Elder mistreatment, elder abuse and neglect

1. Elder Mistreatment
Dr.DoHA RASHEEDY ALY
Lecturer of Geriatric Medicine
Department of Geriatric and Gerontology
Ain Shams University

2. Elder mistreatment:
Involves acts of commission or
omission that result in harm or threatened
harm to the health or welfare of an elderly
person by a caregiver or other trusted
person

3. OR
• “Intentional actions that cause harm or
create a serious risk of harm (whether or
not harm is intended) to a vulnerable elder
by a caregiver or other person who stands
in a trust relationship to the elder.
OR:
• “Failure by a caregiver to satisfy the elder’s
basic needs or to protect the elder from
harm”

4. • The definitions exclude violence by strangers.
• There must be a trusting relationship between
an older person and the abuser.
• Willful (attempts harm) non- willful (lack of
skill, burnt out caregiver)

5. Who is the abuser?
• Partner, adult child or other relative.
• Friend, neighbour or visitor
• Patient or resident
• Health care provider, caregiver or other
social or support worker.
• Person managing an older person’s affairs
(e.g. Attorney or guardian).
• Self (self neglect)

6. Where does elder abuse take place?
• Home.
• Nursing home.

7. Epidemiology
• Increases as world is ageing.
• Ranges from 1.5 – 6% across different
population.
• Underreporting ? (only less than 10%
cases are reported)
• Abuse is manifested differently in different
culture and ethnic groups.

8. Barriers to report elderly mistreatment
 Lack of awareness (especially among health care professionals).
 Health care workers may feel uncomfortable discussing the topic with
their patients or may fear offending their patient’s caregivers.
 Knowing that there are few effective avenues to address the problem once
it is identified. lack of satisfaction with the response by the authorities
 Ageism and negative stereotyping of the elderly.
 It is often difficult to distinguish subtle symptoms of mistreatment from
symptoms of chronic physical and mental illnesses.
 Social isolation of the patient, Cognitive impairment.
 The elderly person's fear of threatening the relationship with the
caregiver and feeling that there is nowhere else to go, that nothing can be
done to help.
 The shame in admitting abuse by one's own family.

9. Risk Factors For Elderly Mistreatment
• Factors in the victim.
• Factors in the abuser.
• External factors as living arrangements, external
stress and social isolation
But, THERE IS NO EXCUSE FOR ABUSE

11. Types of Abuse
• Physical
• Psychological
• Sexual
• Violation of Rights
• Neglect
• Financial exploitation

12. Physical abuse
• Physical abuse is the use of force that results
in physical injury, pain, or impairment and
may include hitting, shoving, shaking,
slapping, kicking, pinching, and burning.
Additionally, the inappropriate use of drugs
and physical restraints, force feeding, and
physical punishment.

14. SEXUAL ABUSE
• nonconsensual sexual contact of any kind or
sexual contact with a person incapable of giving
consent. It includes unwanted touching, sexual
assault, and sexual battery.
• Primary evidence of sexual abuse includes
bruising of the perineal region or presence of
semen. Secondary evidence includes new onset
of a sexually transmitted disease, blood, or
purulent discharge

15. PSYCHOLOGICAL ABUSE
• infliction of anguish, emotional pain, or
distress through verbal or nonverbal acts.
It includes verbal assaults, insults, threats,
intimidation, humiliation, , name-calling or
harassment, silence treatment.
• Psychological abuse also includes
statements that humiliate or infantilize the
elderly person.

17. TYPES OF NEGLECT
• Active Neglect: intentional failure of a
care-giver to fulfill his/her care–giving
responsibilities
• Passive Neglect: Unintentional failure of a
care-giver to fulfill his/her care–giving
responsibilities
• Self Neglect: The older person not
providing his/her own essential needs

18. VIOLATION OF RIGHTS
• Abandonment: desertion of an elderly
person for whom one has agreed to care
for, “dumping” a cognitively impaired elder
at an emergency room with no
identification
• denial of privacy
• participation in decision-making.

19. FINANCIAL EXPLOITATION
• is the illegal or improper use of an elderly
person’s funds, property, or assets.
• It may include cashing checks without
authorization, forging an elderly person’s
signature, misusing elderly person’s
money or possessions, deceiving an
elderly person into signing a document
such as a contract or will, or improper use
of guardianship or power of attorney,
medical fraud.

20. Is Elder Abuse a Crime?
• Physical, sexual, and financial/material
abuses are considered crimes.
• Certain emotional abuse and neglect are
subject to criminal prosecution.
• SELF-NEGLECT IS NOT CONSIDERED
A CRIME.

21. Indicators for elder mistreatment
Physical Signs:-
• Multiple injuries, especially of different ages; bruises,
welts, cuts, abrasions;
• Scalds & burns, especially sock & glove patterns;
• Genital Injuries
• Poisoning especially if recurrent
• Sexually transmitted diseases;
• Patterned bruising;
• Unexplained failure to thrive;
• Poor hygiene;
• Dehydration or malnutrition;
• Fractures, especially if in specific patterns;

22. Behavioral Indicators
• Fear of particular person
• Appears worried and/or anxious
• Becomes easily irritable or upset
• Appears depressed or withdrawn
• Avoids physical eye or verbal contact with carer
or service provider.
• Difficulty in walking or sitting
• Pain or itching in genital area
• Recoiling from being touched
• Fear of bathing or toileting

23. Indicators of Financial Abuse
• Lack of money for necessities
• Depletion of savings
• Disappearance of possessions
• Sale of property by older person who
seems confused about the reasons for the
sale

24. Indicators of Neglect & Acts of Omission
• Malnourishment or dehydration
• Poor personal hygiene
• Clothing in poor repair
• Absence of appropriate dentures, glasses
or hearing aids
• Left unattended for long periods
• Medicines not purchased or administered

25. Indicators of Self Neglect
• Reclusive, filthy and unhealthy living
environments
• Collecting and/or hoarding rubbish
• Poor personal hygiene
• Inappropriate or unusual clothing
• Menagerie of pets

26. INSTITUTIONAL ABUSE
failure of an organization to provide an
appropriate and professional service.
Indicators:
• Low staff morale
• High staff turnover
• High sickness rates
• Excessive hours worked and frequent use of agency staff
• Lack of consideration for Privacy
• Lack of care with personal clothing (including loss of clothes,
being dressed in other peoples’ clothes, dirty or unkempt,
spectacles not clean, wearing other peoples’ spectacles,
hearing aids or teeth)

27. • Poor hygiene with noticeable smell of
urine
• Residents in dirty clothing and/or bed linen
• Inappropriate use of equipment
• Over reliance on sedating medication,
catheterisation and enemas
• Lack of communication between staff, staff
and residents and staff and relatives

28. INTERVENTION

29. • Effective management requires a
multidisciplinary approach that covers
broad areas of
• medical treatment,
• mental health care,
• social services, and
• legal assistance.

30. Prevention
• Education is the cornerstone of preventing elder
abuse.
• Respite care essential in reducing caregiver stress
• Social contact & support the elderly, family members
& caregivers.
• Counseling for behavioral or personal problems in
the family play a significant role.
• If there is a substance abuse problem, treatment is
first step in preventing violence against older family
member.

31. Identification of suspected
cases
• Physicians should learn to recognize the
common signs and symptoms of elder abuse,
many of which can be subtle.
• Health care provider may be the only contact of
the elder other than the abuser.
• When the physician suspects a problem, he
should conduct a thorough history and physical
exam, and the caretaker should be asked to
leave the examining room during the interview.

32. • Victims may not expose truth immediately,
instead asking directly, physician should
begin with questions about nature of
relationship with the caregiver, conditions
of the home, and circumstances
surrounding her physical signs and
symptoms.
• Assess patient safety , if unsafe hospital
admission is warranted.
• Develop a plan-of-care to promote
functional independence

33. Assessment
• Medical
• Cognition
• Mood
• Functional
• Decision making capacity.
• Home assessment
• Documentation of signs of abuse

34. • Reporting
• APS
• Community services
• guardianship

35. Provide the Pt:
Education: Promote the social attitude that no one should be subjected to
violent, abusive, humiliating, or neglectful behavior. Educate about the special
needs and problems of older adults and about the risk factors for abuse.
Provide resources accessible for geographic areas and on-going and emergent
support.
 Respite care: Temporary rest and “time off” is essential in reducing caregiver
stress, a major contributing factor in elder abuse.
 Social contact and support: Encourage being part of a social circle or
support group. Having other people to talk to is an important part of relieving
tensions. Many times, families/ friends can share solutions and provide informal
respite for each other. Abuse is less likely to go unnoticed when there is a
larger social circle, “more eyes” on the Pt.
 Counseling: Encourage changing lifelong patterns of behavior and finding
solutions to problems emerging from current stressors. If there is a substance
abuse, behavior problem in the family, treatment is the first step in preventing
violence against the older family member. Address mental illness issues.
Professionals and Community should:
 Keep a watchful eye out for family, friends, and neighbors who may be
vulnerable.
 Get educated and understand that abuse can happen to anyone.
 Speak up if you have concerns. Trust your instincts! Know what to look for.
 Keep reporting any suspicions you have of abuse to helping agencies.
 Spread the word. Share what you’ve learned to friends, family and people you
work with.

36. Instructions to a caregiver:-
If the caregiver overwhelmed by the demands of caring for
an elder, instruct (he /she ) to do the following:
 Request help, from friends, relatives, or local respite care agencies, so you
can take a break, if only for a couple of hours.
 Find an adult day care program.
 Stay healthy and get medical care for yourself when necessary.
 Adopt stress reduction practices.
 Seek counseling for depression, which can lead to elder abuse.
 Find a support group for caregivers of the elderly.
 If caregiver is having a problems with drug or alcohol abuse, get help.

37. The Right to Refuse Help

38. • Despite your best efforts to identify elder
abuse and offer assistance, the suspected
victim may refuse help.
• Whether abused or not, competent adults
have the legal right to refuse medical and
social services.