Screening may not identify all victims.
Some elders may not talk about abuse or neglect. They may be: • Afraid
• Ashamed
• Unable to report abuse or neglect because of cognitive impairments [glossary]
Therefore, all clinicians who work with older adults must be alert for signs and symptoms.
On the following screens, let’s look at common signs and symptoms of:
• Physical abuse • Physical neglect • Sexual abuse
• Psychological abuse or neglect • Financial abuse or neglect
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Indicators: Physical Abuse (1)
Physical abuse can cause physical injuries. Be especially alert for:
• Injuries on both sides of the body • Injuries in different stages of healing • Unexplained injuries
• Injuries with unlikely explanations
• Injuries with contradictory explanations given by the patient and the caregiver
• Injuries the patient makes light of Also pay attention to:
• Bruises or grip marks around the arms or neck • Rope marks or welts on the wrists or ankles • Broken bones
• Cuts or puncture wounds • Sprains or dislocations • Scratches or scrapes • Burns
• Internal injuries or bleeding
• Physical signs of punishment or restraint
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Indicators: Physical Abuse (2)
Other possible signs of physical abuse are:
• Lab tests showing that the elder is getting too much or too little medication
• Broken eyeglasses or frames • A sudden change in patient behavior
• A caregiver who will not let others talk to the elder alone
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Indicators: Physical Neglect
Possible signs of physical neglect (including self-neglect) are: • Dehydration
• Malnutrition • Weight loss • Sunken eyes • Pressure sores • Poor personal hygiene • Untreated health problems
• Unsafe living conditions (no electricity, heat, running water)
• Unclean living conditions (dirt, fleas, soiled bedding)
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Indicators: Sexual Abuse
Possible signs of sexual abuse are: • Vaginal or anal bleeding • Bruised breasts or genitals • Bruises on the upper thighs
• Torn, stained, or bloody underclothes • STD’s or other vaginal infections
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Indicators: Psychological Abuse or Neglect
Possible signs of psychological abuse or neglect are: • Withdrawal
• Depression or agitation • Fear or suspicion
• Childish behavior usually associated with dementia [glossary] (sucking, biting, rocking)
• Lack of interest in social activities • Not talking or responding
• Not answering questions directly • Chronic health problems
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Indicators: Financial Abuse or Neglect
Possible signs of financial abuse or neglect are: • Poor care or conditions
• Confusion or ignorance about finances
• Sudden changes in bank accounts or banking practices (withdrawing large sums of money, adding names to a bank account, frequent ATM withdrawals, switching bank accounts)
• Sudden transfer of money to a family member or other caregiver
• Disappearance of money or valuable possessions • Sudden changes to a will or other financial document • Forged signatures on checks
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Review
Most elder abuse/neglect occurs: a. At home
b. At senior citizen centers c. At adult daycare centers
d. In nursing homes and other long-term care facilities
MULTIPLE CHOICE INTERACTION
Correct answer: A Feedback for A: Correct.
Feedback for B: Incorrect. The correct answer is A. Most elder abuse/neglect occurs at home.
Feedback for C: Incorrect. The correct answer is A. Most elder abuse/neglect occurs at home.
Feedback for D: Incorrect. The correct answer is A. Most elder abuse/neglect occurs at home.
3019 Review
Determine if each patient below should be screened for abuse.
Bob, a 70 year-old man with no known risk factors for abuse □ Screen □ Do not screen Julie, an 80 year-old woman with physical signs of maltreatment □ Screen □ Do not screen Ben, a 68 year-old man with behavioral signs of maltreatment □ Screen □ Do not screen Pat, a 68 year-old woman with risk factors for abuse □ Screen □ Do not screen Angie, a 75 year-old woman with no signs of abuse □ Screen □ Do not screen
Summary
You have completed the lesson on identifying victims. Remember:
• Certain factors increase an elder’s risk of being abused or neglected. Know these risk factors to help identify victims. • Any elder could be abused or neglected. Therefore, all
elders should be screened. All hospital staff who have contact with older patients should know the screening protocol.
• Elder abuse screening should start with general questions about the patient’s household, financial status, and overall wellbeing. The patient should then be asked direct
questions about abuse and neglect.
• Older patients do not always report abuse or neglect. Know the signs and symptoms of elder maltreatment to identify silent victims.
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Lesson 4: Assessment and Referral 4001
Introduction & Objectives
Welcome to the lesson on assessing victims and making referrals. After completing this lesson, you should be able to:
• Identify the parts of an elder abuse assessment
• Recognize how to collect and document evidence of elder abuse and neglect
FLASH ANIMATION
Lesson 4: Assessment and Referral
• Elder abuse assessment
• Intervention and referral
• Documentation of evidence
Components of the Assessment
An elder abuse assessment should be performed if: • An older patient reports abuse or neglect.
• A healthcare worker suspects that an older patient has been abused or neglected.
In either case, the following should be assessed: • Safety
• Access to medical care • Mental status • Emotional status
• Health and functional status • Social and financial resources
Let’s take a closer look at each.
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4003 Safety
The first part of the assessment is about the patient’s safety. Find out whether the patient is in immediate danger. If so, talk about:
• Admitting the patient to the hospital
• Getting a court order to protect the patient from the abuser If the patient does not seem to be in immediate danger, discuss more general safety issues.
For example, talk about:
• Whether the abuse is becoming more frequent or severe • Possible steps the patient could take to increase safety • Other choices the patient could make
• The risks and possible consequences of these choices • Possible motives for the abuse
• Whether addressing any of these motives might end the abuse
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Point 3 of 16
Access
The next part of the assessment is about the patient’s access to medical care.
Talk to the patient about follow-up care.
Identify anything that might stand in the way of care.
If necessary, talk about options for improving access to care. For example, the patient might be able to get help from:
• A trusted family member or friend • Adult Protective Services
• A local support group for victims of elder abuse
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4005
Mental Status
Next, look at the patient’s mental status. Determine whether the patient has any form of:
• Dementia [glossary] • Delirium [glossary]
If so, is it possible to correct this problem? For example, is it possible to change a problematic medication?
If the patient has untreatable dementia, think about how this might affect his or her ability to report or confirm suspected maltreatment.
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Emotional Status
Now consider the patient’s emotional status. Look for signs of:
• Depression • Shame • Guilt • Anxiety • Fear • Anger
If you find any of these, ask about the underlying causes. Are any of these emotions related to abuse or neglect?
Talk about any denial that may be going on:
• Is the patient in denial of family tension, conflict, or abuse?
• If so, why?
• How does denial affect the patient’s ability to recognize mistreatment if and when it happens?
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4007
Health and Functional Status
Next, look at the patient’s medical status.
First, think about the patient’s presenting medical problem. Could this be the cause of abuse or neglect?
Talk about the activities of daily living. Ask the patient who provides any necessary help. Talk about whether this person has the ability to care for an elder. Talk about the caregiver’s:
• Emotional ability • Mental ability • Financial ability
Identify any physical problems that might limit the patient with regard to self-protection.
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Social and Financial Resources
Finally, find out about the patient’s social support network. Find out whether the patient has friends or family members who:
• Nurture • Listen
• Help with care If not, ask why.
Talk about the patient’s financial situation:
• Does he or she have enough income or savings? • If so, are his or her needs being met?
• If there is enough money and needs are not being met, why not?
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Point 8 of 16
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Plan for Intervention
At the end of the assessment, it may be possible to confirm abuse or neglect.
If so, make a plan for intervention. This plan should:
• Fulfill any reporting requirements (see next lesson). • Keep the patient as independent as possible.
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Referral
Intervention may include referring the patient to outside agencies
for help and support. IMAGE: 4010.SWF
http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_ Help/State_Resources.aspx
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Documentation and Collection of Evidence
When assessing suspected victims of elder abuse and neglect, careful documentation is critical.
Documentation can provide evidence for: • Legal action to protect the elder • Legal action to prosecute the abuser
In some cases, the medical record provides the only concrete evidence of abuse.
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Written Record
The following should be recorded in the suspected victim’s chart: • Chief medical complaint
• Complete medical history and relevant social history o Results of laboratory, imaging, or other diagnostic
procedures
• Description of the abusive event(s) or neglectful situation(s), in the patient’s own words (if given) o If the police were called, the name of the
responding officer and any actions taken
• Detailed description of any injuries (see text image to the right)
It is important to avoid making assumptions when describing a patient’s injuries.
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