Incidents of elder abuse are on the rise, with one report stating that one out of three nursing homes will be the site of this crime. At the same time, it is believed that abuse of the elderly is also under-reported.
The National Center on Elder Abuse (NCEA) defines elder abuse in broad terms, calling it “Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” As the population as a whole ages, it’s important for nurses to be aware of the issues, to recognize the signs of abuse, and to follow through on reporting suspected abuse. (In every state, nurses are listed as mandated reporters—those who are legally required to report instances of abuse to law enforcement or an agency involved with adult protective services).
Victims of elder abuse are typically either physically frail or cognitively impaired—perhaps to the point that they become uncooperative or combative with their caregivers. Elder abuse can fall into several categories:
- Physical abuse—assaults like hitting or shoving, as well as inappropriate use of restraints or confinement.
- Neglect—ignoring the elderly person or not providing for basic needs like food, hygiene, medication, etc.
- Emotional abuse—either verbal (yelling, scapegoating, insults, ridicule) or non-verbal (isolating the elderly person from friends, limiting activities, treating her like an infant, ignoring calls for help).
- Sexual abuse—any non-consensual sexual act.
- Financial exploitation—siphoning off money, stealing household items of value, forging a signature on financial documents, etc.
While elder abuse can occur in hospitals, nursing homes, rehab facilities, and adult day care centers, it most often occurs in the home, with the victim’s adult offspring or another caregiver acting as perpetrators. Unlike children and teens who must attend school, the elderly often become isolated and have little contact with anyone other than their caregivers. This is why it’s so vital for nurses to have their eyes open and look for red flags during every encounter with an elderly patient. Some signs to watch for in your elderly patients include:
- Physical clues: You notice your patient suffers from poor hygiene, dehydration, weight loss, burns, restraint marks, bruises, fractures, pressure sores, frequent infections, or missing medical aids (glasses, hearing aids, dentures, walkers).
- Mental/emotional clues: You notice your patient is confused, anxious, depressed, suspicious, or fearful.
- Caregiver clues: You notice your patient’s caregiver seems unstable, shows signs of substance abuse, has an untreated mental illness, talks about feeling burdened, or seems resentful.
- Relationship/support clues: You notice the patient’s family speaks for the patient or won’t let you talk to the patient alone, delays seeking care, changes doctors frequently, keeps the patient in isolation or without adequate supervision for her condition, or makes financial decisions that seem contrary to good stewardship. Even if you don’t witness these things directly, your patient may hint at them.
- Environmental clues: If you work in home health, you may notice firsthand there is clutter, filth, unsanitary food storage, unsafe conditions, or no heat. If your patient encounters are in a clinical setting, you might consider asking about the patient’s environment.
Any time you have a reasonable suspicion that something isn’t right, follow your instincts. Watch, look at, and listen to your patient. Ask if she has any concerns, or if she needs help in any way. If your assessment seems to indicate your patient is enduring physical abuse, neglect, mental anguish, financial exploitation, or any other unusual situation, you should document everything you see and hear. Depending on the situation, you may need to intervene immediately—but when there is doubt as to the next steps, share your concerns with your supervisor or an administrator. Remember that the nursing code of ethics requires you to advocate for your patient; do not look the other way.
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