Elder mistreatment: Self-Learning Module

MedSurg Nursing,  April, 2005  by Cindy Westley

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The Geriatric Resource Nurses at the University of Virginia developed the Self-Learning Modules in Geriatric Care. The SPPICEES pneumonic addresses the eight distinct modules, each targeting a commonly encountered area of health concern of older adults across health care settings. These include:

S: Sleep

P: Problems with eating and nutrition

P: Pain

I: Immobility

C: Confusion

E: Elimination

E: Elder mistreatment

S: Skin

The modules were designed using a case study approach in order to encourage the learner to gain new knowledge as well as apply this knowledge. Each module includes two case studies, one applicable to the care of an older adult in the inpatient setting and the other applicable to an older adult in the outpatient setting. Each module will take approximately 20 to 30 minutes to complete.

The completion of these self-study modules alone does not ensure the staff member is age-specific competent; this is determined through the observation and demonstration of behaviors while working directly with older adults. However, these modules will enhance the staff member's knowledge as a foundational step in developing competent behaviors.

Purpose

The purpose of this module is to provide age-specific educational information related to elder abuse for the patient care staff.

Target Audience

This self-study module was developed for use by a target audience of health care professionals who care for inpatient and outpatient older adults.

Objectives

At the end of the module the clinician will be able to:

1. Define and explain the dynamics of elder mistreatment.

2. Discuss the clinician's responsibility in regard to assessing, intervening, and reporting suspected mistreatment.

Overview

Eider mistreatment is the most recent domestic violence issue to gain the attention of the public and the medical community. Elder abuse was first described in 1975. A 5-year review of the literature revealed 26 articles on elder abuse, compared to 248 articles on child abuse. A random survey of emergency departments showed that 27% had protocols for elder abuse and 75% had protocols for child abuse. Older adults use emergency medical services at twice the rate of other age groups. The geriatric population is the fastest growing age group in the Unites States, composing 13% of the population in 1990; older adults are expected to reach 18% of the population in 2020, and 25% in 2050. The population of people older than 85 years will more than double during the same time. With a decline in the population under 18, in the year 2020 older adults will outnumber children.

Inpatient Case Study

Mrs. M. is an 80-year-old widow with arthritis and CHF who lives in the home she and her husband bought 50 years ago. Her granddaughter moved in with her after her parents died. A few months later, a neighbor came to visit and noticed there was little food and no medications in the house, and that Mrs. M. was very short of breath. The neighbor was concerned and called the ambulance. In the hospital, the granddaughter was very cold and demanding of all, and would not come to a discharge planning meeting. Mrs. M. was presented with the option of returning home with home health care, have the granddaughter move out and get someone to live with her, or sell her home and move to assisted living. She decided to return home with home health assistance.

* How would you discuss the situation with Mrs. M. before discharge?

* What observations will the home health nurse make?

* What activity would she report and to whom would she report it?

* What factors would make Mrs. M. cover up abuse/neglect?

* What can be done to help make the situation more workable for all?

Outpatient Case Study

Mrs. R. is an 80-year-old woman who moved in with her sister, Mrs. L., because of Mrs. R.'s problems with diabetes and memory. Mrs. L. requests medication for Mrs. R. "to make her sleep at night and control her kidneys." Mrs. R. appears disheveled and smells of urine. Her gait appears unsteady. Her weight is 130 pounds, a 30 pound weight loss since the last visit. Mrs. R. complains about being left alone for long periods of time, and Mrs. L. interrupts and claims that Mrs. R. is very demanding and needs constant attention.

* What aspects of this case cause suspicion of mistreatment?

* How would you assess this situation further?

* What actions would you take?

Definitions

There are seven generally accepted categories of elder mistreatment:

1. Physical abuse includes hitting, grabbing, slapping, pushing, or causing bodily injury. This definition also can include sexual abuse.

2. Psychologic or emotional abuse includes verbal or non-verbal verbal insults, humiliation, infantilization, or threats (for example, to institutionalize or abandon the patient).

3. Financial or material abuse includes theft (social security checks, pensions), misappropriation of funds, and coercion (changing a will or deed).

4. Neglect is the failure of a caregiver to provide basic care to a patient, typically involving assistance with the activities of daily living (ADLs). Active neglect is willful failure to provide care, and passive neglect is the nonwillful failure due to caregiver's ignorance or lack of skills.