Archive for the ‘Elder Abuse & Neglect’ Category

Elder Abuse

February 27, 2013

Elder abuse is an umbrella term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to an older adult. Elder abuse includes physical abuse, neglect, sexual abuse, emotional or psychological abuse, financial or material exploitation or abandonment. Elder abuse can happen within the family. It can also happen in settings such as hospitals or nursing homes or in the community. Elder abuse is a serious problem in this country, affecting as many as 2 million elderly persons. Elder abuse occurs among all racial, ethnic and economic groups. Healthy, as well as frail, aging adults may be victimized. Although elderly men may be victims, the profile of the older adult at greatest risk for abuse is a disabled woman, older than 75 years of age, who is physically, socially or financially dependent on others. Perpetrators may be acquaintances, sons, daughters, grandchildren or others. Most often, physical and emotional abuse stems from stressful caregiving situations. Abuse is also associated with a family history of violence, alcohol or substance problems and emotional or cognitive dysfunction of the abused and/or perpetrator. All elderly patients should be screened for abuse in privacy. An abuser may be reluctant to leave the patient’s side or become angry, overprotective or defensive. Questions about abuse are less threatening when asked, matter-of-factly, in the context of a social history. To ease into a more in-depth screening for abuse, you might say, “Just to make sure you’re okay, we ask all patients questions related to their safety.” A full inspection of the elder’s body should be performed. After assessing and screening the patient, the elder’s response, as well as any suspicious assessment findings should be documented in detail. Being alert for patterns of abuse, as well as paying attention to the patient and caregiver’s interactions, are essential when caring for elderly patients. Additionally, reporting suspected elder abuse is the law in all 50 states. Healthcare providers must know the system for reporting suspected abuse in their state. Although elder abuse occurs to a lesser extent in healthcare facilities, maltreatment in institutions also needs to be policed and violators reported. Dunlap, MAEd, RN, M. (2008). Assessment of elderly abuse. Grown Up, volume 13 (3).

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CDC and Healthy Aging

February 24, 2012

The Centers for Disease Control and Prevention (CDC) has a very nice website. Their mottos are saving lives, protecting people, and saving money through prevention.

The CDC.gov has a subpage titled Healthy Aging. It is packed with information (too much for my seniors). I see Health Aging Topics with a dozen links to topics. I see Interactive Data Tools with its 3 links. There is a Listserv link. There is also contact information.

I am especially interested in subtopics related to senior citizens. I clicked on the “More” link for Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap. It took me to the CDC Features subpage. I see “Clinical Preventive Services for Older Adults.” From here, I see a link to “Injury, Violence, and Safety.” It is not very clear and user-friendly the way the sub-paging is laid out.

Now, I am at CDC Features and subpage Injury, Violence, and Safety. I realize this new page is a general page and not the older adults page. However, I see topics of interest such as Older Drivers (2 separate editions), Elder Abuse (2 separate editions), and Fall Risks for Older Adults.

Even with the CDC site being very large, it can still be made user-friendly, especially for the seniors.

Senior citizens may also be interested in Medicare Supplemental Insurance.

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A Form of Elder Abuse that goes unnoticed

September 29, 2011

Understanding Elder Abuse is a topic that is now a hospital competency for healthcare workers. As a nurse in the ED there are situations where the abuse is evident and other times more subtle and seen through the interactions between the elderly patient and his/her family. What about those families that bring grandma or grandpa to the ED right before a Holiday with a list of symptoms that guarantee an admission? Only for us, the staff to hear the family tell us they are going out of town for the Holidays and won’t be available for X number of days. It is a situation that, when assessed, is a form of Elder Abuse. It happens more often with those elderly patient’s who are not able to verbalize well, have dementia/Alzheimer’s or cannot speak for themselves. With an overhaul of the healthcare system there will have to be an overhaul of the social services in this country because without it there will be no way to provide safe, effective and complete care to the most vulnerable in our population.

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Importance of Skin Assessment in Elderly and Child Abuse, comment

October 18, 2010

Skin assessment is a more valuable tool than we give it credit or time for. There are so many clues to a long list of health issues; from the varience in color, turgor, texture, temperature and thickness, to hair distribution, and condition of the nails.  All of these variances from norm could be linked to some health issue.  Issues like nutritional deficiency, allergy, local or systemic disease; such as melanoma or systemic lupus erythematosus; or they could be signs or the ‘remnants’ of abuse.

Unfortunately, I don’t think the nurse on the floor routinely gives skin assessment the time or attention needed to pick up on these clues.  The most opportune time to find these signs would be on admission, during the initial assessment. What I see on the floor, is short staffing more often than not, trying to care for more patients than can be fully cared for during their shift, and bed shortages, requiring ‘quick’ turnover.  I am also afraid that the gains in my staffing numbers over the past year are in jeopardy with the reforms and cuts in reimbursement that I think are coming. Thorough assessments are an essential part of health care, of preventative medicine, and all of our professional practices; so I truly hope there will be the time and ability going forward to complete this valuable task.

Original Post

May 26, 2009

Title: Importance of Skin Assessment in Elderly and Child Abuse

In studying skin assessment, one cannot help feeling overwhelmed. Without a desire to pursue dermatology, the unlimited amount of skin lesions, pustules, macules and papules can lead one to skim over information out of the pure necessity for mental sanity. The mind can only hold so many pictures at once. However, I do see the need to ensure the memorization and ability to recognize and diagnose normal skin variations. In reading articles and working with children and the elderly, one unfortunately sees the reality firsthand of physical abuse and neglect. This can often be recognized by assessing the skin. Breakdown, malnutrition, physical abuse, bruises, injuries at different stages of healing can all be noted by a thorogh assessment of the skin. As follow up care and the big picture should always be a part of our thought process in nursing assessment, the ability to note whether a skin assessment finding is simply normal or abnormal is vital to our practice.

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ELDER ABUSE

August 2, 2010

Not a week goes by when we do not receive an elderly patient on our floor who is covered by bruises. But what is the cause? Should we jumped to the conclusion that there has been abuse, or ignore what we are seeing? Knowing the sign and symptoms of abuse is extremely important, although most of the screening takes place in the emergency room, floor nurses also need to be aware.
Older patients are often on medications that can cause them to bruise more easily, their skin is also more fragile and tears easily, a client’s mental state may also be impaired. Continuing education is imperative so advanced assessment can be used to be able to distinguish between abuse and the symptoms that occur from medication or the normal aging process.

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Screening for abuse, comment

July 20, 2010

Screening for abuse is a very important element of the nursing assessment.  While screening for abuse should be included in every nursing assessment abuse is seen more frequently within certain patient populations; such as the very young and the very old.  Those patients who are very young or very young are more vulnerable to abuse by their caretakers.  This screening can sometimes be difficult to perform.  There needs to be attention to detail during the interview for any inconsistencies with information given and findings during the assessment.

The nurse assessment of the skin and musculoskeletal systems hold great importance when screening for abuse.  It is during these advanced assessments there may be evidence of abuse may be found.  Any suspicious bruising, welts, or marks that are found should be taken into consideration when screening for abuse.

When a nurse is functioning in the field of forensics their assessments and screenings for abuse may be called into use during a proceeding in court; the nurse may have to testify to their assessment findings.  Forensic nurses will also have to rely on their experience in advanced assessment to accurately screen possible victims for abuse.

Forensic nurse or any other area of nursing this screening for abuse is a vital part of the nursing assessment.  A nurse is responsible for advocating for the patient to their best ability.  Especially in circumstances when the caretaker of the patient is overpowering and does not cooperate with the patient being assessed without them present.

Original Post

September 28, 2009

Title: Screening for abuse, comment

I think that all nurses and doctors should receive additional training in screening for abuse depending on their specialty area. Patients will present differently depending on whom they are being interviewed by. Many times in the situation of children they are with their abuser when they present and it is difficult to separate the two. The abuser does not want you to have words alone with their child. I worked many years as a school nurse and suspected many cases of abuse that were reported to the appropriate authorities only to find that the child was disbelieved and then years later found to be telling the truth. Adults are very savvy at making a child look like a liar but seldom do these children have the capabilities to make up the horrendous story I heard. Unfortunately the investigators seem to want to believe the abuser. These children were also ones with poor grades (not sleeping at night due to the abuse), behavioral issues (they just wanted someone to listen) and many times documented storytellers (the only way to get attention) so it was very easy for the abuser to discredit them. If we are all trained to look for something other than physical marks we may start to diminish abuse against our children. Part of the assessment should not include where the parents reside in society. Several times the investigators simply found out what the parents did for a living and that in itself ended the investigation.

Original Post:
September 8, 2009
Title: Screening for abuse
Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, “Do you feel safe at home?” 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

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My Close Up Experience With Alzheimer’s

May 11, 2010

During my recent management role I had the unfortunate experience of watching a close coworker and friend of mine go from a vibrant hard working nurse to someone easily rattled, couldn’t remember her patients, but unwilling to recognize what was happening to herself. After having to discipline her for medication errors she finally accepted that something was wrong and went to see a doctor. The doctor gave her a diagnosis of Alzheimer’s. It was unsafe for our patients for her to continue in the nursing role and my employer could not see a use for this dedicated employee (find/give her another position). She was only 53 years old and instead of a retirement party ends up leaving the organization in what seems like a disgrace. What a shame that there is no place in the workforce this for someone who had been such a dedicated, patient loved individual.

Original Post
November 6, 2008
Title: Protecting the Elderly
I often wonder if we do enough to protect the frail elderly. Case in point was a patient I took over from another nurse on Sunday. She was a 67 year old female Alzheimer’s patient who had been left supposedly in her grown children’s care while her caregiver husband took a long-deserved overnight fishing trip up north. Her usual state is pleasantly confused and ambulatory. Unfortunately, the daughter never went to the house, but called Mom and told her to take her pills, which apparently she did, and she did, and she did, etc. When the grown children finally arrived to the house around noon the next day, they found her nonambulatory, aphasic, and with an altered mental status. They called the ambulance. The ambulance ALS’d her by only putting in a saline lock and cardiac monitor. (No neuros, no O2) When she arrived, the MD did all the usual labs, CMP, CBC, CIP, Salicylate, Acetaminophen, UA; EKG, CXR and CT head for altered mental status. All the findings were negative except the Na and Cl were low, but CO2 was fine. When the off-going nurse gave me report, she told me the patient was restless, not following commands. She had put in a Foley and had a good output. She made the comment “But she has dementia.” Of course the side rails were up. I went in to do my assessment and introduced myself to the patient and the children. The patient was responsive only to verbal stimuli and made little eye contact and had expressive aphasia. She demonstrated tremors. She was unable to identify her daughter. I asked the family if any of that was her usual state and they said no. I initiated seizure precautions and asked the MD if he minded if I called Poison Control (which are customary nursing interventions in our ED anyway) and of course he said “go ahead.” I updated him on the assessment and he was clueless. I obtained an order for some Ativan. Poison control gave me some parameters. Since some of the meds were BuSpar and Seroquel which could both affect CNS and cardiac systems; I had been right in my gut reaction, but not that familiar with the adverse effects of Seroquel OD. We initiated NS to correct the electrolyte imbalance and she started perking up. Her husband finally arrived and she was bright, cheerful and alert! He was obviously angry and upset, and we talked a long time. I felt bad. I was upset with my co-worker for pigeon-holing my LOL just because she had dementia; she could have had a bad outcome. But should I as a mandated reporter called this in as neglect on the part of the children? After all, the husband had assumed he had left his beloved spouse in good hands for some much needed respite. He was fighting back the tears when he was talking to me.

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Elder Abuse, comment

April 19, 2010

I wanted to post on the subject of elder abuse and how important it is to do a very thorough assessment when admitting a patient to the hospital who you suspect might have suffered some abuse. I work in an ICU unit and we received a patient from home who was bed bound and had several strokes in the past. He was being cared for at home by his wife. She also was taking care of two mentally handicapped adult children in their home as well. Upon admitting him to the hospital, we found that he had two very large areas on his buttocks directly beside his coccyx. They already had eschar on them. We immediately took pictures of the wounds. When the wife came in to see the patient, we asked about those areas and described them to her. She immediately became defensive and asked if we were accusing her of neglect. We told her that we were not accusing her of anything, but that we had to document any present on admission findings. She became very irate and demanded that she speak with the doctor. After talking to the doctor, he assured her that maybe that happened on the "O.R. table and that we would just treat the pt. The patient was only in the OR for an hour and a half so it seemed unlikely that this happened there. The wife stated that he was "not like this" when he came in and therefore, we must have caused them. There was an investigation and APS became involved and did find that there were some issues in the home. Had it not been for the assessment and documentation of the admitting nurse, then we may have thought that those wounds may have happened in the OR and not at home like they really turned out to be.

Original Post
April 14, 2010
Title: Elder Abuse
I wanted to comment on the importance of the assessment facilitated when the skilled nurse performs a head to toe on the elderly client. The skilled nurse not only has a responsibility to assess the body, but the holistic aspects of that client. I am a home health nurse, so from my perspective, the head to toe is a portion of the bigger scope of what I need to address. As we move into this new millennium with advances in technology, we are learning that the geriatric population is growing. More older adults are being placed in the position of caring for aging parents which can, for some, be an extreme balancing act to between their own lives and responsibilities, coupled with caring for their parents business affairs. All of these dynamics can place stress to that child of the older adult. Some of the abuse we as healthcare professionals need to assess is emotional and financial. Some parents, based on my experience, are made to feel guilty when the child needs to pick up a prescription or be taken to the doctors office. We need to ensure that the caregivers have as much support available to them to decrease stress, and increase the relationship dynamic between client and caregiver which will in part, keep the client healthy knowing that they have a good support system.

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Elderly Abuse

April 14, 2010

I wanted to comment on the importance of the assessment facilitated when the skilled nurse performs a head to toe on the elderly client. The skilled nurse not only has a responsibility to assess the body, but the holistic aspects of that client. I am a home health nurse, so from my perspective, the head to toe is a portion of the bigger scope of what I need to address. As we move into this new millennium with advances in technology, we are learning that the geriatric population is growing. More older adults are being placed in the position of caring for aging parents which can, for some, be an extreme balancing act to between their own lives and responsibilities, coupled with caring for their parents business affairs. All of these dynamics can place stress to that child of the older adult. Some of the abuse we as healthcare professionals need to assess is emotional and financial. Some parents, based on my experience, are made to feel guilty when the child needs to pick up a prescription or be taken to the doctors office. We need to ensure that the caregivers have as much support available to them to decrease stress, and increase the relationship dynamic between client and caregiver which will in part, keep the client healthy knowing that they have a good support system.

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Abuse and Neglect of the Elderly

January 8, 2010

I work as a charge nurse in a long term care facility with 100 residents. Assessing and reporting neglect and abuse are part of my job duties. Documentation and investigation are essential elements of elder abuse, with reporting to the Ombudsmen. We use forms for documenting abuse and neglect. These are what the Ombudsmen receive and are not part of the medical record. Quality improvement review these documents as they are initiated, ensuring thoroughness and making changes to the care plans. I have found it difficult, at times, to distinguish self-inflicted injuries from those committed by staff. Skin of the elderly is so thin that a resident can easily inflict scratches and bruises on themselves. Determining whether the injuries are self-inflicted becomes a function of the investigative process by the nurse, along with reporting. An objective view must be maintained during the assessment. The nurse’s judgment has little baring. I have found this course in Advanced Health Assessment to be an invaluable tool in good assessment skills.

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