Page 14 nursing.elitecme.com Complete Your CE Test Online - Click Here Abandonment Traffic is heavy, and Liz is late arriving for her shift as a triage nurse in the emergency department (ED). As she hurries to the ED entrance, Liz notices an elderly man slumped on the sidewalk. He is wearing only a thin sweater even though the night is cold. He is crying. Liz hurries to him. She asks him his name and if he is hurt. He replies, “They told me they were tired of taking care of me. They said they were going to get rid of me. My own children!” The man has been abandoned. Abandonment is the deliberate desertion of older adults by someone who has assumed responsibility for providing care for these older adults. Abandonment includes the following (National Center on Elder Abuse, n.d.b): ● ● Abandonment of an older adult at a hospital, long-term care facility, or other health care institution. ● ● Abandonment of an older adult in a public place, such as a grocery store, restaurant, or shopping center. ● ● An older adult’s report of being abandoned. Financial abuse Ruth is helping her 10-year-old daughter deliver Girl Scout cookies ordered by friends and neighbors. They stop at Mrs. Wilson’s house to deliver her cookies and to obtain payment. When Mrs. Wilson answers the door, she smiles and asks them to come in. “I’ll just get some cash to pay you.” She leaves the room and is gone for nearly 20 minutes. When Mrs. Wilson returns, she is tearful and trembling. “My money is gone. I keep about $300 in the house. My daughter and her husband were here, and every time they visit I find money missing!” Could Mrs. Wilson be the victim of financial abuse? Financial abuse is the unauthorized use of property, assets, funds, credit cards, or bank accounts. This includes stealing cash and checks, forging signatures, identify theft, charity scams, and making unauthorized or pressuring an elder to make financial investments (Stark, 2012). Signs and symptoms of financial abuse include the following (National Center on Elder Abuse, n.d.b; Texas Department of Family and Protective Services, 2017): ● ● Sudden or unexplained changes in bank account balances or banking practices. ● ● Adding names to an older adult’s bank accounts, credit cards, or bank signature cards. ● ● Unauthorized ATM withdrawals. ● ● Sudden or unexplained changes in a will or other financial documents. ● ● Unexplained disappearance of money or valuable possessions. ● ● Unpaid bills. ● ● Substandard care even though adequate financial funds were available. ● ● Discovery of forged signatures on the older adult’s financial documents. ● ● Sudden appearance of relatives who were not previously involved with the older adult but who claim that they have rights to the older adult’s financial assets. ● ● An older adult’s report of financial abuse. Self-neglect Mr. Samson is a 75-year-old retired electrical engineer. He is a widower and has no children. Well off financially, Mr. Samson lives in the home he and his wife shared. One of his few relatives is a niece. She arrives at the local APS office in considerable distress. She is concerned about her uncle. She tells the caseworker, “My uncle has plenty of money and a beautiful home, but he just won’t take care of himself. He won’t bathe or eat properly or take his blood pressure medicine. The house is getting dirty, too. I try to get him to see a doctor but he won’t! He tells me to mind my own business when I try to talk to him about taking care of himself, but something needs to be done!” Mr. Samson is a victim of self-neglect. Nursing consideration: The definition of self-neglect does not include a situation where mentally competent elders who understand the consequences of their own actions make a deliberate and voluntary decision to behave in ways that threaten their health or safety (National Center on Elder Abuse, n.d.b). Self-neglect is defined as the behavior of an older adult that threatens her own health or safety. Examples include an older adult who does not take prescribed medications, consume adequate food or water, or perform necessary personal hygiene (National Center on Elder Abuse, n.d.b; Texas Department of Family and Protective Services, 2017). Signs and symptoms of self-neglect include the following (National Center on Elder Abuse, n.d.b): ● ● Dehydration. ● ● Malnutrition. ● ● Untreated medical condition. ● ● Failure to seek medical help when needed. ● ● Living in an unsanitary environment. ● ● Living in an unsafe environment. ● ● Inadequate or inappropriate clothing. Nursing consideration: Institutional mistreatment is also considered a type of abuse. It occurs when the older adult has a contractual arrangement with an institution and suffers abuse or neglect. It may consist of any combination of any of the previously described types of abuse (Tabloski, 2014). Risk factors for elder abuse Elder abuse can happen to any older adult regardless of socioeconomic status, race, ethnicity, culture, or creed. It can occur in any setting- the home, long-term care facilities, and all other types of health care institutions (National Center on Elder Abuse, n.d.a). However, certain factors can increase the risk of becoming a victim of elder abuse. Dementia This is a significant risk factor for abuse. Older adults affected by dementia and other forms of cognitive impairment are believed to be at greater risk for abuse and neglect than those of the general elderly population. Dementia is thought to increase risk because of increased caregiver burden when dealing with cognitively impaired older adults, inability of the older adult to communicate effectively, and the possibility that the dementia/cognitive impairment may make the older adult aggressive (verbally or physically), thus increasing the risk that others may respond aggressively as well (National Center on Elder Abuse, n.d.a; Olson & Hoglund, 2014; Stark, 2012). Advanced age and gender The risk of abuse increases with age. Although both males and females are victims of elder abuse, research has shown that females 80 years of age and older are at the greatest risk for abuse (Olson & Hoglund, 2014; Stark, 2012). Numerous serious illnesses Older adults affected by many serious illnesses most likely need additional assistance with physical care, financial management, transportation to and from health care appointments, and the normal activities of daily life. Their ability to perform self-care activities and their cognitive abilities may deteriorate. These needs make an older adult vulnerable to physical and emotional regression and place additional burdens on caregivers. All of these factors increase the risk for abuse (Stark, 2012). History of domestic violence Spouses are often the perpetrators of elder abuse. Cases of elder abuse are sometimes referred to as “domestic violence grown old” (National Center on Elder Abuse, n.d.a). Domestic violence that started when people were young may continue as both parties age (National Center on Elder Abuse; Stark, 2012).