Posts Tagged ‘Elder Abuse’

Adult protective services

November 17, 2008

An important premise in adult protective services is that the patient is mentally competent to act in his or her behalf. The abused or neglected adult should be involved in decisions about her or his care and custody. Though this is a relatively concept it is one that I hope holds the best hope to help women. It is difficult for women who have had very little say in their lives to begin making decision about their future. The low self-esteem that accompanies abuse over time is almost insurmountable to overcome; without some type of support these women are doom to failure.

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The Need For Forensic Nursing In The Emergency Room Setting: A Case Study

November 11, 2008

Chapters 1-3 of Forensic Nursing by Lynch discuss the origin, dynamics, principles, and increasing importance for Forensic Nursing in a clinical setting. The realization that Emergency Room patients are not only in need of, but more importantly, are entitled to benefit from this “new” applied science is becoming more evident to me every day. Recently, I was involved in the care of an elderly female patient that had presented to the ER for evaluation and treatment of injuries she sustained in a fall. She was assessed by the triage nurse and her primary nurse. All documentation addressed the mechanism of injury as a fall. The ER physician documented that the patient indeed fell and sustained injuries, but at the hands of domestic violence by the patient’s son. After medical diagnostics and treatment were rendered, I was asked to prepare the patient for discharge. After reviewing the chart, I realized that the initial assessment and documentation by the nurses did not include the circumstances regarding her injuries, nor a body gram description. Involvement of Law Enforcement, Social Services, and Protection Resource Services also had not been discussed with the patient. I then interviewed the patient, taking a full history of the precipitating/actual events. I documented her statements, and patterned her injuries on a body diagram template. I then contacted our Psychiatric Intake Department for collaboration with DHR/Law Enforcement/Social Services. Together we proposed an emergency safety plan for the patient to go to a women’s shelter for protection from further abuse from her son. Fortunately, this patient had a favorable outcome. Without applied nursing forensic techniques and the successful collaboration with other public entities, justice for this patient would certainly have been denied.

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Protecting the Elderly

November 6, 2008

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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Assessment Finding Related to Elder Abuse

July 30, 2008

Elder maltreatment is becoming an increased social problem gaining higher level of scrutiny. Medical programs have limited formal education on the recognition of the different forms of elder maltreatment. The natural changes of aging reflected in pathopysiology can make it difficult to distinguish physical changes of abuse from those of aging.
Elder maltreatment can be classified in six categories: physical abuse, sexual abuse, neglect, psychological abuse, financial and material exploitation and violation of rights. Clinician must be versed in normal pathopysiology of ageing so assessment findings will not be mistaken as trauma or neglect. The victims and perpetrators, scenarios, risk factors, common anatomic and clinical findings, the pathopysiology ageing and limitations of abuse need to be understood.
The American Medical Association defines elder maltreatment as an act or omission that results in harm or threatened harm to the health and welfare of an elderly person. The 2004 report of the National Center an Elder Abuse stated that 83 cases of abuse are reported for 1000 elder Americans. This paper will focus on physical abuse, sexual abuse and neglect.
It is important to have a knowledge base of typical victim and perpetrator characteristic to detect or prevent elder maltreatment. Common characteristics are:
• Age : >75 years old
• Dependency upon one person for ADL-IADL
• Lacks a social net work and has cognitive and physical impairment.
• Perpetrator: Transgeneration violence pattern in family. Perpetrator may be under period stress, substance abuser or have mental illness.

Physical abuse is an act carried with the intention of causing physical pain or injury. Physical abuse makes up 14% of all elder traumas. Clinicians must work to determine if assessment finding are a result of secondary or accidental trauma. Location of trauma in areas of body not commonly impacted during daily activities invite closer inspection. Such areas would be inner thigh, top or bottom of feet, inner wrists or ankle, abdomen, axilla or posterior neck. Areas that are likely non-accidental are also the eye, nose, and inner mouth. Injuries at different stages in healing would indicate repeated pattern of trauma. Imprint pattern of injury needs to be assessed for similar shape and size.
Hair loss from forehead and front temporal region is common in males and postmenopausal females. However, single or multiple patches of alopecia is a sign of traumatic alopecia. The scalp around the patch would show normal hair distribution. Scalp hemorrhage or a hematoma may be a result of hair being forcibly pulled out.

Anogentital injury vaginal hematomas should be investigated. Elderly females are prone to vaginal injury due decreased estrogen, vaginal dryness and thinning of the vaginal wall.

A nurse doing an assessment of the integumentary system should be alert to these various patterns of symptoms. Forensic nurses would be trained to these signs and social interactions between patient and care givers. This group of nurses could serve to bridge this knowledge to other members of the medical team. The medical community should anticipate an increase in elder abuse with the escalating numbers of elders in the community.

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Elder maltreatment

July 1, 2008

Elder maltreatment is becoming an increased social problem gaining higher level of scrutiny. Medical programs have limited formal education on the recognition of the different forms of elder maltreatment. The natural changes of aging reflected in pathopysiology can make it difficult to distinguish physical changes of abuse from those of aging.

Elder maltreatment can be classified in six categories: physical abuse, sexual abuse, neglect, psychological abuse, financial and material exploitation and violation of rights. Clinician must be versed in normal pathopysiology of ageing so assessment findings will not be mistaken as trauma or neglect. The victims and perpetrators, scenarios, risk factors, common anatomic and clinical findings, the pathopysiology ageing and limitations of abuse need to be understood.

The American Medical Association defines elder maltreatment as an act or omission that results in harm or threatened harm to the halt health and welfare of an elderly person. The 2004 report of the National Center an Elder Abuse stated that 83 cases of abuse are reported for 1000 elder Americans. This paper will focus on physical abuse, sexual abuse and neglect.

It is important to have a knowledge base of typical victim and perpetrator characteristic to detect or prevent elder maltreatment. Common characteristics are:
• Age : >75 years old
• Dependency upon one person for ADL-IADL
• Lacks a social net work and has cognitive and physical impairment.
• Perpetrator: Transgeneration violence pattern in family. Perpetrator may be under period stress, substance abuser or have mental illness.

Physical abuse is an act carried with the intention of causing physical pain or injury. Physical abuse makes up 14% of all elder traumas. Clinicians must work to determine if assessment finding are a result of secondary or accidental trauma. Location of trauma in areas of body not commonly impacted during daily activities invite closer inspection. Such areas would be inner thigh, top or bottom of feet, inner wrists or ankle, abdomen, axilla or posterior neck. Areas that are likely non-accidental are also the eye, nose, and inner mouth. Injuries at different stages in healing would indicate repeated pattern of trauma. Imprint pattern of injury needs to be assessed for similar shape and size.

Hair loss from forehead and front temporal region is common in males and postmenopausal females. However, single or multiple patches of alopecia is a sign of traumatic alopecia. The scalp around the patch would show normal hair distribution. Scalp hemorrhage or a hematoma may be a result of hair being forcibly pulled out.

Anogentital injury or vaginal hematomas should be investigated. Elderly females are prone to vaginal injury due decreased estrogen, vaginal dryness and thinning of the vaginal wall.

A nurse doing an assessment of the integumentary system should be alert to these various patterns of symptoms. Forensic nurses would be trained to these signs and social interactions between patient and care givers. This group of nurses could serve to bridge this knowledge to other members of the medical team. The medical community should anticipate an increase in elder abuse with the escalating numbers of elders in the community.

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Medicare Supplement Fraud

March 21, 2008

I am glad to know you offer a program to help senior citizens. Even though your help is indirect, I plan to participate in your course. I will be taking Forensic Nursing so I may help senior citizens who are prey to Medicare Supplement fraud. I understand part of your program deals with Healthcare Computer Forensics and Elder Abuse. Any other suggestions will be greatly appreciated.

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