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Elder Abuse: Mistreatment of Older Americans on the Rise Autumn Leaves of Denton WORK SAMPLE Autumn Leaves Livin Assisted Living for Alzheimer’s and Dementia ELDER ABUSE: MISTREATMENT OF OLDER AMERICANS ON THE RISE By: Arlene Orhon Jech, RN November 4, 2002 nurseweek.com

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

ELDER ABUSE: MISTREATMENT OF OLDER AMERICANS ON THE RISE

By: Arlene Orhon Jech, RNNovember 4, 2002nurseweek.com

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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Purpose• This training is to inform you about elder

abuse and the measures you can take to help prevent it.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

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

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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INTRODUCTIONElder Abuse: Mistreatment of Elder Americans

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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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

Under 65

Over 65 (35 Mil-lion)

2050

Under 65

Over 65 (80 Mil-lion)

+45 Million

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Elder Abuse: Mistreatment of Older Americans on the Rise

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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).

Life Expectancy0

102030405060708090

19002000

+ 29.9 Years

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Between 1986 and 1996, when the elder population increased 10 percent, reports to Adult Protective Services of suspected domestic elder abuse increased 150 percent.

+15 times

The increasing number of older Americans has been accompanied by a disproportionate increase in the prevalence of elder abuse.

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Elder Abuse: Mistreatment of Older Americans on the Rise

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In 1996 alone, more than 550,000 older people experienced some form of abuse or neglect in the domestic setting (3).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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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%)

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Elder Abuse: Mistreatment of Older Americans on the Rise

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ELDER ABUSE DEFINEDElder Abuse: Mistreatment of Elder Americans

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

Elder abuse is defined as: the mistreatment, neglect, or exploitation of

an elderly person.

The abuse can be:­ Physical­ Psychological­ Financial (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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Physical abuse is defined as: the use of physical force that can cause

bodily injury, physical pain or impairment.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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• Evidence of physical abuse includes:– Striking– Shoving– Shaking– Beating– Slapping

– Kicking– Pinching– Burning– Restraining– Improper feeding (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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• Elders who have been physically abused may have:– Bruises– Welts– Lacerations– rope marks– black eyes– Wounds– Cuts– Untreated injuries

­Dislocations­Sprains­internal injuries­broken eyeglasses or frames­medication overdoses or under-doses

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Elder Abuse: Mistreatment of Older Americans on the Rise

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• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Sexual abuse is defined as: Nonconsensual sexual contact of any kind

with an elderly person (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• Evidence of sexual abuse includes:– Bruising around the breasts or genital area– Venereal disease– Vaginal or anal bleeding – Torn or bloody undergarments (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

Psychological abuse is defined as:The infliction of emotional distress, anguish,

or pain through verbal or nonverbal acts (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• Evidence of psychological abuse includes:– Verbal assaults– Insults– Threats– Intimidation– Humiliation– Harassment

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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• 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

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Neglect is defined as:The failure to provide needed care for an

elder.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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• Neglected elders may be being denied:–Food–Water–Clothing–Personal hygiene–Shelter–Medicine–Comfort–Personal safety

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

Financial abuse is defined as:The illegal or improper use of an elder’s

funds, property or assets (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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

are available also can be caused by financial abuse.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

Self-neglect is defined as:The behavior of an elderly person that

threatens his or her safety (5).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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.

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

ABUSE IN THE INSTITUTIONAL SETTING

Elder Abuse: Mistreatment of Elder Americans

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

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).

2000 20500

1000000

2000000

3000000

4000000

5000000

6000000

7000000

Nursing Homes (17,000)Residents

+5 Million Residents

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Elder Abuse: Mistreatment of Older Americans on the Rise

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But in a recent two-year period, almost one out of every three nursing homes was cited for abuse (10).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Facilities with the highest levels of nursing staff had 60 percent fewer violations for abuse (11).

STAFF

Abuse

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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Nursing home staff often are poorly paid and overworked, have high stress levels and feel stretched beyond their limits.

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Nine out of ten U.S. nursing homes are understaffed, according to a recent government study (10).

US Nursing Homes

UnderstaffedFully Staffed

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Elder Abuse: Mistreatment of Older Americans on the Rise

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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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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• 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.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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PREVENTIONElder Abuse: Mistreatment of Elder Americans

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Nurses who admit elders to emergency rooms, hospitals, and nursing homes should be alert for the signs of abuse, neglect, and self-neglect.

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Elder Abuse: Mistreatment of Older Americans on the Rise

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• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

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.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

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• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• Nurses can help caregivers by:– Teaching caregivers to recognize situations that

cause them stress

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• Nurses can also:– Teach caregivers appropriate ways to handle

difficult care receiver behaviors such as violence, combativeness, and verbal abuse (8).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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An ombudsman is defined as: An advocate for residents of nursing homes,

board and care homes and assisted living facilities (11).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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).

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

SUMMARYElder Abuse: Mistreatment of Elder Americans

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

• 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.

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Elder Abuse: Mistreatment of Older Americans on the Rise

Autumn Leaves of DentonWORK SAMPLE

Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

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

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Elder Abuse: Mistreatment of Older Americans on the Rise

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SOURCESElder Abuse: Mistreatment of Elder Americans

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Elder Abuse: Mistreatment of Older Americans on the Rise

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Autumn Leaves LivingAssisted Living for Alzheimer’s and Dementia care

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]

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Elder Abuse: Mistreatment of Older Americans on the Rise

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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].

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Elder Americans Quiz

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