Detecting elder abuse and neglect: The importance of good skin assessment, Armi S. Earlam, DNP, MPA, BSN, RN, CWOCN; Lisa Woods, MSN, RN-BC, CWOCN; and Kari Lind, BSN, RN. The incidence of elder abuse committed by a family member may be as high as; 50%. Your first priority is to ensure that the patient is safe. Follow your organizations policies and the reporting rules outlined by the state where you work. Some families may not trust health care professionals based on past experiences. At least one yes response to questions 2 through 6 indicates a need for further assessment.23. 0000009853 00000 n 0 Interviewing patients and caregivers separately is helpful. By definition, elder abuse is; Some of these signs and symptoms including vaginal bleeding with a toddler, an obvious circular burn on a preschool child's thigh, and a young woman with a black eye, are somewhat obvious and apparent to the nurse; however, other signs and symptoms such as a listless child, a depressed and tearful woman with an anxiety attack and an elderly man's shabby attire are not so clear. The Elder Abuse Prevention Interventions Program provides $5.5 million to states and Tribes to test interventions designed to prevent elder abuse, neglect, and exploitation. Coagulation studies and a platelet count can rule out a medical reason for abnormal or excessive bruising. startxref For example, the elderly person's shabby attire may be related to the fact that the client does not want to wear nicer and cleaner clothes and not the result of neglect by the care provider; and a listless child may be affected with a physical disorder, such as a temperature, and not parental psychological abuse or neglect. Signs of sexual abuse include new-onset sexually transmitted diseases in elderly patients who are cognitively impaired and cant give consent, genital injuries, torn or stained underwear, genital bleeding or pain, difficulty ambulating without obvious reasons, anal bleeding, and bruised breasts or buttocks. For example, nurses determine whether or not serious and non serious physical injuries are treated and stabilized, they determine whether or not the patient has made decisions relating to their safety plan, and nurses also evaluate the patient's responses to psychological interventions and support. Specific patterns of injury are more suspicious for intentional injury in older persons. Abuse or neglect can also be reported to members of law enforcement. An older patient's neurologic, cognitive, or psychiatric conditions and family dynamics may create barriers to obtaining a reliable history. A victim may be malnourished or may be in pain from physical injuries like fractures or burns. Data Sources: The search included Agency for Healthcare Research and Quality Evidence Reports, Cochrane Database of Systematic Reviews, Clinical Evidence, National Guidelines Clearinghouse, Institute for Clinical Systems Improvement, U.S. Preventive Services Task Force, PubMed, and Google Professional. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. We used electronic libraries from the University of Tennessee Health Sciences Center, and the Oregon Health and Sciences University. Elevated therapeutic drug levels without medical explanation may indicate intentional or unintentional overdose. A safety plan helps identify options for the patient and provides ideas to increase his or her safety. endstream endobj 1872 0 obj <>/Metadata 140 0 R/OCProperties<>/OCGs[1880 0 R]>>/Outlines 162 0 R/PageLayout/SinglePage/Pages 1860 0 R/StructTreeRoot 261 0 R/Type/Catalog>> endobj 1873 0 obj <>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1874 0 obj <>stream Research on older adults living in domestic settings in several European countries, Canada, and the United States consistently indicates that between 2 and 10 percent are abused. A brief functional assessment should assess activities of daily living (e.g., hygiene, toileting, dressing) and instrumental activities of daily living (e.g., shopping, managing finances, managing medications).26,27 Next, the patient should be asked about the safety of the home environment. 0000001138 00000 n Required fields are marked *. A 1. Depression and alcohol abuse in the caregiver are particularly important risk factors. As a caregiver, the following steps can help you prevent elder abuse or neglect: Take immediate steps to relieve stress and burnout. 479 41 Physical abuse Responding with reassurance and sensitivity overcomes patient and family resistance in many, if not most, cases. The vulnerable and those who must depend upon others to care for them are often targets of abuse and neglect. Elder abuse is a complex issue with various causes. WebEthical and Legal Foundations of PMHNP Care Across the Lifespan In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments Body charts or clinical photographs (obtained with appropriate consent) are useful to document the location and shape of injuries such as bruises, skin tears, burns, and other skin conditions. However pathologic the relationship, severing that tie is always serious. We are often reluctant to consider the possibility. At this time, there does not appear to be supportive evidence that screening and early detection of elder abuse and neglect reduce exposure to abuse, or physical or mental harm from abuse.19 The Joint Commission, National Center on Elder Abuse, National Academy of Sciences, and American Academy of Neurology recommend routine screening, and the American Medical Association recommends routine inquiry.20 Identification of and intervention in abuse are considered by many to be a professional responsibility for physicians and are an accreditation requirement for hospitals. Your first priority is to ensure that the patient is safe. However, the general algorithm provided in Figure 2 is acceptable for most practice settings.34 Physicians may insert the statutory requirements for their practice location into the appropriate sections. (3) Prevent further potential abuse, neglect, exploitation, or mistreatment while the investigation is in progress. Key terms: elder abuse and neglect; screening instruments for elder abuse, neglect; injury, wound, bruise patterns for elder abuse; mandatory reporting for elder abuse, neglect; and safety plans for elder abuse, neglect. Public Health Nurs. Less than 2% of reports of elder abuse and neglect to state APS agencies come from physicians.15 A 2005 survey of family physicians and internists found that more than 80% of them could not recall any medical school or residency training in this area.16,17 Another survey showed that 44% of residency program directors report actively screening patients for elder abuse.18, The U.S. Preventive Services Task Force found that current evidence is insufficient to assess the balance of harms and benefits of screening all older or vulnerable adults for abuse and neglect. It is an unfortunate fact that many vulnerable people are victims of different types of abuse. document.getElementById( "ak_js_3" ).setAttribute( "value", ( new Date() ).getTime() ); 2023 HealthCom Media All rights reserved. 8/0r)JFa Webhome abuse and neglect. This can raise the likelihood of elder abuse and neglect, especially when This history and the cycle of violence, also referred to as the cycle of battering, places great risk on the spouse victim when spousal abuse is occurring. d&Ipy9.lLmFqP62oJ7uJjkX> HVR* dAA Physicians should routinely inquire about risk factors for elder abuse. WebAuthor: Mary Joy Quinn, RN, MA Publisher: Springer Publishing Company ISBN: 9780826151230 Category : Medical Languages : en Pages : 365 Get Book. 0000002191 00000 n Physical findings specific to abuse are rare. WebOne of the first nursing intervention priorities for action after someone has been found to be a victim of abuse is to provide a safe environment. The term elder abuse refers to any physical, psychological, sexual or financial abuse that is carried out against an elderly person; domestic violence entails the use of physical, psychological, sexual or financial abuse against a spouse, family member or significant other; and child abuse and neglect includes acts of violence or neglect against children that can include physical, psychological, sexual or financial abuse as well as physical, psychological, and financial neglect. The types of abuse and neglect are sexual abuse, physical abuse and neglect, psychological abuse and neglect, and financial abuse and neglect. These acts include: (1) physical abuse, acts done with the intention of causing pain or injury; (2) psychologic abuse, acts intended to cause emotional distress; (3) sexual abuse; (4) material exploitation, any misappropriation of the money or property of the elder; and (5) neglect, all aspects of failing to meet the needs of a dependent older adult (see accompanying table). Some ethnic groups use traditional healing methods, such as cupping, moxibustion, or coin rubbing, which may cause skin lesions resembling intentional injury.29. 0000013347 00000 n 0000012903 00000 n 0000015006 00000 n The consensus definition for elder abuse is: intentional actions that cause harm or a serious risk of harm to a vulnerable elder by a caregiver or person who stands She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. what should a nurse do if they suspect a patient is a. elder abuse in the united states teaching strategy. However, if the caregiver wishes to stay with the patient, dont assume abuse exists; the patient may depend on the caregiver for remembering instructions. Isolation, illness, fear, financial need, and lowered levels of contact and oversight all increase the risks of abuse, neglect, and exploitation. 0000000016 00000 n Some nursing diagnoses that may be appropriate for the child that is abused include: Examples of some nursing diagnoses that may be appropriate for the child that is neglected include: Examples of some nursing diagnoses that may be appropriate for the victim of spousal and intimate partner domestic violence include: After a complete biopsychosocial assessment, the nurse plans interventions to meet the victim's identified needs; and they also report cases of abuse and suspected abuse, as mandated by law. 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