Page 12 nursing.elitecme.com Complete Your CE Test Online - Click Here Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. ©2018: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Elite Professional Education, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Elite Professional Education, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Introduction The number of Americans 65 years of age and older is growing at a rapid pace. On July 1, 2015 (as of this writing, the most recent data available), the number of people age 65 and older in the United States was 47.8 million. This population accounted for 14.9% of the total population and grew in numbers by 1.6 million from 2014 (United States Census, 2017). It is predicted that by 2060, there will be 98.2 million Americans (one in four people) 65 years of age and older (United States Census, 2017). Increasing numbers of older adults in the United States mean that health care professionals (HCPs) must be prepared to provide safe and appropriate health care for a segment of the population that is rapidly growing. Part of this preparation includes providing care to people with chronic illnesses and memory changes. End-of-life care will become even more important as the population ages. Unfortunately, the recognition, intervention, and prevention of cases of elder abuse will also grow in importance because this problem is a growing concern. In Texas, nearly 12% of the population, or 3.2 million people, are 65 and older, and the number is growing. It is estimated that by 2050, that number will increase to nearly 20% (Texas Health and Human Services, 2017). This means that there will be an increased demand for health care, home care, personal care, long-term care, and health care professionals with expertise in gerontology. This education program, which meets the mandatory older adult continuing education requirements of the Texas Board of Nursing, focuses on the following: ● ● Elder abuse. ● ● Age-related memory changes. ● ● The impact of chronic conditions in the elder population. ● ● End-of-life care. Elder abuse Definitions of elder abuse vary somewhat from state to state. In Texas, according to the Texas Human Resources Code, Section 48.002, abuse is “the negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment of an elderly or disabled person with resulting physical or emotional harm or pain” (Texas Department of Family and Protective Services, 2017). Following are additional definitions relating to abuse from the Texas Department of Family and Protective Services (2017): ● ● Sexual abuse: “Any involuntary or nonconsensual sexual conduct committed by the person’s caretaker, family member, or other individual who has an ongoing relationship with the person.” ● ● Exploitation: “The illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with the elderly or disabled person using the resources of an elderly or disabled person for monetary or personal benefit, profit, or gain without the informed consent of the elderly or disabled person.” ● ● Neglect: “The failure to provide for one’s self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caretaker to provide such goods or services.” A number of additional types of elder abuse have serious, even fatal, consequences. It is important that nurses understand, in detail, each type of elder abuse and corresponding signs and symptoms. Physical abuse Sandy is a registered nurse who works in a busy pediatric office. One day, a toddler’s 68-year-old grandmother brings the child in for a wellness visit. It is a warm summer day, but the grandmother is wearing a long-sleeved sweater. As the child and his grandmother leave the office, Sandy, who is leaving the office for her lunch break, happens to walk by the grandmother’s car. She notices that the grandmother has removed her sweater. The upper portions of both of the woman’s arms are covered with ugly purple bruises. Sandy is alarmed and is concerned that the woman may have been abused. The National Center on Elder Abuse (NCEA) defines physical abuse as the “use of physical force that may result in bodily injury, physical pain, or impairment”(National Center on Elder Abuse, n.d.b). Examples of physical abuse include the following (National Center on Elder Abuse, n.d.b): ● ● Striking (with or without an object). ● ● Hitting. ● ● Pushing. ● ● Shaking. ● ● Slapping. ● ● Kicking. ● ● Pinching. ● ● Burning. ● ● Inappropriate use of drugs. ● ● Physical restraints. ● ● Forced feeding. ● ● Any kind of physical punishment. Nurses must be able to recognize signs and symptoms of physical abuse, which include the following (National Center on Elder Abuse, n.d.b; Olson & Hoglund, 2014; Stark, 2012): ● ● Bruises, black eyes, and welts. ● ● Bone fractures, including skull fractures. ● ● Open wounds, cuts, punctures, and lacerations. ● ● Sprains, dislocations, and internal injuries or bleeding. ● ● Signs of being restrained, such as rope marks, bruising around ankles or wrists. ● ● Broken eyeglasses. ● ● Laboratory evidence of overdose or underuse of prescribed drugs. ● ● An elder’s report of being abused. ● ● A sudden change in the elder’s behavior, such as becoming agitated, fearful, or depressed. ● ● A caregiver’s refusal to allow visitors, family members, or health care workers to see the elder alone. Nurses must also pay attention to the pattern of injuries found on the older adult’s body. The following patterns of injury indicate abuse rather than accidental injury (Olson & Hoglund, 2014; Stark, 2012; Ziminski et al., 2013): ● ● Bilateral bruising over the upper arms, lateral arms, or anterior arms. ● ● Face, skull, and neck injuries. ● ● Bruising, cuts, lacerations, scars, or other wounds around the breasts or genital areas. ● ● Bruises or injuries that have a particular pattern - a cigarette burn, the imprint of a hand or an object, such as a cane. ● ● Bruises in different stages of healing.