Page 78 Complete Your CE Test Online - Click Here ● ● Unexplained injuries such as bruising, broken bones, pressure marks, abrasions, welts, or scars, especially any that occur in specific shapes. ● ● Signs of physical restraints such as brush burns or rope marks on the wrists or ankles are suspicious. ● ● Broken eyeglasses or eye frames. ● ● Excessive sleepiness, confusion, and/or lethargy may be suggestive of attempts to restrain the older adult chemically (e.g. using sleeping tablets). Nursing consideration: When evaluating abrasions, lacerations, and cuts, it is important to describe them accurately. Many nurses refer to any wound as a laceration. When documenting these kinds of trauma, it is important to be accurate: ● ● Abrasion: A scraping injury that can occur if the older adult is pulled or dragged across a surface (e.g. a carpet) that abrades the skin [39]. ● ● Laceration: Full-thickness splitting open of the skin with ragged edges that occurs when the individual is traumatized by blunt force [39]. ● ● Cut: A cut is an incision made by a sharp object and has smooth, clean edges [39]. Sexual abuse Sexual abuse is defined as any type of nonconsensual sexual contact. Examples include rape, molestation, sexual harassment, unwanted touching, sodomy, and coerced nudity as well as forcing an individual to undress, and forcing an older adult to watch or be part of sexual acts [9,39,40]. Signs and symptoms of sexual abuse include: ● ● Bruises around the genitals and/or breasts. ● ● Unexplained vaginal or anal bleeding. ● ● Unexplained occurrence of sexually transmitted infections or genital infections. ● ● Torn, stained, or bloody undergarments. ● ● An older adult’s verbal report of sexual abuse. Emotional or psychological abuse Emotional or psychological abuse is defined as an infliction of distress, anguish, or sadness via verbal and/or non-verbal acts [9]. Examples include: intimidation with yelling/or threatening language; blaming, name calling, or insults; intimidation or terrorizing the individual; and humiliation. Other forms of emotional abuse include isolating the older adult from family and friends, preventing them from pursuing their regular social activities (e.g. attending church, visiting a senior citizen’s center), isolating them from others in the home, and/or giving the older adult the “silent treatment” and not providing any affection [40,42]. Signs and symptoms of emotional or psychological abuse include sadness, emotional upset or agitation, withdrawal, and verbal reporting of emotional abusive behaviors [9,39,42]. Nursing consideration: Recall the example of Mrs. Douglas earlier in this section? She says she is ignored and made fun of by her family. She needs to be evaluated for emotional abuse. Neglect Neglect is defined as the failure to fulfill or refusal to fulfill obligations to an older adult such as safety, shelter, affection, food, water, clothing, hygiene, medicine, and/or comfort [9,49,40,42]. Neglect may be on the part of a spouse, family member, friend, or caregiver. Additionally, older adults may also initiate self-neglect, which occurs when the older adults disregard such needs as hygiene, safety, etc. due to mental or physical impairments or because they choose not to take care of themselves [9,49,40,42]. Signs and symptoms of neglect include malnutrition, dehydration, poor personal hygiene, untreated health problems, unsanitary or unsafe living conditions, a history of being left alone or choosing to be alone, and reports of being neglected [49,40,42]. Abandonment Abandonment is the desertion of an older adult by someone who is responsible for providing care to the older adult or who has physical custody of the older adult [9,42]. In such cases the older adult is simply deserted or abandoned at a hospital (e.g. emergency department), long-term care facility, shopping center, or other public location [9]. In addition to being abandoned, the older adult may also exhibit signs and symptoms of other types of abuse. Financial or material abuse Financial or material abuse is defined as unauthorized illegal, or improper use of an older adult’s money, property, and/or other assets. The person committing this abuse does so for personal or monetary gain or benefit [9]. Examples of this type of abuse include unexplained disappearance of personal items, unusual withdrawals of money from savings or checking accounts, or changes in property ownership. As a result of financial losses, older adults may not be able to pay bills or buy food and medicine [40]. Risk factors for older adult abuse Older adult abuse can occur within all socioeconomic, cultural, and intellectual groups. However, research shows that certain characteristics surface most commonly among abuse victims. These include [9,421]: ● ● Sex: Women are more likely to be victims of abuse than men. ● ● Age: Victims of abuse are likely to be over 75 years of age. ● ● History of violence: Older adult victims of abuse are more likely to be prior victims of abuse such as child abuse or spousal or intimate partner abuse. Also, if the abuse victims were abusers (e.g. abused their children), they are more likely to be victims of abuse by those they previously abused. ● ● Functional status: Older adults whose physical and/or mental status is impaired are more likely to be abused. ● ● Poor social network: Older adults who have fewer than three significant others are more likely to suffer abuse. ● ● Economic status: Older adults who are poor are more likely to be abused. ● ● Education: Older adults who have less than an 8th grade education are more likely to be abused. ● ● Minorities: Members of minority groups have statistically higher rates of older adult abuse. Characteristics of abusers Some common characteristics of abusers include the following [9,40,42]: ● ● Sex: Abusers are more likely to be men. ● ● Substance abuse: Abusers are more likely to have a history of substance abuse including alcohol abuse. ● ● Mental health: Abusers are more likely to suffer from mental illness. ● ● Family status: Older adults are more likely to be abused by members of their own families. ● ● Social network: Abusers have a poor social network and are more likely to be dependent on the older adult for finances, shelter, or other needs. ● ● Caregiver stress: Caregivers overwhelmed by the burden of caring for the older adult may abuse the person for whom they are caring. ● ● Cycle of family violence: Caregivers may have been abused by the older adult they are now abusing. ● ● Difficulty coping with stress: This may coincide with financial problems or depression. Screening for older adult abuse Evaluate signs and symptoms that may indicate abuse. Monitor those who provide care for older adults. Do they show signs and symptoms of stress and difficulty coping? Is there a history of abuse in the older adult and/or caregiver’s family? There are a number of assessment screening tools available for use. The Hartford Institute for Geriatric Nursing recommends the Elder Assessment Instrument (EAI) as a screening tool in the clinical setting [9]. This is a 40-item tool used to determine if the older adult patient needs to be referred for suspected abuse [9,43]. Older adults are often reluctant to report abuse. They may be afraid of retaliation by the abuser. Or, they may believe that they have done something to deserve the abuse, or feel guilty about being an abuser themselves at some point in their lives. Abused older adults may also be reluctant to report abuse if they are dependent on the abuser for care, shelter, or financial help.