GERI- Elder Neglect

Question 1

Neglect is often wrongly attributed to what 3 illnesses?

Answer 1

1. Dementia 2. Depression 3. Failure to thrive

Question 2

What is the definition of elder mistreatment?

Answer 2

• Intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. - Failure by a caregiver to satisfy the elder’s basic needs to protect the elder from harm.

Question 3

Do elders who are abused have an increased mortality risk compared to unabused seniors?

Answer 3

YES. 3x greater risk of death compared to unabused seniors.

Question 4

How many elder abuse cases typically happen each year?

Answer 4

1.1-2.5 million cases per year. at HOMES and SNFs

Question 5

What are the 4 most common types of elder abuse?

Answer 5

1. MC-Neglect 2. MC-Fiduciary 3. Physical 4. Psychological Less common —> abandonment, sexual assault

Question 6

Who most commonly is abusing elders?

Answer 6

Their MC- children or spouse

Question 7

What are the risk factors for elder abuse?

Answer 7

1. Lack of clinical and neuropsychological capacity 2. Increased vulnerability (i.e. unwillingness to face disabilities, medical illness, dementia, socially isolated)

Question 8

What risk factors are commonly seen in abusers?

Answer 8

1. Mental illness, hostility, and alcohol abuse 2. Caregiver stress

Question 9

What are 5 types of perpetrators of elder abuse? This is in regards to their personality.

Answer 9

1. **Overwhelmed (MC)2. Impaired
2. Narcissistic
3. Domineering or bullying
4. Sadistic

Question 10

What are possible abuse indicators that you may see on a patient?

Answer 10

• Weight loss - Dehydration - Poor hygiene/elongated toenails - Inappropriate attire (not dressed warmly for cold weather) - Abrasions/lacerations, hematomas, bruises in unusual locations - Traumatic alopecia - Welts, burns, pressure ulcers - Rectal/vaginal bleeding - Signs of STDs

Question 11

Red flags for neglect?

Answer 11

• Individuals with dementia left unsupervised - Hoarding in home - Home without basic utilities - Individual with untreated bedsores

Question 12

If neglect is suspected, what should you do as a provider?

Answer 12

Visit the individual at home to gain a full understanding of the problem.

Question 13

What are risk factors for sexual assault of an elder?

Answer 13

• Female gender. 70+ - Physically weak/disabled - Lonely - Shame - Trusting - Thought that “this can never happen to me” - Paranoid that crime would be reported

Question 14

What are risk factors for the abuser of elder sexual assault?

Answer 14

Often male caregivers

Question 15

How many women have been sexually assaulted? How many of these women were assaulted >10 times?

Answer 15

86% sexually assaulted. 50% of these >10 times.

Question 16

What are the 4 primary hallmarks of neglect?

Answer 16

1. Pressure ulcers 2. Malnutrition 3. Dehydration 4. Feces 2/2 Delay in care, Noncompliance, Miss Apts. Restraints

Question 17

What are signs of malnutrition?

Answer 17

On PE: temporal or thenar wasting, weight loss/FTT. Labs: - Albumin - Prealbumin - Cholesterol

Question 18

What are clinical findings of dehydration?

Answer 18

Poor skin turgor - Dry mucous membranes Lab findings: - BUN - Sodium

Question 19

What are 4 risk factors for pressure ulcers?

Answer 19

Braden Scale- Pressure - Friction - Moisture - Malnutrition

Question 20

What is elder abandonment?

Answer 20

Vulnerable elder left in an unsafe, unrealistic situation.

Question 21

What is elder abduction?

Answer 21

Vulnerable elder removed from safe environment, with or without their consent.

Question 22

What is responsibility of HCP?

Answer 22

1. Prevent 2. Recognize 3. Respond.4. Must report, HCP under or over report. 5. Consult SWS 6. Court appearance. 7. Elder abuse is repetitive

Question 23

What is “the diogenes syndrome?”

Answer 23

Hoarding: a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage or animals, and lack of shame.

Question 24

Where and how should you report elder abuse?

Answer 24

Adult protective Services (APS): fax a written report within 48 hours.

Question 25

What are the key elements to have on a written report to APS?

Answer 25

1. Careful documentation of multiple forms of abuse 2. Cognitive and functional assessment 3. Body diagrams 4. Documentation of underlying conditions 5. Establish pain and suffering 6. Lab evidence —> malnutrition or dehydration 7. Photo Documentation

Question 26

What is the FAST team?

Answer 26

Family Assertive Support Team. For emotional/psychological health.

Question 27

What is the most important thing to remember when it comes to elder abuse?

Answer 27

IT CAN HAPPEN TO ANYONE. Even under the best circumstances (i.e. a loving family, adequate resources), never take it off your radar.