Elder Abuse

Elder abuse manifests itself in physical or emotional abuse, neglect or financial exploitation.

Common types of elder abuse are physical abuse, mental abuse, neglect and financial exploitation. Each From may be intentional or unintentional. The perpetrators are usually adult children, but other relatives or paid or informal carers. The abuse usually increases with time frequency and severity. Less than 20% of the abuse cases are reported; Therefore, doctors must be vigilant in identifying elderly patients at risk for abuse.

Elder abuse manifests itself in physical or emotional abuse, neglect or financial exploitation. Common types of elder abuse are physical abuse, mental abuse, neglect and financial exploitation. Each From may be intentional or unintentional. The perpetrators are usually adult children, but other relatives or paid or informal carers. The abuse usually increases with time frequency and severity. Less than 20% of the abuse cases are reported; Therefore, doctors must be vigilant in identifying elderly patients at risk for abuse. Physical abuse is coercion, which manifests itself in physical or mental injury or discomfort. This includes hitting, pushing, shaking, restraint, feeding under duress and undue administration of drugs. It is also possible sexual assault can include: (any form of sexual intimacy without consent or using or threatening violence). Psychological abuse is the use of words, actions, or other agents that cause emotional stress or anxiety. It includes threats (eg. As institutionalization), insults and harsh commands and silence and ignoring the person. This includes the infantilism (a condescending form of age discrimination, in which the perpetrators the elderly person treated as a child), which drives the older people in a dependence on the perpetrator. Neglect means the failure or refusal of food, medicines, personal care or other necessities provide; it closes the reject one with. Neglect, causing physical or mental harm, must be regarded as abuse. Financial abuse means to exploit the ownership or the funds of a person and not have to worry about this. These include fraud, pressure on a person to distribute its assets, and the irresponsible management of a person’s money. Although the true incidence is unclear, the abuse of older people seems to be a growing problem of public health in the United States. Reports of the “National Center on Elder Abuse” I According to is one of ten older adults victims of physical abuse, emotional abuse or neglect. Because certain forms of abuse (eg. As financial exploitation) were not included, the actual incidence of abuse was probably higher. In Canadian and Western European studies, the incidence of abuse was comparable to that in the US. Risk factors for the victims are risk factors for previous abuse disorders (chronic diseases, disorders, cognitive impairment) and social isolation. Risk factors include substance abuse, mental disorders, a history of violence, stress and dependence on the victim for the perpetrator (including common forms of housing-see table. Risk factors for elder abuse). Risk factors for elder abuse factor Comments For the victim Social isolation abuse of isolated people is recognized and less likely to complete. Social isolation can intensify stress. To escape a chronic disease, functional impairment, or both, the ability to seek help and to defend himself, is reduced. Such elderly may need more care, which increases the stress for the caregiver. Cognitive impairment, the risk of financial abuse and neglect is particularly high. People with dementia can be difficult to maintain, frustrate caregivers, and they can be aggressive and counterproductive and provoke the abuse by üerforderte carers. For the offender substance abuse alcohol or drug abuse, intoxication or substance withdrawal can lead to abuse behavior. Substance addicts carers can try to use the medications that were prescribed to the elderly person himself or sell it, thus bringing the older person about their treatment. Mental disorders Mental disorders (eg. As schizophrenia, other psychoses) can lead to abuse behavior. Patients who were discharged from an inpatient psychiatric facility may return to their old parents home to be cared for. Although these patients were not violent in the facility, it may be this at home. History of violence A history of violence in a relationship (especially between spouses) and outside the family can predict the abuse of the elderly. One theory is that violence is a learned response to difficult life experiences and learned a way to express anger and frustration. Since reliable information about past violence are hard to come by in the family, this theory is unfounded. Dependence of the offender with respect from the older person dependent on the older person. Financial assistance, housing, emotional support and other needs can cause resentment that contribute to abuse. If the elderly person refuses to provide a member (especially an adult child) resources, the abuse is likely. Stress Stressful life events (eg. As chronic financial problems, death in the family) and the caring responsibilities increase the probability abuse. Victims and perpetrators Common living arrangements living alone elderly people are abused with a lot of those clotting probability. If living arrangements are shared, there are more opportunities for tensions and conflicts that preceded the abuse usually. Adapted from salmon MS, Pillemer K: Current concepts: Abuse and neglect of elderly persons. New England Journal of Medicine332: 437-443, 1995. Diagnostic Former abuse is difficult to detect because many characters are hardly recognizable and the victim often is not willing or able to talk about the abuse. The victims can hide the abuse because of shame, fear of retaliation or to protect the perpetrators the desire. Sometimes when abuse victims seek help, they encounter ageist responses from medical professionals, the z. B. dismiss displaying the abuse as confusion, paranoia or dementia. Social isolation of the elderly victim makes the detection of abuse of older people is often difficult. Abuse increases the insulation tends because the perpetrators often limited access of the victim to the outside world (eg. As are the victim visits and phone calls denied). Symptoms and signs of prior abuse may be wrongly attributed to a chronic illness (eg. As a hip fracture, which is due to osteoporosis). However, the following clinical situations speak particularly to abuse: Time interval between an injury or illness and the prospect of medical aid discrepancies between the description of the patient and the caregiver injury severity, which can not be brought in line with the declaration of the caregiver Implausible or vague statements of violation by the patient or caregiver Frequent visits to the emergency room due to exacerbations of chronic disease, although an appropriate treatment plan and sufficient resources exist absence of the caregiver when a functionally impaired patient presents to the doctor laboratory findings that do not fit the prehistory refusal of the caregiver to accept home care (eg. as visits to a nurse) or elderly patients with a health professional alone can prehistory If a former abuse is suspected, the patient should be interviewed alone, at least temporarily. Other involved people can be interviewed separately. Patient consultation can begin to assess the safety with general issues, but should also direct questions about possible abuse include (z. B. physical violence, fixations, neglect). If abuse is confirmed, the nature, frequency and severity of events should be determined. The triggering circumstances of abuse (eg. As alcohol intoxication) should also be investigated. The social and financial resources of the patient should be assessed because they influence management decisions (eg. As living arrangements, setting a professional caregiver). The examiner should inquire whether the patient has relatives or friends who are able and willing to care to listen and provide support. If the financial resources are sufficient, but basic needs are not met, the examiner should determine the reason. The evaluation of these resources can also help determine risk factors for abuse (z. B. financial burden, financial exploitation of patients). Speaking to the caregiver of the family confrontations should be avoided. The interviewer should find out if the nursing responsibility for the family is a burden and possibly recognize his difficult role. The caregiver is asked about the recent stressful events (eg. As grief, financial stress), the patient’s disease (z. B. care needs, prognosis) and the documented causes any recent Verletzung.Körperliche examination The patient should carefully for signs be examined from past abuse, preferably at the first visit (s refer to the table. signs of elder abuse). The doctor can help a trusted family member or friend of the patient in need of government services to protect Older or occasionally by law enforcement authorities in order to encourage the caregiver or the patient to allow the clarification. If abuse is detected or assumed a message to the Adult Protective Services in most states is mandatory. Signs of elder abuse Item character behavior withdrawal of the patient infantilization of the patient by the caregiver insistence of the caregiver on delivering the prehistory General appearance Lack of hygiene (eg. As unkempt appearance, uncleanliness) Report clothing skin and mucous membranes Weak skin turgor or other signs dehydrogenation of bruises, contusions in particular a plurality of different (To be distinguished from male or female pattern alopecia) s stages of development pressure ulcers Poor maintenance of existing skin lesions head and neck Traumatic alopecia torso bruises welts (the form can infer the addition can-z. B. utensils, stick, belt) urogenital tract Rectal bleeding Vaginal bleeding pressure ulcer infections extremities wrist or ankle lesions not indicate the use of restraints or immersion burns (ie in the form of a stocking-glove distribution) Musculoskeletal System Previously diagnosed fracture Unexplained pain unexplained gait disorders mental and emotional health Depressive symptoms anxiety The cognitive status should be judged for. B. using the Mini-Mental State Examination test (test of mental status). Cognitive impairment is a risk factor for ill-treatment of older people and can affect the reliability of the history and the patient’s ability to make management decisions. The mood and the emotional status should be assessed. If the patient depressed, ashamed, guilty, anxious, fearful or angry feels that the emotions underlying beliefs should be explored. If the patient downplays family tensions or conflicts or rationalized or are reluctant to talk about abuse, the examiner should determine whether these settings interfere with the confirmation or approval of an abuse. Functional status, incl. The ability to perform activities of daily living (ADL) to pursue should be checked, and any physical limitations that affect the self-protection should be noted. If help with ADL is required, the examiner should determine whether the current caregiver brings sufficient emotional, financial and intellectual skills for the task. Otherwise, a new caregiver must be determined. Comorbid disorders that are caused by the misuse or exacerbated (eg. Electrolytes to determine the degree of hydrogenation, albumin to determine the nutritional status, drug levels, to document the compliance to the prescribed therapy) should determine werden.Labortests imaging and laboratory tests possibly carried out to determine the abuse and dokumentieren.Dokumentation the medical record should contain a full account of actual or suspected abuse, preferably in their own words the patient. If possible, a detailed description should be included of any injury, supported by photographs, drawings, x-rays and other objective documentation (eg. As laboratory values). It should be documented concrete examples of how the needs are not met despite an agreed care plan and adequate resources. Forecast Abused elderly are at high risk of death. In a large longitudinal 13-year study, the survival rate was 9% for abuse victims compared with 40% in controls without abuse. A multivariate analysis to determine the independent effect of abuse showed that the mortality risk for abused patients over a three-year period after abuse was three times higher than in controls over a similar period. Treatment An interdisciplinary team approach (with doctors, nurses, social workers, lawyers, law enforcement officers, psychiatrists and other specialists) is essential. Each earlier intervention (z. B. injunctions for protection) and the reason for their failure should be examined in order to avoid the repetition of mistakes. Intervention If the patient is immediate, physicians should in consultation with the patient hospitalization, pull an intervention of law enforcement or resettlement to a safe home into consideration. The patient should be informed of the risks and consequences of each option. If the patient is not in immediate danger, steps to reduce the risk should be taken, but these are less urgent. The choice of intervention depends on the harmful intention of the perpetrator. If a family member such. B. administered too much of a drug because the doctor’s instructions were misunderstood, the only necessary intervention can be to give clearer instructions. Deliberate overdose requires a stronger intervention. In general, the interventions need to be adapted to the particular situation. Interventions may be medical aid education (to explain z. B. the victims abuse and available options, helping them to develop contingency plans) Psychological support (eg. As psychotherapy, support groups) prosecution and legal intervention (eg. As the arrest of perpetrator, instructions for protection, legal advocacy incl. protection of goods) to therapaieren alternative living environment (eg. as protected senior housing, accommodation in a nursing home) the victim psychiatric, usually requires many sessions (progress can be slow) If victim to decision-making are capable, they should help to determine their own intervention. If this is not the case, most of the decisions by the interdisciplinary team should be ideally taken by a legal guardian or an objective nurses. The decisions are based on the severity of the violence, the former life choices of the victim and the legal framework. Often there is not the right decision; each case must be carefully monitored werden.Fragen nursing and social work members of the multidisciplinary team, nurses and social workers can help prevent elder abuse and monitor the results of interventions. A nurse, a social worker, or both may be appointed as Coordinators to ensure that relevant information accurately recorded, can be contacted key stakeholders and informed and that the necessary care 24 hours a day available. Service training on elder abuse should be offered to all nurses and social workers once a year. In some states, the training on child abuse mandatory for admission as a doctor, nurses and social workers. However, a mandatory professional training regarding is etabliert.Berichterstattung All states require on elder abuse in only a few states that suspected or confirmed abuse must be reported in a home, and most states require that domestic abuse must also be reported. All US states have laws on the protection and access to services for vulnerable, incapable of action or disabled adults. In> 75% of the US states is determined that the authority that reports of abuse will receive, which is State Social Service Department (Adult Protective Services). In the other countries, the corresponding authority is the State Unit on Aging. For abuse within an institution, the local ombudsman for long-term care should be contacted. Phone numbers of those agencies and offices all over the US are calling the Eldercare Locator (800-677-1116 or www.eldercare.gov)) or the National Center on Elder Abuse (855-500-3537 or www.ncea.acl.gov to get) when given the county and the place of residence of the patient or the postal code. Medical professionals should the laws and reporting procedures in their states kennen.Angelegentheiten of nurses caregivers of physically or cognitively impaired older person can not be able to provide adequate care, or they may not realize that their behavior sometimes to abuse borders. These caregivers can be involved in their nursing role so that they are socially isolated and lack an objective frame of reference, which accounts for normal care. The harmful effects of exposure of carers, incl. Depression and increase in stress disorders, and a shrinking social network are well documented. Doctors must inform caregivers to these effects. Services to support carers include day care for adults, respite programs and home care. Families should be directed for such services to the senior care (800-677-1116 or www.eldercare.gov) or the National Association of Area Agencies on Aging (202-872-0888 or www.n4a.org). Prevention A doctor or other health professional may be the only person with whom a victim of abuse, apart from the perpetrator, is in contact, so he should respect. Risk factors and signs of ill-treatment be vigilant. to identify high-risk situations that can prevent elder abuse-if for. As a frail or cognitively impaired elderly person by someone with a history of drug abuse, violence, a mental disorder or care Stress is supervised. Physicians should be particularly attentive when a frail older person (eg. As a person with a recent stroke had taken place or a newly diagnosed disease) is released into a precarious home environment. Physicians should also remember that perpetrators and victims are no stereotypes. Older people are often agreed to share their homes with family members who have a drug or alcohol problem or severe mental disorders. A member can be dismissed by a psychiatric or other institution in the home of an elderly person, without having been checked to a risk of abuse. Physicians should therefore advise older patients when they draw such living arrangements contemplated v. a. if the relationship in the past had been tense. Other considerations should be made for the screening and recruitment of volunteers for the home, both through formal service agencies as well as by informal private arrangements. A small, but significant percentage of patients who take home care services, reports of theft, neglect or abuse. Screening and training for such workers can help to prevent poor treatment. The National Center on Elder Abuse provides a comprehensive review entitled Preventing Elder Abuse by In-Home Helpers, and elderly patients and their families should be made aware of this resource, if such forms of support are considered. Patients can actively reduce their risk of abuse (eg., By maintaining social relationships, through strengthening social contacts and contacts within the community). You should seek legal advice before signing documents related to where they live or who makes financial decisions for them.

Health Life Media Team

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