Page 13 Complete Your CE Test Online - Click Here ● ● Unexplained injuries or injuries that do not fit with the elder’s (or the elder’s caregiver’s) explanation of how the elder was injured. Nursing consideration: Not all injuries are caused by physical abuse. Older adults do fall and bump into things. Nurses should perform a thorough physical and mental assessment as well as observe the older adults and their interactions with family, friends, and health care workers to help differentiate accident from abuse (Olson & Hoglund, 2014; Stark, 2012; Ziminski et al., 2013). Sexual abuse David is a nursing supervisor at a long-term care facility that has an excellent reputation in the health care community. One day he arrives at work and instead of going to his office, sits at the computer in the nurse’s station to check his email before going to an administrative meeting. He notices that an email has been sent to staff members from an anonymous source. It contains a picture of a resident exposing her genitalia and crying. David is outraged and triggers an immediate investigation into the possibility of sexual abuse. Older adult sexual abuse is nonconsensual sexual contact with an older adult. It involves physical sex acts, unwanted touching, rape, sodomy, coerced nudity, sexually explicit photographs, forcing the older adult to view sex acts or pornographic material, or forcing an older adult to disrobe (Stark, 2012; Ziminski et al., 2013). Signs and symptoms of sexual abuse include the following (National Center on Elder Abuse, n.d.b; Stark, 2012; Ziminski et al., 2013): ● ● Bruising around the breasts or genital area. ● ● Unexplained vaginal or anal bleeding. ● ● Unexplained venereal disease or genital infections. ● ● Torn, stained, or bloody underclothing. ● ● Evidence of the elder’s being photographed in a sexually explicit manner. ● ● An elder’s report of being sexually assaulted or raped. Emotional or psychological abuse Monica is a nurse practitioner who specializes in geriatric care at a large medical center. She stops outside one of her patient’s hospital room and overhears the patient’s son speaking in an angry tone of voice. He tells his father, “You are really a stupid old man. You had better learn to behave yourself or I won’t let you come back home to live with me and my family. And believe me, nobody else will put up with an old man like you.” Monica is horrified and decides to monitor this patient for evidence of emotional or psychological abuse. Emotional or psychological abuse is the use of verbal or nonverbal means to inflict emotional anguish, pain, or distress. Examples of emotional or psychological abuse include the following (National Center on Elder Abuse, n.d.b; Stark, 2012): ● ● Ongoing intimidation. ● ● Humiliation. ● ● Threats. ● ● Blaming. ● ● Scapegoating. ● ● Insults. ● ● Harassment. ● ● Treating an older person like a child. ● ● Isolating an older adult from family, friends, or normal activities. ● ● Giving the older person the “silent treatment.” Signs and symptoms of emotional or psychological abuse include the following (National Center on Elder Abuse, n.d.b; Texas Department of Family and Protective Services, 2017): ● ● Being emotionally upset. ● ● Agitation. ● ● Depression. ● ● Anxiety. ● ● Agitation. ● ● Hesitates to talk openly. ● ● Becoming very withdrawn, nonresponsive, or noncommunicative. ● ● Unusual behavior often attributed to dementia, including sucking or rocking. ● ● An older adult’s report of being verbally or emotionally mistreated. Neglect Margaret lives in an upper middle class neighborhood. She is especially fond of her neighbors, Leslie and Paul Mason. She thinks they are wonderful people, so kind and thoughtful. And they have been so generous to take in Leslie’s elderly mother. She thinks, “I wonder if the old lady is sick. I hardly ever see her anymore.” That afternoon Margaret receives some mail for the Masons by mistake. She knocks on their door to deliver it and Leslie’s mother answers the door. “My daughter isn’t home. She doesn’t like it when I talk to anybody else.” Even though it is a cold winter’s day, Leslie’s mother is wearing a thin dress with short sleeves and no shoes or stockings. Her hair is dirty and untidy. Margaret asks the woman if she is sick and says, “Aren’t you cold in that little dress?” The woman replies, “This is the only dress I have.” Could this woman be a victim of neglect? Neglect is the failure of a caregiver to fulfill any part of his obligation or duties to an older adult. Neglect may also include failure of the person who has fiduciary responsibilities, such as using the older adult’s financial assets to pay for rent or groceries, to provide responsibilities appropriately (National Center on Elder Abuse, n.d.b). Evidence-based practice alert! About 1 in 10 American 60 years of age and older has experienced some type of abuse (National Council on Aging, 2017). Neglect is quite prominent among abuse cases. Neglect accounts for 40% to 50% of all elder abuse cases referred to adult protective services (APS) annually in the United States (Stark, 2012). It is imperative that nurses screen for older adult abuse and report suspected abuse to the appropriate authorities. Neglect usually refers to the refusal or failure to provide an older adult with the necessities of life: food, water, clothing, shelter, personal hygiene, medication, and safety (National Center on Elder Abuse, n.d.b; Texas Department of Family and Protective Services, 2017). Signs and symptoms of neglect include the following (National Center on Elder Abuse, n.d.b; Texas Department of Family and Protective Services, 2017): ● ● Malnutrition. ● ● Dehydration. ● ● Poor personal hygiene. ● ● Neglected health problems. ● ● Unsafe living conditions (no heat, dangerous electrical wiring). ● ● Unsanitary living conditions (dirt, soiled bedding, a smell of urine or feces). ● ● Inadequate clothing. ● ● An elder’s report of neglect.