In 2006, The International Network for Prevention of Elder Abuse (INPEA) commissioned June 15 as the World Elder Abuse Awareness day. The day is dedicated to creating awareness about the issue, and highlighting possible solutions. Elder abuse is a global problem that was for many years neglected. Today, most countries have legislation that protects the elderly against abuse, and have put in place measures where different agencies and institutions can work together to curb inhuman acts against the elderly. This paper defines elder abuse and explains the role of nurses in assessment, reporting and prevention of elder abuse cases. It also records my own experience in trying to educate my family and grandmother about the topic.
Elder abuse, also known as senior abuse, elder mistreatment or abuse of older adults, is an act or lack of appropriate action, whether once or repeated, that can cause distress or harm to an elderly person. Abuse of elders is a worldwide issue, which has been identified by professional groups, government agencies and community leaders as a social problem.
Elder abuse can be physical, financial, neglect, psychological or emotional, or sexual. Countries such as the U.S. also recognize abandonment, and rights abuse as elder abuse. Though treated as conceptually different from abuse by others, self-neglect, which involves a person not caring about their own safety or health, is also recognized as abuse. Elder abuse can also be categorized as institutional abuse, where physical or psychological harm occurs under those entrusted with giving care and assistance to the elderly.
Common abusers can be a relative, a spouse, friend, neighbor, volunteer or paid worker, practitioner, or any other person whose intent is to deprive an elderly person his or her rights or resources. The core element to the harm of a victim is the trust of the victim toward the abuser (Summers, Hoffman, & American Public Health Association, 2006). This means that, in most cases, the abuser is someone well known to the victim and a relationship exists. Whereas different circumstances count as elder abuse, it does not always include criminal activity such as battering or mugging. Abuse can include hiding an elderly person’s medication or denying them food.
Many cases of elder abuse are overlooked because signs and effects of elder of such acts may not always be evident. According to Ziminski and Phillips (2011), signs of elder abuse can also be mistaken for changes associated with declining health or aging. The authors explain that many elderly people cannot articulate accurate details about their abuse due to cognitive impairments that come with aging. However, nurses are trained on how assess situations where they suspect abuse and analyze their findings to establish the truth. The Elder Assessment Instrument in the U.S. is one example of a general assessment guideline. Assessment items include mood, skin integrity, and clothing.
Assessment findings that would lead a nurse to suspect elder abuse can be physical or psychological. A nurse should suspect abuse when an elderly person cannot explain burns, wounds, fracture and lacerations, or when the diagnostic results do match with the geriatric patient’s medical assessment. Confusion, depression, changes in behavior, depression and loss of sleep can also be symptoms of elder abuse. When an elderly person has unexplained anal or vaginal bleeding, has torn or stained undergarments, or has a sexually transmitted infection, a nurse is justified to suspect abuse.
A nurse should also suspect abuse if an older person launches a complain about abuse, looks and acts unusually depressed, acts withdrawn, confused, agitated or fearful, denies any incidents of abuse, and has sudden changes in alertness in the presence of people. Possible exploitation indicators that a nurse can use as the basis of investigations includes lack of accountability for property of money belonging to an elderly person, or a case where the victim has been denied access to their money or documents about their property. Possible abandonment indicators include complaints by the victim, poor hygiene and grooming, unusual weight loss or evidence that the patient is left alone for prolonged periods of time without any care.
Nurses have an obligation to report abuse cases of refer them to relevant social or criminal authorities. Based on a nurse’s finding, he or she can use a score provided by the assessment guideline, or make a judgment based on any positive evidence (Summers, Hoffman, & American Public Health Association, 2006). In the absence of concrete evidence of abuse, but strong suspicion exists, a nurse can refer the case to the social service department for further investigations.
The California Nursing Practice Act 2010 edition outlines the mandate of nurses in California when they encounter abuse cases. According to the State of California’s Department of Consumer Affairs (2010), “registered nurses are among the health practitioners who must report known or observed instances of abuse to the appropriate authorities”. The mandate applies to situations that occur in nurses’ professional capacities, or within the scope of their employment. Failure to report elder abuse cases is considered an unprofessional conduct and can attract disciplinary actions against a nurse’s license. The Welfare and Institution Code also provide nurses with definitions of all terms and situations related to elder abuse.
When nurses suspect elder abuse, they first determine if the victim is in impending danger and whether there is a need to remove the elderly person from the environment as investigations proceed. They then report to relevant authorities and agencies to ensure the patient’s safety. Also, by talking about suspected abuse openly without fear of intimidation, nurses expose the vice and pave way for corrective measures. In cases where the abuse is a one-time act, a nurse decides if the patient is likely to be abused again and works with social workers to monitor the case.
When doing an assessment, nurses focus on both the history from a patient and evidence of specific types of abuse to establish the truth. They also analyze the relationship between a patient and his or her caregivers to get clues to elder abuse. By exploring all areas to find information, a nurse ensures that abusers do not get away with elder abuse. When a patient is hesitant to speak about the abuse in front of the caregiver, nurses question the patient alone to provide them with an opportunity to identify inconsistencies regarding the abuse situation.
Documenting their findings accurately also ensures that abuses face consequences of their acts as provided for by the law. In addition, by observing federal and local elder abuse practice guidelines and protocols, nurses ensure that the vice is not misdiagnosed or overlooked (Nerenberg, 2008). Nurses are also allowed to participate in community education and awareness programs. This way, they can promote proactive interventions for those at risk.
In my own experience, I chose to work with my grandmother who is 70 years of age. By using day-to-day experience, I explained what elder abuse. My approach was to first and foremost explain her basic rights to her. My second step was to ask her to give me examples of instances where she has felt sad or bitter about something that someone did or did not do to or for her. By listening to her example, I was able to explain what falls under normal disagreements and elder abuse. For example, I explained if she gave me advice and I didn’t take it, though that can be disappointing, it does not abuse to abuse. However, if I denied her an opportunity to express herself and her opinions, and even covered her mouth with tape so that she doesn’t talk, that amounts to emotional abuse.
The next time that I have an opportunity to provide education about elder abuse, I would use more simple language to explain the legal rights of an elderly person when she experiences abuse. I will also ensure that the family members and caregivers are present to ensure the message reaches as many people as possible. By educating my grandmother and not doing the same to her caregivers, I leave a gap where a caregiver might do something considered as abuse without their knowledge. For example, family members can deny their elderly grandmother conventional medicine when she is sick, and instead use herbal or home remedies on her against her will. While this might be an innocent act based on a belief that home remedies have fewer side effects, it can amount to elder abuse.
The experience opened my eyes to a need for awareness and education to prevent elder abuse. It also made me realize how vulnerable elderly people because they are weak physically and also suffer cognitive impairments such as dementia. By informing my family members about what I was doing, I managed to trigger a sense of curiosity about the topic among them. This gave me an opportunity to explain what elder abuse is, and the role of every one of us in preventing, identifying and pushing elder abuse.
Nurses play a significant role in dealing with elder abuse by working with social workers, government agencies, families and community groups. In many states, they are mandated to report any form of abuse to authorities. Using clinical tools, they are able to use assessment tools to identify elder abuse cases. They help prevent such cases by participating in public awareness programs, documenting abuse cases to ensure guilty parties are prosecuted accordingly, and working with social workers to identify those at risk and remove them from danger. From the research paper, it is evident that it is the responsibility of family members and other caregivers to protect elderly people. This can only happen when there is information on how to identify abuse and abusers, as well as who to involve should it happen.
Nerenberg, L. (2008). Elder abuse prevention: Emerging trends and promising strategies. New York: Springer Pub.
State of California’s Department of Consumer Affairs (2010). Abuse reporting requirements. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-i-23.pdf
Summers, R. W., Hoffman, A. M., & American Public Health Association. (2006). Elder abuse: A public health perspective. Washington, DC: American Public Health Association.
Ziminski, C.E., & Phillips, L.R. (2011). The nursing role in reporting elder abuse: Specific examples and interventions. Journal of Gerontological Nursing, 37(11), 19-23.