Abuse and neglect of elderly

Manoj Kumar L
MSc (N), MA (Psy), DCCN,CRM, HRF
Assistant Professor
St Thomas College of nursing
Editorial Board Member - JNOH (USA)
Abuse of elderly
 Abuse

• Abuse is defined as any action that intentionally

harms or injures another person.

• In short, someone who purposefully harms

another in any way is committing abuse.

• Abuse of elderly individuals, which at times has

been referred to in the media as “granny-

bashing,” is a serious form of family violence.

• Sadock and Sadock, (2007) estimate that 10

percent of individuals over age 65 are the

victims of abuse or neglect.

 Factors contributing to abuse

• Long life

• Dependency

• Stress

• Learned violence
 Factors for Abuse……………

• Low socioeconomic status

• Low educational level

• Impaired functional or cognitive status

• History of domestic violence

• Depression in the older adult or caregiver

 Types of abuse
1. Physical abuse

2. Neglect

3. Psychological abuse

4. Financial exploitation

5. Violation of rights

6. Sexual abuse
 Physical abuse
• An act of violence which results in bodily harm or
injuries.
• These include;
– Physical injury
– Malnutrition
– Severe dehydration
– Lack of personal care
– Withholding of necessary medical care
– Failure to give proper medication
 Signs of physical abuse
• Rope burns
• Bruises
• Illness which seem chronic and untreated
• Abrasions or laceration
• Burns
• Fractures
• Sagging skin and skin deterioration
• Any injury that is not compatible with the
story given
• An injury not properly cared for
• Unkept appearance (uncombed hair, unshaven face)

• Poor hygiene (dirty skin, untrimmed nails)

• Evidence of dehydration/ malnutrition

• Ravenous eating habits of older

• Evidence that elder is confined unwillingly to

bed/chair/room

• Without freedom of movement (restraints at wrist or

ankle)
 Examples of Physical Abuse

• Striking, hitting, beating

• Shoving

• Bruising

• Cutting

• Restraining
 Psychological abuse
• Verbal abuse incorporating the threat of
deprivation of property or services and resulting
in emotional suffering.
• This include;
– Threaten to place in nursing homes
– Withdrawal of financial support
– Isolation
– Harassment
– Intimidation
– Withholding of affection/ security
– Refusing to allow outside home or allow visitors
 Signs of psychological abuse
• Expressions of fear, anger
• Elder embarrasses or fearful when asked about
injury
• Family member afraid to allow anybody with EP
alone
• Family member acting as if elder did things on
purpose
• Elder refuses to walk
• Elder fails to get attention
 Examples of Psychological Abuse

• Yelling

• Insulting, name-calling

• Harsh commands

• Threats

• Ignoring, silence, social isolation

• Withholding of affection
 Neglect

• Deliberate or unintentional withholding of

assistance vital for performance of activities of

daily living or behavior that causes mental

anguish.
 Signs of self-neglect
• Complaints from neighbors who report

wandering

• No food in house or lots of spoiled food in house

• Prescription medication not taken

• Evidence of alcohol or drug abuse

Neglect (Intentional or Unintentional)
Examples
• Withholding food and water

• Inadequate heating

• Unclean clothes and bedding

• Lack of needed medication

• Lack of eyeglasses, hearing aids, false teeth

 Financial exploitation

• Improper use of resources of an elderly person

by the caregiver for their personal gain.

• It include

– Theft of money possessions or medications

 Signs of financial neglect
• Rent overdue on more than one occasion; utility

and other bills have not been paid.

• Noticeable discrepancy between what is known

about the elderly person’s financial status and

how they now appear.

 Signs of financial neglect…

• Discrepancy between resources available and

how he or she is cared for.

• Condition of home

• Level of personal care, nutrition, medical care,

clothing, transportation, opportunities for social
interaction.
 Violation of rights

• Suppressing decision making powers

• Involuntary confinement of the elderly person

to the bed, room or chair

 Signs of violation of rights

• Unreasonable confinement to a bed, chair, room

or other parts of house.

• Denial of visitors or freedom to go out of the

house, to visit friends.

• Kept in darkness of their financial affairs.

 Sexual abuse

• Non-consensual sexual contact with an older

person, including touching, sexual assault, and
rape, is elder sexual abuse.

• Dependency can put the older person at risk of

abuse by family or professional caregivers
 Signs of sexual abuse
• Bruising on inner thighs

• Genital or anal bleeding

• Sexually transmitted diseases

• Difficulty walking or standing

• Pain and/or itching in the genital area

 S/S of sexual abuse

• Exacerbation of existing illness

• Emotional signs include:
– Scared or timid behavior
– Depressed, withdrawn behavior
– Sudden changes in personality
– Odd, misplaced comments about sex or sexual
behavior
– Fear of certain people or of physical characteristics
 Management

1. Access

2. Identification

3. Assessment

4. Interventions

5. Follow up

6. Prevention
 Assessment
• Careful history
• Both patient and caregiver should be present to
observe their relationship, anxiety on part of the
patient or an overbearing attitude of the caregiver
• Patient must be interviewed privately; current health
status, living arrangements, financial status,
emotional stressors, and social support;
• History of alcohol and drug abuse; sexual history
 Questions to ask
• Has anyone at home ever hurt you?
• Has anyone ever touched you without your
consent?
• Has anyone ever made you do things you didn't
want to do?
• Has anyone taken anything that was yours without
asking
 Questions to ask
• Has anyone ever scolded or threatened you?

• Have you ever signed any documents that you didn't

understand?

• Are you afraid of anyone at home?

• Are you alone a lot?

• Has anyone ever failed to help you take care of

yourself when you needed help
 Access

• Access to an abused person in home.

• Survey the home environment and offer

suggestions to make life easier for the elderly

person and the care giver.

 Identification and Assessment
• Identify the signs of abuse.

• Establish the diagnosis and recognize the

immediate danger to elderly person.

• Establish goals to maintain or restore the safety

of the elderly person and to break the cycle of
mistreatment.
 Intervention
• Protect the elderly person from immediate and
subsequent harm.
• Recognize the needs of both the abuser and the
abused.
• Observe the home environment.
• Help to improve the well being of elderly person.
• Encourage the abuser to cope up with the
abilities.
 Follow up

• Establish a mechanism for regular contact with

the elderly person.

 Prevention
• Recognize increased anxiety among family
members about the possibilities of caring for the
elderly person at home.
• Evaluate all aspects of elder care before allowing
the elder person to back home.
• Alleviate stress affecting the care givers.
• The care giver may be made aware of the
recognition of the ageing process and the effect
of stressors on this.
 What you can do as a caregiver to
prevent elder abuse
• 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.
 What you can do as a caregiver to
prevent elder abuse

• Seek counseling for depression, which can lead to

elder abuse.

• Find a support group for caregivers of the elderly.

• If you’re having problems with drug or alcohol

abuse, get help.
 References
• Murray, Zentner, & Yakimo (2009); Sadock & Sadock (2007);
and Stanley, Blair, & Beare (2005).
• Townsend, Mary C.. Psychiatric Mental Health Nursing:
Concepts Of Care In Evidence-based Practice. Philadelphia :
F.A. Davis Co., 2012
• Gerontological Nursing. Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins, 2010
“where abuse is reported,
prevention begins”

THANK YOU