By: Arlene Orhon Jech, RN

November 4, 2002
nurseweek.com

ELDER ABUSE: MISTREATMENT OF

OLDER AMERICANS ON THE RISE
 Purpose
• This training is to inform you about elder
abuse and the measures you can take to help
prevent it.
 Topic Objectives
• When you complete this training, you will be
able to:
– Identify the four types of elder abuse
– Describe steps nurses can take to prevent elder
abuse
– Discuss domestic elder abuse and name the most
frequent perpetrators
Elder Abuse: Mistreatment of Elder Americans

INTRODUCTION
The U.S. population is aging. In 2000,
about 35 million Americans, or 12.8%
of the population, were older than 65.
By 2050, more than 80 million people,
or 20 percent of the population, will
be older than 65 (1).

2000 2050

Under 65 Under 65
+45
Over 65 (35 Million Over 65 (80
Million) Million)
Americans also are living longer. At the
beginning of the 20th century, life
expectancy was 47 years; by 2000, it
had increased to an all-time high of
76.9 years (2). 90
80
70
60 + 29.9 Years
50
1900
40 2000
30
20
10
0
Life Expectancy
 The increasing number of older Americans has been accompanied by
a disproportionate increase in the prevalence of elder abuse.

Between 1986 and 1996,

when the elder
population increased 10
percent, reports to
+15 times
Adult Protective
Services of suspected
domestic elder abuse
increased 150 percent.
In 1996 alone, more than 550,000 older
people experienced some form of
abuse or neglect in the domestic
setting (3).
Abuse significantly increases an elder’s chance of dying.
Only 9 percent of mistreated elders and 17 percent of
self-neglected elders in one study survived during a 13
year period, compared with 40 percent of elders with no
history of mistreatment or neglect (4).
Survival after 13 Years

Mistreated Elders (9%)

Self-Neglected Elders (17%
No History or Mistreatment or
Neglect (40%)
Elder Abuse: Mistreatment of Elder Americans

ELDER ABUSE DEFINED

Elder abuse is defined as:
the mistreatment, neglect, or exploitation of
an elderly person.

The abuse can be:

­ Physical
­ Psychological
­ Financial (5).
Physical abuse is defined as:
the use of physical force that can cause
bodily injury, physical pain or impairment.
• Evidence of physical abuse includes:
– Striking – Kicking
– Shoving – Pinching
– Shaking – Burning
– Beating – Restraining
– Slapping – Improper feeding (5).
• Elders who have been physically abused may
have:
­ Dislocations
– Bruises ­ Sprains
– Welts ­ internal injuries
– Lacerations ­ broken eyeglasses or frames
– rope marks ­ medication overdoses or under-doses
– black eyes
– Wounds
– Cuts
– Untreated injuries
• Other signs are:
– Withdrawal
– Anxious or depressed behavior
– Fearfulness around a family or caregivers
– Change in the elder’s behavior.
– Another red flag is a caregiver’s refusal to let the
elder have visitors without the caregiver being
present (5).
Sexual abuse is defined as:
Nonconsensual sexual contact of any kind
with an elderly person (5).
• Sexual Abuse includes:
– Unwanted touching
– Sexual assault or battery
– Rape
– Coerced nudity
– Sexually explicit photographing (5). Bruising around
the breasts or genital area, venereal disease,
vaginal or anal bleeding and torn or bloody
undergarments are signs of sexual abuse (5).
• Evidence of sexual abuse includes:
– Bruising around the breasts or genital area
– Venereal disease
– Vaginal or anal bleeding
– Torn or bloody undergarments (5).
Psychological abuse is defined as:
The infliction of emotional distress, anguish,
or pain through verbal or nonverbal acts
(5).
• Evidence of psychological abuse includes:
– Verbal assaults
– Insults
– Threats
– Intimidation
– Humiliation
– Harassment
• Other examples of psychological abuse are:
– Isolation of the elder from family, friends, or
regular activities and ignoring or giving the elder
“the silent treatment”.
– Treating an older person as if he or she were an
infant is also a form of psychological abuse .
(5)
• Psychologically abused elders may appear:
– Agitated
– Emotionally upset
– Withdrawn
– Non-communicative
– Unresponsive
– As well as unusual behavior such as biting or
rocking also can be caused by psychological abuse
Neglect is defined as:
The failure to provide needed care for an
elder.
• Neglected elders may be being denied:
–Food
–Water
–Clothing
–Personal hygiene
–Shelter
–Medicine
–Comfort
–Personal safety
• Neglect also can take the form of:
– Failure to fulfill an obligation to an elder, such as
failing to pay for necessary home care services or
the failure of an in-home caregiver to provide
necessary care (5).
• Elders who have been neglected may also:
– Appear dehydrated and malnourished
– Have untreated bedsores
– Lice or flea infestation
– Urine or fecal smell
– Be inadequately clothed
– Live in hazardous, unsafe or unsanitary conditions.
Financial abuse is defined as:
The illegal or improper use of an elder’s
funds, property or assets (5).
• Financial abuse can include:
– Cashing an elder’s checks without permission
– Forging an elder person’s signature
– Stealing money or possessions
– Coercing or deceiving the elder into signing a
contract or will
– Improperly using the power of attorney,
guardianship, or conservatorship (5).
• Indications of the Financial Abuse of Elders
can include:
– The disappearance of financial papers, checkbooks
and legal documents
– Sudden change in banking or a bank
– Withdrawal of large sums of money by a person
who accompanies the elder
– Unauthorized use of an ATM or credit card
– The unexplained disappearance of funds or
possessions
– Substandard care even though financial resources
• Other signs of financial abuse include:
– The sudden appearance of previously uninvolved
relatives claiming a right to the elder’s possessions
– Unexplained transfer of assets to a family member or
person outside the family
– Provision of unnecessary services
– The elder’s report of being financially exploited (5).
Self-neglect is defined as:
The behavior of an elderly person that
threatens his or her safety (5).
• Self Neglect includes:
– An older person’s refusal to provide himself or herself
with enough food, clothing, shelter, cleanliness,
medications or safety.
– This definition does not apply to a mentally competent
person who makes the elders come in contact with the
health care system at some point.
– Nurses and other health care providers are well placed
to detect situations of potential abuse and to connect
the patient and family with community resources.
Elder Abuse: Mistreatment of Elder Americans

ABUSE IN THE INSTITUTIONAL

SETTING
Institutional abuse is defined as:
abuse and neglect that occurs in residential
facilities that care for the elderly, including
nursing homes, foster homes, group
homes, and board and care facilities (5).
• Examples of abuse in the institutional setting
are:
– Slapping
– Hitting
– Isolating
– Improper feeding
– Theft of the resident’s property
– Intimidation and psychological abuse by care
providers.
About 17,000 nursing homes in the
United States care for 1.6 million
residents, a figure expected to
quadruple to 6.6 million residents by
2050 (10). 7000000
6000000
5000000 +5 Million
Residents
4000000 Nursing Homes
(17,000)
3000000
Residents
2000000
1000000
0
2000 2050
But in a recent two-year period, almost
one out of every three nursing homes
was cited for abuse (10).
Facilities with the highest levels of
nursing staff had 60 percent fewer
violations for abuse (11).

STAFF

Ab
u se
Nursing home staff often are poorly paid
and overworked, have high stress
levels and feel stretched beyond their
limits.
Nine out of ten U.S. nursing homes are
understaffed, according to a recent
government study (10).
US Nursing Homes

Understaffed
Fully Staffed
Legislation:
Citing insufficient levels of staff as the cause
of poor care, a U.S. House of
Representative committee introduced the
nursing Home Staffing Improvement Act,
HR 4715, in May 2001 (10).
• The bill helps the elderly by:
– Establishing minimum staffing levels for nursing
homes
– Requires that all nursing home residents receive at
least four hours of nursing care each day
– And provides the funding to pay for the increased
nursing staff (10).
Note: As of this writing, the bill has yet to be introduced to the full House of
Representatives and the Senate.
• Report Violence Immediately:
– Instances of one resident hitting another and
suspected or resident reported caregiver abuse of
residents are abuse and must be reported
immediately to local law enforcement, Adult
Protective Services or the long-term care
ombudsman (11).
– In most states, Adult Protective Services is the
public agency responsible for investigating reports
of elder abuse and for providing victims and
families treatment and protective services (5).
Elder Abuse: Mistreatment of Elder Americans

PREVENTION
Nurses who admit elders to emergency
rooms, hospitals, and nursing homes
should be alert for the signs of abuse,
neglect, and self-neglect.
• Abuse can be detected by:
– Obtaining a detailed history from the patient and
caregiver in a nonjudgmental manner (9).
– Interviewing the patient privately, preventing him
or her from being inhibited by the caregiver’s
presence (9).
• You can also:
– Perform an assessment, it should include a
thorough physical exam for signs of physical
injuries, as well as testing for neurological and
cognitive status.
– The assessment should be documented with
careful notes, drawings and photographs (9).
After your assessment, If you suspect
abuse:
Report it to local law enforcement or county
Adult Protective Services, following the
facility, state, and county reporting
requirements (6).
Seeking assistance for caregivers:
Stressed caregivers can be put in contact with
social and support groups for referrals for
adult day health care, delivered meals,
and respite care. Finding helpers,
attendants and home health aides to help
with care giving can be a lifesaver.
• Caregiver assistance can be obtained from:
– An area’s Agency on Aging (in the city or county
section of the telephone directory under “Aging
Services” or “Social Services”) and the Eldercare
Locator can help (8).
• Nurses can help caregivers by:
– Teaching caregivers to recognize situations that
cause them stress
• Nurses can also:
– Teach caregivers appropriate ways to handle
difficult care receiver behaviors such as violence,
combativeness, and verbal abuse (8).
An ombudsman is defined as:
An advocate for residents of nursing homes,
board and care homes and assisted living
facilities (11).
• The federal Older Americans Act requires that:
– Every state have an ombudsman program to
handle complaints and advocate for
improvements in long-term care (11).
• To find your area’s long-term care
ombudsman, contact:
– The State Ombudsman’s office or the National
Long-Term Care Ombudsman Resource Center
online (11).
Elder Abuse: Mistreatment of Elder Americans

SUMMARY
• By being aware of the signs of elder abuse, nurses can
help protect the safety of some of our most vulnerable
citizens.
– When we suspect elder abuse, we can accurately document
our observations and notify the appropriate authorities to
investigate.
– When we see domestic care situations at high risk for
becoming abusive, we can refer the care providers to agencies
for help to relieve their stress.
– Nurses working in long term care should be ever vigilant and
help relieve situations of care provider stress that can give rise
to institutional elder abuse.
 Topic Objectives
• Having completed this training you should be
able to:
– Identify the four types of elder abuse
– Describe steps nurses can take to prevent elder
abuse
– Discuss domestic elder abuse and name the most
frequent perpetrators
Elder Abuse: Mistreatment of Elder Americans

SOURCES
Citation
 
Administration on Aging. Older Population by Age: 1900 to 2050.
[Online]. Available: www.aoa.gov/aoa/STATS/AgePop2050.html
 
National Center for Health Statistics. Deaths: preliminary Data for
2000,2001. [Online]. Available:
www.cdc.gov/nchs/about/major/dvs/mordata.htm.
 
Administration on Aging. Elder Abuse Prevention, 2001. U.S.
Department of Health and Human Services. [Online]. Available:
www.aoa.dhhs.gov/factsheets/abuse.html. [Aug.26,2002]
 
National Institute on Aging, national Institutes of Health. (1998). Abuse
Associated With Increased Risk of Death for Older People. [Online].
Available: www.nia.nih.gov/news/pr/1998/08%2D04.htm. [Sept.
2,2002]
National Center on Elder Abuse. (2002) The Basics: What is Elder
Abuse? [Online]. Available:
www.elderabusecenter.org/basic/index/html. [Aug. 30,2002]
 
Citation (cont.)
 
Administration on Aging (1998) The National Elder Abuse Incidence Study;
Final Report, September 1998. [Online]. Available:
www.aoa.dhhs.gov/abuse/report/default.htm. [Sept. 2,2002]
 
National Center on Elder Abuse. (2002). Fact Sheet on Caregiver Stress and
Elder Abuse. [Online]. Available: www.elderabusecenter.org. [Sept. 2,
2002].
 
National Center on Elder Abuse. (2002). Preventing Stress from Becoming
Harmful: A Guide for Caregivers. [Online]. Available:
www.elderabusecenter.org.
 
Hoban, S., Kearney, K. (2000). “Elder abuse and neglect. It takes many
form- if you’re not looking, you may miss it.” American Journal of
Nursing, 100(11), 49-50.
 
United States House of Representatives Committee on Governmental
Reform-Minority Office. (2002). Special Investigations-Nursing Homes.
[Online]. Available:
www.house.gov/reform/min/inves_nurseing/index.htm. [Sept. 2,2002].
 Elder Americans Quiz

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