N/T interaction: develop trusting relationships.
• Overcome barriers (Ageism, attitudes)
• Improve pt’s self-esteem:
– Help improve appearance
– Acknowledge any progress pt made.
– Encourage socialization - Dec. anhedonia.
– Focus on here-and now: A graded system.
• Milieu management
• Reminiscence Therapy
• Cognitive Behavioral Therapy
Normal Changes with Aging:
• Cognitive function
• Personality and Self-Concept
• Stress and Coping
Aging and Cognitive Changes:
• Pathology begins
• _55__60_65__70__Onset symptoms________
• Loss of ADLs
• _________________ 75 80 85 <85
• _______/___________/_________/__90 <90
Normal Prodromal Symptomatic
Death
Prevalence of Dementia: Increase with Age
50%
45%
40%
35%
30% 65-75
25% 75-84
20% > 85
15%
10%
5%
0%
Cognitive Mental Disorders: Organic
• Dementia:Permanent, chronic progressive form
of CMD developed over an extended time.
• Incidence & Prevalence: Alzheimer’s disease
is the most common form of dementia (50-70%).
• Multi-infarct dementia:By repeated strokes.
• Small # caused by neurological disorders:
huntington, Parkinson’s, and head injury.
• Alcoholism, drug overdose, malnutrition.
• Infectious diseases: HIV
Etiology
• Genetic
• Biological: loss of neurons in the brain
cerebral cortex and Hippocampus.
• Neurofibrillary tangles
• Amyloid plaques
• Environmental
Diagnostic Test
• Spinal fluid analysis for b-amyloid measure
• Neuronal thread Protein (NTP)
measurement.
• Postmortem autopsy.
• Differential DX:
• Alzheimer’s D vs other organic dementia
• Alzheimer’s D vs Psuedodementia
Cognitive Testing :
Mini-Mental State Exam(MMSE):
• Score 5/5 Orientation
• Score 3 Registration
• Score 5 Attention & Calculation
• Score 3 Recall
• Score 9 Language
• Total score:
• Assess level of consciousness:
• Alert Drowsy Stupor-coma
Cognitive Testing: Clock Draw
• CLOX(Clock)
• Measure the executive control function(ECF)
– eg: goal selection, motor planning, sequencing,
selective attention.
• Directions: Ask the pt to draw a clock:
– Start by drawing a large circle
– Fill in all the numbers on a clock
– Set the hands to show the time 8:40
Cognitive Testing: Mini-Cog
• 3 item recall and clock drawing:
• Directions:
– Say 3 categorically unrelated words (like
MMSE)
– Ask pt to repeat back to you and remember
them
– Give the clock drawing test
– Ask the pt to tell you the 3 words again
Cognitive testing: Mini-cog
• Mini-cog
• Recall=0 Recall=1-2 Recall=3
• Clock abnormal Clock normal
• Demented Non-demented
•
Diagnostic Studies:
• Blood Studies: CBC, B12, Folate, TSH,
• Chem profile, homocysteine,
• Brain imaging
• MRI or CT
Physical Exam:
• Complete physical and neurological
• Essentially normal in AD
• Co-morbidities that may contribute to
cognitive impairment.
2
3
1
4
Diagnostic Criteria for Dementia
Multiple Cognitive impairment manifested by:
• 1). Memory loss(enable to learn new or recall).
• 2). One or more of the cognitive disturbances.
• -Aphasia, Agnosia Apraxia,, disturbance in
executive functioning.
• Significant Impairment in social or
occupational functioning due to deficit in
criteria 1) and 2) above.
• Gradual onset & progressive cognitive decline
Dementia v.s. Delirium
• Chronic Acute
• Not easy to ident. early Obviously sick
• Irreversible Reversible
• Insidious Rapid onset
• Clear sensorium - Clouded sensorium
(until progressed).
•
Alzheimer’s D: Clinical feature
• EARLY STAGE: Mild Stage ( 2-4 years). Intermediate
state between normal cognition and dementia.
• Symptoms mild -some IADLs maintained.
• Difficulty holding onto new information
– sign of short-term & recent memory losses.
• Slower reactions ,slower learning
• labile affect and Poor concentration.
• Subtle personality & behavioral changes
• Inc. risk for progressing to next phase.
Alzheimer’s D :
• MIDDLE/moderate STAGE:( 2-8 years).
• Progressive need for help with ADL’s: Difficult to
perform previously learned skills, & Enable to retain
new information. Loss of IADL’s
• Behavioral and personality changes -
agitation, aggression,
• Increasing long-term memory loss as well
• Confused, wonder off
• Ends with dependency for basic ADL’s
• MMSE: decrease from 19 to 12
Alzheimer’s D:
• LATE STAGE: Severe stage (2-8 years)
• Nursing Home Care: 24 hour nursing care
• Lives within the present only, still ambulatory.
• Incontinent. Follows only simple repetitive commands
• Disorientation - time and place - wandering off
• Behavior and personality change: agitated, depressed,
• Unable to recognize family members, friends
• Remembers only distant past
• Difficult to perform most of ADLS
• MMSE < 12
Alzheimer’s D :
• FINAL STAGE:
• Memory loss: all three
• Total loss of ADL
• Bedridden - Fetal position.
• Physical and mental deterioration
Terms associated with
speech/language findings in AD
• Aphasia, Anomia, Alexia
• Agnosia, Agraphia
• Apraxia
• Dysphasia, Dysphagia, Dysphonia
• Dysarthria
• Confabulation
Depression among AD
• Mild cognitive impairment accompanied by
mild depression inc risk for AD (visser et al
2000).
• Depression is common in dementia at all stages
• (Lyketsos et al, 97).
• Symptoms may be subtle or unrecognized by pt
and carer.
• Cornell Scale for Depression in Dementia
Psychosis and Agitation:
• Common in Alzheimer’s disease and other
dementing illness
• Major source of caregiver distress
• Contribute to premature institutionalization
• Causes of distress to caregivers: disturbing
symptoms.
• Management of aggressive behavior in AD:
• Risperidone, Olanzapine, and Quetiapine
NURSING ASSESSMENT
• Assess current status of:
• Extend of memory loss,Cognitive,affective/Mood,
Behavioral ( aggression, agitation) problems.
• Risk factors: injury, elope,
• Ability to perform IADLs, & ADLs.
• Rest, exercise, recreation, socialization,
communication difficulties.
• Events that trigger behavioral change( sundown
syndrome? Wandering?)
Nursing DX & Intervention
• Risk for injury R/T…
• Self-care Deficit R/T...
• Impaired Communication R/T…
• Management of target symptoms
AD: Treatment Strategies
• Early detection
• Effective Tx:
– Delay symptomatic onset
– Slow progression
• Palliative:
– Affect the disease process to alter symptoms
Disease slowing Tx: AD
• Potential Drugs
• Nasal Al Vaccine: Designed to attack brain
B-Amyloid, and slow down mental decline.
The result were not conclusive -stopped due
significant SE.
• There is a host of new medications in
various stages of development.
Symptomatic Tx: cognitive
• Acetylcholinesterase inhibitors:
• Physostigmine
• Tacrine (Cognex)
• Donepezil (Aricept)
• Rivastigmine (Exelon)
• Galantamine (Reminyl)Razadyne(new name)
• Memantine(Namenda)
• Vitamin E supplements
Promotion of General Health
• Ensure adequate Medical Care:
• Promote physical health: nutrition, exercise
• Tx of Comorbid medical condition
• Care for iatrogenic events
• Monitor drugs taken for other medical
disorders: Need stringent control of
unnecessary drugs taken - prescription/
OTC, herbal.
Psychosocial Interventions
• Early stage: Support group for person with
AD and carer.
– An increase in knowledge
– Sharing of experiences and feelings
– Creation of individual support networks.
Other Tx for Alzheimer’s D
• Anticonvulsant/Mood stabilizer -Divalproex
( aggression management)* Fall precaution.
• Antianxiety agents- Benzodiazepines
• Antipsychotic - Atypical.
• Sedatives
• Antidepressants
• Ergoloid Mesylate (Hydergine) - Slow down
mental deterioration.
Reference
• New videotapes in Nrsg Labn:
• No.NV 132 - Preventing Client Abuse
• No.NV 133 - The Cognitively Impaired Geri
• No.NV 134 - The Cognitively Impaired Geri
• Also reference materials are available at
Alzheimer’s Disease and rel. disorders
Association. 1-800-621-0379
• 360 N. Michigan Ave.Chicago,IL60601
Pick’s Disease
• Differential Dx
• Usually occurs after age 70
• Onset is slow, progress until death( duration
4y)
• Postmortem exam- Shrinkage of localized
cortical areas and dec. number of neurons.
Alcoholism in late life
• Introduction: Incident, Myths
• Impact of alcohol on elders:
• Decreased tolerance + age-related
physiological changes inc. likelihood of
physical injuries.
• Interaction with prescription & OCT drugs.
Risk Group:
• Older men when their wives die
• Older adults with freq. Hospitalization.
• Older adults with psychiatric illness:
• Hx of ETOH use earlier in life.
Diagnosis of Alcoholism
• Types of elderly alcoholics:
• Early-onset: Aging alcoholic
• Late-onset: No previous Hx. Usually
develop in response to stressor of aging.
• Future generation of elderly - more
expose
• Referral Barriers - several pitfalls
• Brief Michigan Alcohol Screening Test
ETOH Screening Tools
• Short Michigan Alcoholism Screening Test-
Geriatric Version(S-MAST-G):
• Total 10 questionnaire
• Scoring 2 or more “Yes” responses
indicative of alcohol problem.
• * SMAST-C scale available upon request
• CAGE questionnaire.
Treatment of elderly alcoholic
• Identify high risk elders in the community.
• Assess and recognize elderly pts with
alcohol abuse.
• Be aware of their financial and
transportation abilities.
• Be aware of recovery potential.
• Tx plans - emphasize social and
interpersonal therapies that are appropriate
Outcome Criteria: The pt will
• Be free of physical /mental sign of abuse
by (date)
• Be able to name two people who can be
called for help by (date).
Elder Mistreatment
“Current issues related to elder abuse and
abusers in the United States of America”
___________________
Presented by Dr. Maria J. Park, Professor of
Nursing at Kkotongnae Hyundo University
On October 13th, 2008
Elder Mistreatment
• This presentation includes discussion of
– National Incidence and Prevalence of Elder
Abuse in the U.S.A.
– Institutions and Agencies that are responsible
for handling Elder Abuse and Abusers in the
U.S.A.
– Theories, etiology, types of abuse, signs &
symptoms of abuse and neglect.
– Best Tools: the Elder Assessment Instrument
(EAI)
– Mandatory report: Who is responsible, the
process, and what need to be included in the
report.
Elder Mistreatment
• National Incidence and Prevalence of Elder
Abuse in the U.S.A.
Categories of Elder Abuse
• Where does elder abuse take place? And by
whom?
• Domestic setting.
• Institutional setting –similar types of abuse
as domestic, plus, polypharmacy problems
• Self-neglect – neglect by dose who are
mentally competent but engage in
behaviors that threaten their own safety.
Types of Abuses and Definitions
• The Panel to Review Risk & Prevalence of Elder
Abuse /Neglect (’02) has defined the following:
• Physical abuse
• Psychological/Emotional abuse
• Sexual abuse
• Financial exploitation
• Caregiver neglect
• Self-neglect
• Abandonment
• Institutional mistreatment
According to the NEAIS report:
• More than 1.5 million older adults experience
abuse/neglect in domestic setting.
• Half of the cases were neglect
• 35% were psychological abuse
• 30% were financial exploitation
• 25% were physical abuse
Theories of the Etiology of Elder Abuse
• Psychopathology of the abuser – Care givers
who have preexisting conditions.
• Transgenerational violence – Part of the
family violence continuum
• Situational theory- Caregiver stress, burdens
• Isolation theory – Abuse is prompted by a
dwindling social network
Ten(10) Risk Factors
associated with the Elder Abuse
• 1. Gender: Men – victim of physical violence.
Women – more neglected.
• 2. Age: 75 and older are more likely abused.
• 3. Dependent elder/Caregiver burden
• 4. Alcohol Abuse in the family
• 5. Hx of family violence – cycle may continue
• 6. Isolated elder – seldom noticed by others
Ten Risk Factors: cont.
• 7. Physical/mental Impairment
• 8. Provocative Behavior
• 9. Living with family/Relatives
• 10. Cognitive impairments.
Ten(10) Risk Factors Associated
with Abusive Caregivers:
• 1. Alcohol / drug abuse. 2. Mentally ill unstable
• 3. Unemployed. 4. Hx. Of Child abuse
• 5. Excess stress. 6. Lack of supportive network
• 7. Duration of care-giving
• 8. Dependence on the elder
• 9. Reluctance or inexperience
• 10. Hx of violence outside the family – criminal
Signs and Symptoms of Elder Abuse
• General considerations
• Assessment of signs and symptoms of elder
abuse: Warning signs of specific types of elder
abuse.
• Best Tools:
– The Elder Assessment Instrument (EAI)
The Elder Assessment Instrument
• The Best Tools: The Elder Assessment
Instrument (EAI). 41-item, 7 sections that
reviews SS and subjective complaints of
abuse/neglect, exploitation, & abandonment.
• No “score”. A victim should be referred to
appropriate social services if the following
exists: Next slide
Base on EAI findings
• Report to social services:
• If there is any evidence of mistreatment
without sufficient clinical explanation.
• Whenever there is a subjective complaint by
the elder of mistreatment.
• Whenever the clinician believes there is
high risk or probable abuse, neglect,
exploitation, or abandonment.
Elder Assessment Instrument: EAI
• 1. General assessment: 4 items
• 2. Possible physical abuse indicators: 6 items
• 3. Possible neglect indicators: 13 items
• 4. Possible exploitation indicators: 5
• 5. Possible abandonment indicators: 3
• 6. Summary: event of abuse, neglect,
exploitation, abandonment, additional
comments:
• 7. Comments and follow-up
Assessment of the Victim
• Physical appearance and behavior
• Physical condition: Malnutrition? Bruises?
Laceration?Scars? Burned marks?Fractures
Hematomas? Sign of internal injuries?
• Emotional and Mental: Level of anxiety,
• usual defense mech. Sign of depression (sense
of hopelessness, low self-esteem), cognitive
/sensory functions
• Assess risk for further abuse/neglect.
Reporting Elder Abuse
• How to report suspected elder abuse:
• Agencies associated with elder abuse
care:
• National Center on Elder Abuse(NCEA)
• Area Agency on Aging (AoA)
• Adult Protective Services (APS)
• National Eldercare Locator (NEL)
Legal & Ethical Issues
• Victim’s concerns about reporting.
• Controversy re: mandatory reporting by
• The neighbor
• Healthcare providers
Emergency calls
• 911 call
• Paramedics, the emergency response crews
• Home assessment for elder abuse/neglect
• Emergency treatment:
• Victim assessment – suspicion of abuse –
Preparing a report of the findings
• ( documentation according to the hospital’s
protocol),
Victim Interview:
• Provide privacy - l:l is important
• Communicate mater- of - factly
• Non-threatening manner- general to specific
• Question the victim direct to the point if
abuse is suspected.
• Reporting and Documentation of the
finding
• Pay extreme caution when confronted with
suspected batterers.
Process of screening for elder abuse
• If mistreatment suspected
• Report to adult Protective Services and/or other
public agencies as mandated by your states.
• If there is no immediate danger
• Find out whether full, private assessment can be
done now? If no,
• Discuss safety issues. Schedule for full assessment, if
possible, in appropriate –geriatric, assessment unit.
• If there is a immediate danger, Create safety plan.
Options include: hospital admissions, court protective
order, safe home placement. -Cont. to next slide
The Process. Cont.
• If full, private assessment can be done now, let
the responsible person initiate assessment:
safety, access, cognitive status, emotional
status, health and functional status, social and
financial resources, frequency, severity, and
intent
• If there is reasons to believe that
mistreatment has occurred, plan interventions
• If no mistreatment found, dismiss the case
Intervention for Abused Elderly
• Coordinate approach with Adult Protective Services
as mandated in your state
• If patient is willing to accept voluntary services:
• 1) Educate patient about incidence of elder abuse
and tendency for it to increase in frequency and
severity over time.
• 2) Implement safety plan e.g., safe home
placement, court protective order, hospital
admission.
• 3) Provide assistance that will alleviate causes of
mistreatment, e.g., refer to drug or alcohol
rehab for addicted abusers.
• 4) Provide education, home health, homemaker
services for overburdened caregivers.
– Cont. next page
Intervention: cont.
• 5) Referral of victim and/or family members to
appropriate service, e.g., social work, counseling
services, legal assistance and advocacy.
• If victim is unwilling to accept voluntary services or
lacks capacity to consent,
• Person lacks capacity:
• Discuss with Adult Protective Services the following
options:
• Financial management assistance, conservatorship,
guardianship, committee, special court proceedings,
e.g., orders of protection.
• Cont. to next page
Intervention: cont.
• If person has capacity, but unwilling to accept
• Voluntary services:
• Educate person about incidence of elder
mistreatment and tendency for it to increase in
frequency and severity over time.
• Provide written emergency numbers and
appropriate referrals
• Develop a follow-up plan
Home Assessment for
Elder Abuse/Neglect
• Environmental Conditions:
– Heating, lighting, furniture, cooking
utensils
– Food in the refrigerator ( old? Locked?)
– Blocked stairways, doors.
– Victim lying in urine, feces, or food
– Unsanitary living cond. -pile of garbage.
• Medical Attention / Medication.
Family Therapy
• Family members are the primary
caretakers
• Abusers are usually the caretakers
• Family therapy can assist with:
– elderly person’s functional status
– function of the family system.
– Supportive services
– family therapy for maladaptive behavior
References & Resources re: Elder Mistreatment
• National Center on Elder Abuse (NCEA)
www.elderaabusecenter.org
• Area Agency on Aging (AoA)– Check local directory.
• Statewide Agencies include:
– The eldercare locator – Sponsored by AoA
– The Adult Protective Service (APS):
– The Division of Aging (DOA)
– The Dept of Aging
– The Dept of Social Services
Resources: cont
• Elder abuse and neglect. Archives of Family Medicine,
2(4).371-388.
• National Center on Elder Abuse at the American
Public Human Services Association ( formerly the
American Public Welfare Association) in collaboration
with Westat (1998). The National Elder Abuse
Incidence Study: final report: September 1998.
Washington, DC: Natl Aging Information Center.
• Omnibus Budget Reconciliation Act (1987). Public
Law 100-203. Subtitle C: Nursing home reform.
Washington, DC: U.S. Department of Health and
Human Services:52 Fed. Reg. 38583.38584
