1. By,
Gangadhar Shirahatti
Nursing Tutor

2. DEFINITION
Elder abuse can be defined as "a single, or
repeated act, or lack of appropriate action, occurring
within any relationship where there is an expectation
of trust which causes harm or distress to an older
person".
-WHO

3. INTRODUCTION
 Approximately 450,000 non-institutionalized
elderly person aged 60 and over were victims of
abuse and/or neglect, or about 1% to 2% of the
total population. ---National Elder Abuse
Incidence Study pub. By the US Administration
on Aging (AOA)
 Approx. 80% went unreported to adult
protective series (APS) agencies

4.  Physical Abuse : Wilful infliction of physical
pain or injury, Hitting, slapping, shaking, striking
with objects, use of physical or chemical restraints.
 Sexual Abuse : Non-consensual sexual contact,
Rape, unwanted touching, sexual advances.
ABUSE CATEGORIES

5. Con…
 Psychological Abuse : Conduct resulting in mental or
emotional anguish. Threats to institutionalize or
withhold medication, nutrition, or hydration.
 Financial or Material Exploitation:
Misappropriating an older person’s assets for someone
else’s benefit. Theft and blackmail, coercion to change
wills or other legal documents to counter to the victim’s
best interest

6.  Neglect: Failure to provide the goods or services
necessary for maintaining health and avoiding harm or
illness.
Active: Intentional refusal to provide basic needs
associated with hygiene assistance, medications, food,
and physical assistance when needed for personal safety
Passive: Unintentional ; the result of caregiver ignorance
or inability to provide for the patients’ basic needs.
Con...

7. Con...
 Self Neglect:
• “A pattern of intentionally neglecting prescribed
self-care activities despite available resources and
knowledge”
• Difficult to define due to conflicting individual and
ethnic perspectives.

8. Con...
• Concerns regarding mental competence frequently
complicate intervention, as do ethical issues related to
patient autonomy.

9. RISK FACTORS
A. Characteristics common to victims of abuse and
neglect:
Female >75 year
 Poor health
 Low income
 Isolation
 Alcohol abuse & History of mental illness or
domestic violence

10. Con...
B. Warning signs associated with those who are at
risk of abusing or neglecting others:
 Male
 Financial dependence on the victim
 History of substance abuse
 History of prior violent acts
 Current/prior history of psychiatric disorders
 Caregiver burnout

11. IDENTIFICATION BARRIERS
A. Patient-Related
 Socially isolated
 Fear of retribution
 Cognitive impairments
B. Physician-Related
 Underestimate prevalence of elder abuse
 Don’t know how to assess for abuse
 Failure to develop a systematic plan on how to
respond to identified abuse
 Denials; reluctance to intervene, fear of reprisal

12. ASSESSMENT
A. Careful history
 Both patient and caregiver should be present to
observe their relationship, anxiety on part of the
patient or an overbearing attitude of the caregiver
 Patient must be interviewed privately; current
health status, living arrangements, financial status,
emotional stressors, and social support;
 History of alcohol and drug abuse; sexual history

13. Con...
B. Physical Examination
 Poor physical care and signs of psychosocial
distress
 Bruising; burns
 Cognitive function
 Injuries sec. to fall and abuse
 Injuries that can’t be explained by patient’s history
& Findings of sexual abuse

14. Con...
C. When elder is suspected; Document al findings:
 Written note
 Diagram of injuries
 Photographs
 X-rays
 Laboratory testing (CBC, BUN, Creatinine,
total protein, and albumin levels)

15. MANAGEMENT
 Discuss concerns related to suspected abuse or
neglect
 Include in the treatment plan and enlist their active
support and participation
 Involve professionals from other disciplines
 To assist in the evaluation
 Continued contact with a trusted family physician
 Significantly enhance the intervention process

16. PREVENTION
 Identifying those at risk
 Advantage in assessing and addressing patient as well
as caregiver risk factors
 Home health care professionals or other home-based
service providers
 Can observe both in the home environment
 Office and home-based assessment
 An excellent opportunity to determine the appropriate
level of care needed

17. COMMUNITY SERVICES
 Coordination with community agencies staffed
with interdisciplinary teams trained
 To deal with abuse and neglect situations from a
social and medical perspective

18. CONCLUSION
 Proper care of elderly individual at risk for abuse can
and should be provided by Family Persons.
 Adequate understanding of associated warnings
 Working relationship with supportive community
services
 Meaningful doctor-patient relationship
 All these can have a significant impact on the
emotional and physical well-being of older patients.