Page 16 nursing.elitecme.com Complete Your CE Test Online - Click Here Screening tools Elder abuse screening tools may be quite helpful as the nurse conducts assessment and screening. Following are examples of such screening tools. Elder Assessment Instrument (EAI) The EAI is appropriate for use in all clinical settings. It facilitates review of signs, symptoms, and subjective statements made by the elder concerning abuse and neglect. The EAI includes assessment of general factors, such as skin integrity; indicators of possible abuse, such as bruising or lacerations; and possible signs of neglect, such as malnutrition. The tool also includes screening for financial abuse and abandonment (Stark, 2012). H-S/EAST The H-S/EAST is the earliest tool developed for elder abuse screening. It originally consisted of 15 items to assess three major domains of elder abuse: overt violation of personal rights or direct abuse, characteristics of vulnerability, and characteristics of potentially abusive situations. Ten years later the Vulnerability to Abuse Screening Scale (VASS) added two additional questions to the H-S/EAST: “Has anyone close to you called you names or put you down or made you feel bad recently?” and “Are you afraid of anyone in your family?” (Cohen, 2011). Elder Abuse Suspicion Index (EASI) The EASI was developed to help physicians identify patients who might be victims of abuse. It consists of six items, five of which are yes/no questions that the elder answers, and a sixth item that asks the physician if he has identified any behaviors that suggest abuse (McMullen et al., 2014). Caregiver Abuse Screen (CASE) CASE is an eight-item questionnaire answered by caregivers. It is designed to help respondents feel comfortable answering the questions (MacDonald, 2015). Dealing with elder abuse All older adults should be screened for abuse. In a clinical setting, elders need a safe environment so their injuries (if present) can be treated and they can answer questions without fear of being overheard. Treatment is focused on dealing with the current consequences of the abuse and taking steps to prevent further abuse (CPH & Associates, 2017; Stark, 2012). If older adults are in immediate danger, it is important to separate them from the alleged abuser immediately. If the caregiver is no longer able to deal with the challenges of caring for the older adult, respite services and counseling are options that may help alleviate stress (CPH & Associates, 2017; Stark, 2012). All health care settings are required to have policies and procedures for dealing with suspected abuse, including circumstances that involve an employee as the possible abuser. Remember, the older adult must be separated from the caregiver so that the older adult can be questioned in private. Most victims of abuse do not readily report the abuse or identify their abuser (CPH & Associates, 2017; Stark, 2012). Documentation of findings is critical. It is especially important that documentation in the medical records be objective and factual. A body map is a helpful guide when documenting injuries. Nursing consideration: Nurses must be careful not to draw conclusions, document personal opinions, or interpret the elder’s comments. Documentation should include the following (National Center on Elder Abuse, n.d.a; Olson & Hoglund, 2014; Stark, 2012): ● ● The time and place of injury if known or reported by the older adult. ● ● The date and time of documentation. ● ● The exact location, size, color, and shape of the injury. The size should be measured with a ruler or tape measure. The size should never be estimated. ● ● The older adult’s comments exactly as stated, in quotation marks. The nurse should not try to interpret the remarks or document personal opinions about the remarks. ● ● When documenting, the nurse should keep in mind the acronym OLD: observe, listen, document. The effective intervention for victims of elder abuse requires the collaboration of the entire interdisciplinary health care team. Possible services needed include placement into long-term care, counseling, home health interventions, and financial management (Olson & Hogland, 2014). Olson and Hoglund (2014) suggested the following for helping elders stay safe in their homes: ● ● Assist older adults to develop a safety plan that includes a list of actions to take in the event of an abusive situation. ● ● Compile a list of telephone numbers for use in an emergency, including 911 or the number of a trusted friend or family member who could help in an emergency. ● ● Facilitate, if needed, a move to an alternative living situation (senior living community, assisted living community, long-term care facility). ● ● Register the older adult’s telephone numbers with the National Do Not Call Registry to reduce telemarketing calls and the possibility of financial exploitation. ● ● Caution the older adult to shred financial documents before throwing them away. ● ● Warn the older adult not to give out personal or financial information to anyone except a trusted family member or friend. ● ● Help the older adult to develop a strategy to avoid social isolation. Referrals can be made to a visitor or to a well-being check program. Arrange a contact system for trusted neighbors, friends, or family members to check in on the older adult, or for the establishment of a buddy system for one elder to check in with another. ● ● Help the older adult identify transportation services for older adults. Assess older adults for their feelings of hope and purpose and their spiritual/faith background. Older adults who experience hopelessness and spiritual distress may be more vulnerable to abuse. Research has shown that churches and other centers of spirituality can promote the well-being of elders. Faith communities and parish nurses can help advocate for and counsel and educate older adults and their families regarding safety and well-being, as well as facilitate contact with community resources that can help older adults stay safe in their homes. Such resources include home health nurses, reliable cleaning services, and persons willing to run errands for elders and transport them to important appointments (Olson & Hoglund, 2014). Education can help HCPs, those who work in health care settings, older adults, family members, neighbors, and friends recognize and intervene in circumstances involving elder abuse. Community education programs can increase awareness of the problem and teach people what to do if they suspect elder abuse (Stark, 2012). The primary goals relating to elder abuse are to prevent elder abuse and to remove older adults from dangerous situations when abuse is discovered. Nurses and other HCPs are critical to achieving these goals. By taking a proactive stand, they can identify those at risk for or currently being abused, act to stop the abuse and protect the elders, and work to ensure a safe environment for vulnerable older adults. Age-related memory changes Amanda is a 75-year-old retired pharmacist. She enjoys good health and has an energetic lifestyle. She enjoys traveling throughout the country, is active in her church, and volunteers at the local hospital. Amanda has two children who live close by and many friends. She laughingly complains, “My memory sure isn’t what it used to be. Yesterday I couldn’t remember where I put my glasses, and today I had to search for my car keys for 15 minutes!” David is 72 years old. He and his wife live in a condo in a large urban area. David is a retired business owner and has an excellent retirement income. He and his wife enjoy socializing and patronizing affluent community events. Lately David has become forgetful to the point that his wife is insisting he see a doctor. While driving home from a golf game one afternoon, David got lost and could not find his way home despite having driven the same route numerous times. Today his wife found