Page 15 Complete Your CE Test Online - Click Here Social isolation Social isolation is a significant risk factor for elder abuse. Older adults unable to maintain contact with family or friends or participate in social activities are at greater risk for abuse. Abusers often deliberately isolate their victims from family, friends, and social outlets to hide their abuse. Or they may use isolation as a form of abuse (National Center on Elder Abuse, n.d.a; Olson & Hoglund, 2014; Stark, 2012). Physical immobility Research has shown that older adults whose physical mobility is compromised are at higher risk for abuse. Physical immobility may be accompanied by an increased need for physical assistance (Olson & Hoglund, 2014; Stark, 2012). Low income Although abuse can and does occur among persons at all socioeconomic levels, research has shown that it is more common among those who have a reduced or low income (Olson & Hoglund, 2014; Stark, 2012). Risk factors for becoming an abuser It is not enough to consider risk factors directly related to the older adults themselves. It is important to evaluate which persons are at risk for committing abuse. Following are some of the factors that increase the likelihood that someone will become an abuser: ● ● Gender: Research has shown that males commit abuse more often than females do (Olson & Hoglund; 2014; Stark, 2012). ● ● Relationship to victim: It is estimated that 90% of elder abuse cases are committed by a family member (Stark, 2012). However, elder abuse can and is also committed by friends, peers, strangers, and health care workers (National Center on Elder Abuse, n.d.a). ● ● Poor coping mechanisms: Persons who lack coping mechanisms to deal with life’s stressors, including perhaps the challenge of taking care of an elder, are more prone to commit abuse (Olson & Hoglund, 2014; Stark, 2012). ● ● Mental health issues: Research has shown that persons who have mental health issues, such as depression, are more likely to commit abuse (Olson & Hoglund, 2014; Stark, 2012). ● ● Lack of support systems: Persons who lack support systems are at risk for becoming abusers (Olson & Hoglund, 2014; Stark, 2012). ● ● Substance abuse: Research has shown that substance abusers are at risk for committing abuse (Olson & Hoglund, 2014; Stark, 2012). ● ● Financial difficulties: Persons dealing with financial burdens of their own, who have acquired debt as a result of taking care of an older adult, or who are dependent on an older adult for financial help are at higher risk for committing abuse (Olson & Hoglund, 2014; Stark, 2012). ● ● History of being abused or of witnessing abuse: A history of personal abuse, witnessing abuse, or growing up in an environment of family violence increases the risk for becoming an abuser (Olson & Hoglund, 2014; Stark, 2012). ● ● Feelings of being overwhelmed or overburdened: Persons overwhelmed with life’s challenges, such as the care of an elderly adult, are at increased risk for becoming abusers. These feelings can increase if they share a home with the elder (Olson & Hoglund, 2014; Stark, 2012). Elder abuse reporting The law Texas law says that anyone who thinks a child or a person 65 years or older or an adult with disabilities is being abused, neglected, or exploited must report it to the Department of Family and Protective Services (DFPS). Texas law further states, “A person who reports abuse in good faith is immune from civil or criminal liability.” The name of the person making the report is kept confidential, and a person who makes an abuse report in good faith is immune from civil or criminal liability. However, anyone who suspects abuse and does not report it can be held liable for criminal charges, which could be a misdemeanor or a felony (Texas Department of Family and Protective Services, n.d.). Nursing consideration: The Texas Abuse Hotline number is 1-800-252-5400. This number can be called 24 hours a day, 7 days a week. Reports can also be made via a secure website at https:// The Texas Department of Family and Protective Services (2016) cautioned that website reporting should not be used to report urgent or emergency situations. Instead, the Texas Abuse Hotline should be called if the situation is urgent and needs to be investigated within 24 hours. Or 911 should be called if there is an emergency or life-threatening situation that must be dealt with immediately. Once a nurse suspects abuse, he is obligated to report it (Stark, 2012). Federal and state laws require HCPs to report suspected abuse of children, elders, and physically or mentally compromised persons (CPH & Associates, 2017; Texas Department of Family and Protective Services, n.d.). Following are some key points about reporting elder abuse (CPH & Associates, 2017; Olson & Hoglund, 2014; Stark, 2012): ● ● Nurses are mandated by law to report any case of suspected elder abuse. ● ● If the elder is in immediate danger, calling 911 for prompt intervention by emergency and law enforcement personnel is the protocol. ● ● The nurse is not responsible for determining why or how the abuse occurred. ● ● Suspected abuse of older adults living at home should be reported to adult protective services (APS). Nurses should check for the local number of the APS in their specific location. ● ● If abuse is suspected within the facility where the older adult is hospitalized, where he lives as a resident of a long-term care facility, or within other health care institutions, the nurse should follow the policies and procedures of that facility for reporting the abuse. If attempts are made to cover up suspected abuse, the nurse is still obligated to report it to local APS. If the abuse is suspected in a long-term care setting, it should also be reported to the local long- term care ombudsman, a position required by law. ● ● Even if a patient or other person that the nurse suspects is a victim of abuse asks her not to report it, the nurse is still legally mandated to report the suspected abuse. ● ● Anonymous reporting can be done by calling the local elder abuse hotline or APS. ● ● Nurses who report elder abuse are not responsible for proving that the abuse actually occurred. The agency that receives the report of suspected abuse is responsible for investigating and determining abuse. Assessment The first step is to treat any injuries that require medical intervention. After assuring that the older adult is not in immediate danger, the nurse should conduct a thorough screening assessment. A history and head-to- toe physical exam should be obtained in a secure, private setting away from potential abusers and in an environment where the older adult feels safe (CPH & Associates, 2017; Olson & Hoglund, 2014; Stark, 2012). Adults with cognitive deficits may not be able to provide a history. Even elders who are not cognitively impaired may be reluctant to report abuse because of shame, fear of retaliation, embarrassment, concern that if the abuser goes to jail there will be no one to take care of them, or fear that they would be discharged from long-term care settings, if that is where they live (CPH & Associates, 2017; National Center on Elder Abuse, n.d.a; Olson & Hoglund, 2014; Stark, 2012). Nurses must be supportive, objective, and tactful when asking questions relating to abuse. General questions – such as: How are things going for you at home? or How did you get those bruises on your chest? – can pave the way for more specific follow-up questions (Olson & Hoglund, 2014).