elder abuse power point

Elder Abuse

Elder Abuse is:-

“....a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm of distress to an older person”

(Action on Elder Abuse, 2004; WHO/INPEA 2002)

Elder Abuse

Older persons may be abused by:-

Partner, adult child or other relative

Friend, neighbour or visitor

Patient or resident

Health care provider, caregiver or other social or support worker

Elder Abuse and Neglect

• Residential care facility owner or manager

• Volunteer worker

• Person managing an older person’s affairs (e.g. Attorney or guardian)

ELDER ABUSE & NEGLECT

• From 1998-2001 Age Concern saw 2441 cases of elder abuse and neglect

• Psychological abuse (56%)

• Financial abuse (46%)

• Physical abuse (22%)

• Active & passive neglect (18%)

• Sexual abuse (3%)

Elder Abuse and Neglect

Analyses of cases seen by elder abuse services found that family members were most often identified as the abuser, in particular adult sons or daughters (40% of abusers) or the spouse or partner of an older person (15% of abusers)

(Age Concern NZ, 2005; Hong et al, 2004)

ELDER ABUSE AND NEGLECT

Discounting of Abuse by Professionals:

• There is no problem

• There is a problem but it’s not my problem

• There is a problem but it’s too big for me

• There is a problem and there’s nothing I can do about it


Discounting of Abuse by Victims

• Makes excuses for perpetrator

• Blames self

• Influence of tradition/religion

• Blaming others (not perpetrator)

• Denies severity & causes of injuries


• Denial of Injury (failure to acknowledge being hurt)

Example:-

She wasn’t really abusive. She just shoved me.

She didn’t hurt me that bad. Just a few bruises


• Denial of the victimizer (blame on external factors)

Example:-

His boss has been picking on him

His daughter has been acting up

He doesn’t get paid enough


• Denial of options (both practical and emotional)

Example:-

I couldn’t make it without him/her. I don’t have the ability.

No one else would want me


• Denial of victimization (victim self-blame)

Example:-

If only I hadn’t kept on about needing the bath/toilet/tea

I knew better than to say anything


• Appeal to the salvation ethic (help him/her overcome his/her problem and endure abuse until that is achieved)

Example:-

I know s/he is basically good. I’m sure with a little time and understanding s/he may stop......................


• Appeal to higher loyalties (endure violence for ‘higher purpose’ such as religion or tradition)

Example:-

This is the will of Allah/God. I am being punished for.................................

I don’t believe in revealing private family matters


Who is protected and who is harmed when abuse is discounted?


THERE IS NO EXCUSE FOR ABUSE


• Know what abuse is

• Understand how it can happen

• Be alert to indicators of abuse

• Know the procedures for reporting concerns and poor practice

• Provide support through good assessment and care planning


TYPES OF ABUSE

• Physical

• Sexual

• Psychological and Emotional

• Financial or material abuse

• Neglect and acts of omission

• Institutional abuse


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;


Behavioural Indicators

• Fear of particular person/persons

• 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


Behavioural Indicators

• Difficulty in walking or sitting

• Pain or itching in genital area

• Recoiling from being touched

• Fear of bathing or toileting


Indicators of Financial or Material 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


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


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


INSTITUTIONAL ABUSE

Institutional abuse is the collective failure of an organization to provide an appropriate and professional service.


Indicators of Institutional Abuse

• Low staff morale

• High staff turnover

• High sickness rates

• Excessive hours worked and frequent use of agency staff


• General Lack of consideration for Privacy

• Residents appear unusually subdued

• 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)


• 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


Power and Control

Being a vulnerable adult instantly determines the balance of power in a relationship with the carer in a position of power


As a carer, use your power and control wisely and be aware of when power and control can turn in abusive care practice


Responding to a Report of Abuse

• Listen and ask ‘open’ questions like ‘what happened next?’

• Validate feelings

• State that you cannot keep what they are saying confidential and you will have to pass it to your line manager


Documenting Abuse Concerns

• On blank piece of paper/daily record sheet

• Include:-

• What was said to you using his/her words

• What you said to them

• Include date/time of disclosure and full names of who was present


Making an Assessment

Any investigation must start with the approach that the safety, wellbeing and rights of the older person is the main focus.


Safety Planning (Strategy Discussion)

The purpose of the strategy discussion is to:

• Gather information

• Assess the risk

• Determine course of action to be taken

• Establish who will take the lead in any subsequent action


Safety Planning (Strategy Meeting)

It is recommended that the strategy meeting is chaired by the elder abuse and neglect prevention coordinator for Age concern who will:

• Establish facts of the abuse

• Assess the needs of the person for protection from further abuse


• Determine a course of action

• Agree responsibilities

• Circulate copies of the protection plan to all parties present at the strategy meeting


Monitoring the Situation

The Age Concern elder abuse and neglect prevention coordinator will ensure services are coordinated in accordance with action plan.

The Health & Disability Advocate will monitor whether services are fulfilling the intended functions.


Review and Evaluation

Purpose of the review is to assess effectiveness of the services by exchanging information about progress and determine if situation has changed and whether new services are required


References

Age Concern NZ Incorporated ‘Promoting Age Concern NZ Incorporated ‘Promoting the Rights and Well-being of Older People the Rights and Well-being of Older People and Those Who Care for Them’ (1992)and Those Who Care for Them’ (1992)

Ministry of Health ‘Elder Abuse and Neglect’ Ministry of Health ‘Elder Abuse and Neglect’ Guidelines (2007)Guidelines (2007)

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