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The Role of Health Care Professionals in the Prevention, Detection, and Intervention of Elder Mistreatment
Health care professionals from all settings play an integral role in the multidisciplinary response to elder abuse, neglect, self-neglect, and exploitation. Since many older individuals are likely to seek health care services from both in-patient and out-patient facilities, physicians, nurses, physical and occupational therapists, emergency services personnel, dentists, and other practitioners are uniquely positioned to detect indicators of suspected or actual mistreatment. Furthermore, these professionals are often in a position to identify risk factors for mistreatment, and to intervene before a crisis occurs.
The following annotated bibliography underscores the need for health care professionals to become fully integrated in the prevention of, and response to, elder mistreatment.* It is a supplement to an earlier bibliography entitled "The Health Care System: Addressing Elder Mistreatment" (July 2003).
Most of the reference materials can be obtained through local university and community libraries or interlibrary loan services. Increasingly, many resources are available online, and the web addresses are also included.** Some material must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. If you have difficulty obtaining any of these references, please contact the CANE office for assistance by emailing cane-ud@udel.edu or telephoning (302) 831-3525.
*CANE has recently produced annotated bibliographies on the topics of multidisciplinary approaches to elder mistreatment, and on institutional abuse and neglect; therefore, articles that deal primarily with these aspects of health care have not been included in the following listing. Similarly, articles that focus exclusively on ageism in health care have not been included as they were recently highlighted in a compilation addressing age discrimination. The associations between elder mistreatment and cognitive impairment, mental health issues, and substance abuse have also been the topics of previous compilations, and references that deal principally with these subjects were not included in the following bibliography. To access these and other annotated bibliographies, visit the CANE Bibliography Series on the NCEA Web site (Inadequate pain management legally defined as elder abuse is the topic of an upcoming bibliography.)
Note: This is a selected annotated bibliography, which does not include all published references related to this topic. To review earlier publications on the topic, see "The Health Care System: Addressing Elder Mistreatment" posted on the NCEA Web site.To search for additional references on this and related topics, please visit the CANE Web site at:
http://cane.udel.edu .
**Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing cane-ud@udel.edu or telephoning (302)-831-3525.
The National Center on Elder Abuse (NCEA) serves as a national resource for adult protective services, elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.
The NCEA is administered under the auspices of the National Association of State Units on Aging.
NCEA Partners
National Association of State Units on Aging (NASUA), Lead Partner
American Bar Association (ABA) Commission on Law and Aging
Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
National Adult Protective Services Association (NAPSA)
National Committee for the Prevention of Elder Abuse (NCPEA)
This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services. Grant No. 90-AM-2792.
Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.
2006
1. T6611-7
Burgess, A., Watt, M., Brown, K. & Petrozzi, D.
Management of Elder Sexual Abuse Cases in Critical Care Settings
Critical Care Nursing Clinics of North America; Vol. 18 (3), 313-319; September 2006.
Journal article (scholarship)
This article provides an overview of elder sexual abuse for critical care nurses. These nurses may not only provide acute care intervention, but are also likely to be responsible for forensic evidence collection. Guidelines are presented for collecting evidence and documenting and photographing injuries, in order to enhance the possibility of potential criminal accountability of perpetrators.
2. T6631-7
Collins, K.
Elder Maltreatment: A Review
Archives of Pathology and Laboratory Medicine; Vol. 130 (9), 1290-1296; September 2006.
Journal article (scholarship)
This overview of elder mistreatment is intended to assist physicians and medical examiners in the identification of physical abuse, sexual abuse, and neglect. Potential forensic markers are considered and contrasted with aspects of normal aging processes (for example, normal hair loss patterns versus traumatic alopecia, which is related to injury to the hair or scalp). Topics such as force feeding, improper restraint, under-medication, malnourishment, dehydration, decubitus ulcers (pressure sores or bedsores), and abuses occurring in institutional care facilities are discussed. Ancillary studies that may be ordered to evaluate cases of potential abuse include full body radiographs; microbial cultures of blood, lungs, and wounds; blood and vitreous analysis; and procedures for autopsy. Five areas of age-related changes that compound the difficulty of detecting elder abuse are examined: skin and soft tissue; bleeding; fractures; malnutrition and dehydration; and anogenital injury.
3. S6265-5
Collins, K., & Presnell, S.
Elder Homicide: A 20-Year Study
American Journal of Forensic Medicine & Pathology; Vol. 27 (2), 183-187; June 2006.
Journal article (research)
In this study, researchers examined cases of elder homicide occurring over a 20 year period. From 1985 through 2004, 127 homicides of individuals aged 65 to 94 (including 12 aged 85 and over) were examined at the forensic laboratories of the Medical University of South Carolina. Fifty-eight percent of the victims were male, 55 percent were Black, and 45 percent were White. Thirty-one percent of the deaths were attributed to gunshot wounds, 28 percent to blunt force trauma, 22 percent to stabbing, 13 percent to asphyxia, and six percent to other causes (including four cases of neglect). Eighty-three percent of the homicides occurred in the victims' residences, including three occurring in nursing homes. More than half of the perpetrators were known to the victim; 28 percent of the perpetrators were categorized as acquaintances and 23 percent were identified as relatives. Cases involving sexual assault were also identified, but relatively few sexual assault examinations had been completed.
4. T6633-7
Francois, I., Moutel, G., Plu, I., Pfitzenmeyer, P., & Herve, C.
Concerning Mistreatment of Older People: Clinical and Ethical Thoughts Based on a Study of Known Cases
Archives of Gerontology and Geriatrics; Vol. 42, 257-263; 2006.
Journal article (research)
In this research, the authors retrospectively studied 600 case files of elders treated by the Gerontologist Coordination Team in a suburb of Paris, France, in order to determine the extent of involvement of physicians in the detection and intervention of elder mistreatment. In all, 12 cases of mistreatment involving 14 elders (including two couples) were identified by the case review process. Although each of these patients had health conditions warranting frequent contact with their general practitioners, none of the incidents of elder abuse or neglect were identified by the physicians, who were only minimally involved in the follow-up of those victimized. (France)
5. T6610-13
Greenbaum, A., Horton, J., Williams, C., Shah, M. & Dunn, K.
Burn Injuries Inflicted on Children or the Elderly: A Framework for Clinical and Forensic Assessment
Plastic and Reconstructive Surgery (PSR); Vol. 118 (2), 46e-58e; 2006.
Journal article (scholarship)
This continuing medical education article is designed to aid physicians assessing and treating elderly and pediatric burn victims. Clinicians are introduced to the concepts of elder abuse and neglect, including difficulties in legally defining such mistreatment and issues surrounding mandatory reporting. Guidelines for assessment are provided.
6. T6629-12
Hoyt, C.
Integrating Forensic Science into Nursing Processes in the ICU
Critical Care Nursing Quarterly; Vol. 29 (3), 259-270; July-August 2006.
Journal article (scholarship)
Critical care nurses may routinely encounter forensic cases (child and elder abuse victims, victims of crime, victims of industrial or vehicular accidents, etc.) This article provides an overview of forensic issues and the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) guidelines for addressing these issues. A list of potential indicators of mistreatment is provided, and nurses are encouraged to fully pursue their instincts in detecting victimization. Guidelines for conducting a thorough assessment, documenting with accuracy and detail (in order to assist forensic pathologists in determining causes of injuries, noting patterned injuries, etc.), and handling and storing clothing and personal items are presented. Several included case studies illustrate the importance of these procedures. The "JCAHO Compliance Checklist for Forensic Issues in the ICU" is also included.
7. S6335-10
Jayawardena, K. & Liao, S.
Elder Abuse at End of Life
Journal of Palliative Medicine; Vol. 9 (1), 127-136; February 2006.
Journal article (scholarship)
This article provides palliative care professionals, including the hospice team, with an overview of elder abuse and neglect issues that may be encountered during end of life care. The authors point out that caregiver stress should be of special consideration when assisting terminally ill patients. All health care professionals should be aware of family dynamics and cultural issues relevant to patients' circumstances. The multidisciplinary nature of hospice care is also effective in addressing elder abuse and neglect. Providing education regarding the dying process, assistance in delegating responsibilities, and providing referrals when necessary are not only elements of good care provision, but are also strategies that reduce stress and may prevent abuse and neglect. If the need to report mistreatment to protective services arises, members of the palliative care team are in a position to collaborate with APS in various ways: by providing information regarding mistreatment, as well as patient and family needs; by assisting in engaging the victimized patient in protective services; by participating in the evaluation of the patient's capacity to make decisions; and in communicating ongoing concerns.
8. S6413-5
Kenney, J.
Domestic Violence: A Complex Health Care Issue for Dentistry Today
Forensic Science International; Vol. 159 (Supplement 1), S121-S125; 2006.
Journal article (scholarship)
This article discusses the role of the dentist in the detection and intervention of domestic violence, including child abuse, intimate partner violence, abuse of the disabled, and elder abuse. As the head and neck are visible during dental exams, clinicians can observe many injuries that may result from mistreatment. The author recommends using the RADAR protocol: Routinely screen; Ask direct questions; Document findings; Assess patient's safety; and Review options and refer victim for appropriate services. In addition, dentists may further assist victims by providing reduced price or free dental care.
9. T6630-10
Mandiracioglu, A., Govsa, F., Celikli, S. & Yildirim, G.
Emergency Health Care Personnel's Knowledge and Experience of Elder Abuse in Izmir
Archives of Gerontology and Geriatrics; Vol. 43, 267-276; 2006.
Journal article (research)
This cross-sectional study was conducted to assess the knowledge and experience of emergency health care personnel in Izmir, Turkey, regarding elder abuse. A sample of 125 professionals from four emergency medical services (two based at university hospitals and two at state hospitals) were surveyed regarding beliefs, knowledge, and attitudes concerning elder abuse. In general, participants did not demonstrate awareness of risk factors for abuse, knowledge of how to conduct a focused history or examination regarding potential abuse, or how to report suspicions of mistreatment. Although the university-based professionals saw fewer older patients (and fewer patients in general), they appeared to have a greater awareness of elder abuse than did the state hospital professionals. Although almost 86 percent of the study sample had identified a case of elder abuse, only seven referred the cases directly to the forensic office, two referred to the social worker, and two tried to talk directly to the family members. Three participants treated only the chief presenting problem. Most participants admitted feeling uncomfortable asking older patients about potential mistreatment, and almost three-fourths of the participants did not believe that elder abuse was common in Turkey. (Turkey)
10. T6463-4
Nusbaum, N., Cheung, V., Cohen, J., Keca, M., & Mailey, B.
Role of First Responders in Detecting and Evaluating Elders at Risk
Archives of Gerontology and Geriatrics; Volume 43, (3), 361-367; November-December 2006.
Journal article (research)
Observing that first responders, such as police, fire fighters, and emergency medical personnel, may have interaction with elders who live in relative isolation, this study was designed to evaluate their approach to vulnerable elders who may be victims of (or at risk for) elder abuse and neglect. One-hundred eighty-six first responders from northern Illinois completed a brief survey regarding their interactions with elders during the previous six months. More than half had encountered at least one elder that they believed may have been abused or neglected, and more than three-fourths estimated that they had met an elder who posed a danger to self or others, but very few (two percent) had screened the elders for potential risk. Immediately following the survey, first responders participated in an educational intervention designed to promote awareness and routine screening. The results of the survey indicate that although first responders have potential to identify abused, neglected and at risk elders, a structured approach to screening for these conditions is warranted.
11. T6627-15
Payne, B.
Problems Controlling Fraud and Abuse in the Home Health Care Field
Journal of Financial Crime; Vol. 13 (1), 77-91; 2006.
Journal article (research)
This study considers the criminal justice perspective in assessing fraud and abuse in the home health care (HHC) industry. In this survey, 18 fraud control unit directors were asked to describe problems in the investigation and prosecution of such cases. Content analysis revealed four basic barriers: detection obstacles; witness problems; ambiguity regarding the offender; and lack of referrals or untimely referrals. Problems in prosecution were related to statutory or policy issues, individual case circumstances, difficulty proving the negative, denial on the part of the victim, and "record chasing" (problems with documentation and the quality of record keeping, which is a common problem among many white-collar crime investigations). Overall, fraud and abuse in HHC was viewed as a "hybrid offense," sharing characteristics of both conventional crimes and white-collar crimes. The article concludes with discussion of various theories of HHC abuses, and practical implications for improvements in the criminal justice response, which include increased funding for fraud control, and increased awareness regarding HHC crimes.
12. T6599-10
Teitelman, J.
Sexual Abuse of Older Adults: Appropriate Responses for Health and Human Services Providers
Journal of Health and Human Services Administration; Vol. 29 (2), 209-227; Fall 2006.
Journal article (scholarship)
This overview of sexual abuse of older individuals discusses the scope, dynamics, risk factors, signs and symptoms, issues surrounding capacity determination, and appropriate responses for health care and social services professionals who encounter suspected mistreatment. A lack of awareness and ageism may create barriers to identification of elder sexual abuse. Physical, cognitive, and functional incapacity on the part of the victim, dependence upon the victim, inadequate screening practices for employment with vulnerable populations, and mental health and substance abuse issues on the part of the perpetrator have been associated with elder sexual abuse. Service providers are encouraged to watch for physical (such as injury to the genitals, infection) and psychological signs (such as depression, anxiety, and emotional changes on the part of the victim, sexual acting out) that may indicate abuse. Guidelines for assessing whether or not behaviors are mutually consensual are provided. If health and social services professionals can reasonably determine that sexual activity was consensual, no further investigation is needed. However, if there is a suspicion of abuse, providers are urged to immediately contact adult protective services (APS), or other local law enforcement or health regulatory agencies as mandated by state law in addition to offering protection and emotional support to the victim. Guidelines for preserving physical evidence and documenting information are outlined.
2005
13. P5843-8
Beach, S. et al.
Risk Factors for Potentially Harmful Informal Caregiver Behavior
Journal of the American Geriatrics Society/JAGS; Vol. 53 (2), 255-261; February 2005.
Journal article (research)
The results of this study hold significant implications for health care practitioners working with older, dependent patients and their caregivers. Risk factors for potentially harmful behavior by informal caregivers were examined. The primary focus was on the relationship between the caregiver's physical and mental status and lower quality care, which may be a precursor to elder abuse and/or neglect. The sample included 265 caregiver-care recipient dyads who were interviewed regarding the level of care recipient needs, and indicators of psychological abuse (such as screaming and yelling, threats, verbal abuse) and physical mistreatment (including withholding food, hitting, shaking, and handling roughly). Participants self-rated their physical health status, researchers evaluated the cognitive status of both caregivers and care recipients, and then screened caregivers for depression. The most prevalent potentially harmful behavior identified was yelling and screaming, reported by 22.2 percent of the participants. Physical indicators were reported by one percent. Significant risk factors included higher levels of care recipient needs; spousal caregiving relationships; higher degrees of caregiver cognitive impairment; higher degrees of caregiver physical symptoms; and caregivers at risk for clinical depression. Practitioners are urged to provide education as well as support by referring caregivers for diverse, and higher intensity, early interventions (such as counseling, support groups, skills training, case management, respite care, etc.).
14. R6062-5
Collins, K. & Sellars, K.
Vertebral Artery Laceration Mimicking Elder Abuse
The American Journal of Forensic Medicine and Pathology; Vol. 26 (2), 150-154; June 2005.
Journal article (case study)
This case study presents a forensic analysis of a 94 year old male resident, diagnosed with dementia, who died due to vertebral artery laceration. While the case "mimicked" the signs of elder abuse, the autopsy indicated that death was not due to abuse. The authors emphasize the need for physicians and health care professionals to be cognizant of the potential for elder mistreatment, to be alert to the indicators and risk factors of elder abuse and neglect, but also to be aware of differential diagnoses.
15. P5842-7
Community and District Nursing Association (CDNA)
CDNA Elder Abuse Survey - Draft Report (U.K.)
Community and District Nursing Association (CDNA); 2005.
Agency report (online)
This report presents the results of the Community and District Nursing Association (CDNA) Elder Abuse Survey. Three-thousand nine-hundred and twenty-two surveys were mailed to members of the CDNA. Two-hundred seventy-six responses were received, representing a seven percent return rate. Of the respondents, 40 percent had witnessed or were aware of elder abuse occurring during 2004. Nearly half of the respondents knew more than one patient who had been abused. Verbal abuse was most commonly observed, followed by emotional abuse and physical abuse. Eighty-two percent of the incidents occurred in the patients' homes. While 77 percent of the abusive incidents were perpetrated by family members, half of the respondents indicated that they were aware of abuse perpetrated by professional caregivers. Nearly two-thirds of the incidents were reported to social services, and approximately half were reported to general practitioners. Eighty-eight percent of the respondents indicated that they were in need of more training regarding elder abuse. (U.K.)
16. R6055-6
Garner, J.
The Role of the Doctor in the Institutional Abuse of Older People: A Psychodynamic Perspective
Journal of Adult Protection; Vol. 6 (4), 16-21; December 2005.
Using a psychodynamic framework, this article considers the role of the physician in institutional abuse of older patients. Health care professionals must be aware of all feelings (even negative) regarding patients in order to accept them without acting out with malice or aggression. Ageism, which is dehumanizing, is considered as a potential prejudice doctors may experience. Countertransference, which occurs when the practitioner sees and reacts to the patient as if he or she represents an individual from his or her personal life, is also considered as a possible contributing factor towards mistreatment. Questions are raised regarding the imbalance of power experienced in institutional settings, along with issues of dependency. Inappropriate use of psychotropic medication is also discussed.
17. P6003-14
Gorbien, M. & Eisenstein, A.
Elder Abuse and Neglect: An Overview
Clinics in Geriatric Medicine; Vol. 21 (2), 279-292; 2005.
Journal article (scholarship)
This article provides an overview of elder abuse, neglect, and self-neglect. Occurrence rates of abuse in the U.S., Canada, the Netherlands, and Great Britain are discussed. Offender characteristics are also provided. Problems in identification and reporting of suspected abuse are cited, particularly as they relate to physicians. The topics of elder mistreatment among special populations (patients with dementia, depression, and residents of long-term care facilities) are also considered, along with the role of the geriatrician in addressing elder abuse and neglect.
18. P5924-23
McGreevey, J.
Elder Abuse: The Physician's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 83-103; 2005.
Journal article (scholarship)
This article is part of an issue that focuses on three case studies in order to analyze and clinically manage elder mistreatment employing a multidisciplinary approach. The physician's role is highlighted in this entry. The responsibilities to thoroughly and objectively document any observations related to suspected abuse or neglect, to assess whether or not the patient is in immediate danger, and to report suspected abuse to adult protective services (APS) are paramount. Barriers to assessment are also outlined, and include the difficulty of identification of elder abuse in the presence of chronic diseases. Issues addressed in the discussion of the case involving self-neglect include the need to evaluate substance abuse, depression, functional and decisional capacity, and cognitive impairment. In the case study of the victim of domestic violence who is now the neglectful (and potentially abusive) caregiver of her terminally ill spouse, the doctor is cautioned to focus on the patient's current needs rather than past actions, to directly communicate with the patient regarding his wishes (not through his caregiver), and to be aware of increased signs of caregiver burden. In the case study of the abusive and neglectful adult daughter of the Alzheimer's patient, the physician is urged to continue to attempt direct communication with the patient, to maintain an ongoing monitoring of the home situation, the patient's behavior and functioning, including her need for increased supervision, to monitor and treat underlying medical conditions that may contribute to problematic behaviors, and, if victimization is known or suspected, to refer to APS for investigation and intervention. Interventions are recommended in the context of Ohio state statutes. (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)
19. P5925-28
Miller, C.
Elder Abuse: The Nurse's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 105-133; 2005.
Journal article (scholarship)
This article is part of an issue that utilizes three case studies to analyze elder mistreatment employing a multidisciplinary approach. This entry describes the issues nurses encounter throughout the process, and how assessment of elder abuse and neglect differs from other nursing assessments. For example, resistance by the patient to elder abuse assessment and intervention is not uncommon. Specifically, it is recommended that the nursing assessment involve consideration of the patient's physical status (such as nutrition, hydration, bruises, injuries, etc.), degree of frailty, caregiver's understanding of the patient's needs, living conditions (especially life threatening circumstances), history of violence on the part of the caregiver, and decisional capacity. (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for more information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)
20. R6041-2
Potter, J.
The Importance of Recognizing Abuse of Older People
British Journal of Community Nursing; Vol. 10 (4), 185-186; 2005.
Journal article (scholarship)
This brief article presents an overview of elder abuse for home care and community nurses. Signs and symptoms of abuse are presented, and the responsibility of the nurse to protect and promote the dignity and well-being of all patients is emphasized. Results from the Community and District Nursing Association (CDNA) survey on elder mistreatment are also summarized, including the finding that two-thirds of all participants indicated that they had encountered abuse on a regular basis. (U.K.)
21. R6049-10
Sosin, J.
Fighting Elder Abuse
Nursing Spectrum; April 11, 2005.
Journal article (scholarship)
This article presents an overview of elder abuse and neglect for home care nurses. Training and education initiatives from the Metropolitan Jewish Health System (MJHS) are described, and include a preceptorship program which pairs newly hired nurses with a staff development specialist. The specialist is not only an experienced nurse but is also skilled at assessing the patient's home environment for risk factors, signs and symptoms of abuse, neglect, and self-neglect. Reporting issues related to New York legislation are discussed. (Note: This article is accessible online at:
http://news.nurse.com/apps/pbcs.dll/article?AID=2005504110342 .)
22. P5942-11
Westley, C.
Elder Mistreatment: Self-Learning Module
MedSurg Nursing; Vol. 14 (2), 133-138; April 2005.
Online training
This training module is part of a series developed by the Geriatric Resource Nurses at the University of Virginia. The objectives of the module are to allow participants to define and explain the dynamics of elder abuse and neglect, and to understand the clinician's responsibility regarding assessment, intervention, and reporting of suspected mistreatment. Two case studies are presented (one inpatient and one outpatient) that allow health care professionals to explore the practical aspects of this process. Virginia state laws regarding mandatory reporting are presented. (Note: This learning module is accessible online from "Look Smart: Find Articles" at: http://findarticles.com/p/articles/mi_m0FSS/is_2_14/ai_n17209145 .)
23. P6004-8
Zink, T. & Putnam, F.
Intimate Partner Violence Research in the Health Care Setting
Journal of Interpersonal Violence; Vol. 20 (4), 365-372; April 2005.
Journal article (scholarship)
Given the physical and mental health complications and tremendous cost in health care dollars associated with intimate partner violence (IPV), practitioners in clinical settings have been encouraged to conduct routine screenings. Thus far, there has been a lack of evidence generated regarding the benefits and effectiveness of routine screenings. This article describes the barriers to developing and conducting evidence-based research on such interventions in clinical settings. The authors suggest that randomized controlled trials may not be a realistic standard for IPV research in these settings. Realistic standards and explicit outcomes and process measures are necessary to advance the field of study. (Note: This article is not specific to elder abuse.)
2004
24. P5850-9
Brown, K., Streubert, G. & Burgess, A.
Effectively Detect and Manage Elder Abuse
The Nurse Practitioner: The American Journal of Primary Health Care; Vol. 29 (8), 22-31; August 2004.
Journal article (scholarship)
This continuing education article is designed to assist nurse practitioners in identifying elder abuse and initiating appropriate interventions. Guidelines are offered for examination of bruises, abrasions, lacerations, the condition of skin and genitalia, as well as injuries to the head, neck, chest wall, abdomen, extremities, and genitals. The authors note that decreased pain perception and memory impairment can contribute to difficulty in assessment. (Note: This article is accessible online at http://www.findarticles.com/p/articles/mi_qa3958/is_200408/ai_n9454134 . Continuing nursing education (CNE) credits are available for a fee.)
25. P5856-3
Bond, C.
Education and a Multi-Agency Approach Are Key to Addressing Elder Abuse
Professional Nurse; Vol. 20 (4), 39-41; December 2004.
Journal article (scholarship)
After presenting an overview of elder abuse, this article discusses nurses' reluctance to address elder abuse issues. Fear of repercussions for exposing abuse and lack of professional protocols are among the reasons for this. Enhanced education and a multidisciplinary approach appear the most promising means to strengthen prevention and encourage intervention.
26. P5748-00
Foland, K.
Prevention and Treatment of Two Critical Health Care Issues: Substance Abuse and Elder Abuse (from the "Native American Elders Health Care Series - Module 3")
South Dakota State University; 2004.
Online module
This web-based module designed for nurses outlines the changes in Native American culture that have increased the risk for elder abuse and elder substance abuse. Changes in family systems, stress, and economic difficulties are among identified risk factors. Nurses are urged to be prepared to assess patients for these problems routinely, and to be aware of the possibility of pre-existing depression. Practical, culturally appropriate nursing interventions for at risk elders are discussed.
27. P5510-9
Fulmer, T., Guadagno, L., Bitondo Dyer, C. & Connolly, M.
Progress in Elder Abuse Screening and Assessment Instruments
Journal of the American Geriatrics Society (JAGS); Vol. 52 (2), 297-304; 2004.
Journal article (literature survey)
The purpose of this article is to review and critique the elder abuse and neglect screening and assessment instruments currently available to health care professionals. Tools are categorized as checklists and guidelines, qualitative assessments, quantitative assessments, and combinations of the above. The following instruments are evaluated: AMA Diagnostic and Treatment Guidelines on Elder Abuse and Neglect; Case Detection Guidelines (Rathbone-McCuan); H.A.L.F. (health, attitudes towards aging, living arrangements, and finances); Elder Abuse and Neglect Protocol (Tomita); Screening Protocols for the Identification of Abuse and Neglect in the Elderly (Johnson); Elder Assessment Instrument (EAI); Brief Abuse Screen for the Elderly (BASE); Indicators of Abuse Screen (IOA); Conflict Tactics Scale; Hwalek-Sengstock Elder Abuse Screening Test; and the Screening Tools and Referral Protocol: Stopping Abuse Against Older Ohioans: A Guide for Service Providers. The article includes a table listing the name of the instrument, author, year developed, method, whether there have documented psychometrics, and comments highlighting unique aspects of the tool.
28. P6009-9
Gray-Vickrey, P.
Combating Elder Abuse
Nursing; Vol. 34 (10), 47-51; 2004.
Journal article (scholarship)
This overview on elder abuse and neglect is intended for nurses providing care for older patients. Warning signs for various types of mistreatment are listed, but practitioners are cautioned against assuming all that geriatric patients with bruising and skin tears have been victimized. Practical advice is provided on interviewing, documenting, reporting suspected abuse, and educating patients.
29. P6006-2
Jones, K.
Ethical Moment - Dentistry and the Law
Journal of the American Dental Association (JADA); Vol. 135, 1172-1173; August 2004.
In this brief advice column, a case of suspected elder abuse is examined according to ethical standards in dentistry.
30. P5648-289
Kendall-Tackett, K.
Health Consequences of Abuse in the Family - A Clinical Guide for Evidence-Based Practice
American Psychological Association (APA), Washington, D.C.; 2004.
Book (scholarship)
This book, part of APA's Division 38 Health Psychology Series, considers the health care needs of individuals who have experienced abuse and developed chronic illnesses and conditions. Chapters address child abuse, domestic violence, and elder abuse. (Note: This book is not available through CANE. For more information, view the APA's description at http://www.apa.org/books/4317023.html .)
31. P5824-00
Kentucky Medical Association's Subcommittee on Domestic Violence
KMA Model Health Care Protocol on Abuse, Neglect & Exploitation - Child, Spouse/Partner, Adult & Elder
Updated 2004.
Protocol, online
As quoted from the purpose statement of this protocol: "...This model policy and protocol information is provided: to facilitate, simplify, and standardize quality health care intervention for patients at risk of abuse, neglect or exploitation; to assist physicians to comply with standards, regulations and laws related to adult and child abuse, neglect and exploitation. These materials are to be used as guidelines to assist physicians to develop policies and procedures related to the needs of these patients. Every physician and facility administrator should have a mechanism established in which initial patient contact assesses for current and historical identification of abuse, neglect or exploitation..." The guidelines cover issues such as screening and assessment, examination and documentation, reporting, medical record keeping, insurance and legal issues (including consent), patient education, and referral. Interview and assessment forms are provided.
(Note: This protocol is accessible online at: https://www.kyma.org/content.asp?q_areaprimaryid=7&q_areasecondaryid=19)
32. P5733-10
Lachs, M. & Pillemer, K.
Elder Abuse
The Lancet; Vol. 364 (9441), 1263-1272; October 2, 2004.
Journal article (scholarship)
In this overview, the authors present a summary of recent international research and clinical findings regarding elder abuse. It is intended to assist physicians and other health care professionals in the identification of elder mistreatment, and to offer guidance in intervention. Definitions, estimates of prevalence, and risk factors are reviewed. A comprehensive discussion is provided regarding the efficacy of formally screening asymptomatic patients for elder abuse. Authors also provide a table that describes a proposed medical assessment of elder abuse, linking specific recommendations with particular areas of concern. The importance of multidisciplinary interventions in treatment planning is discussed, along with the need to determine if patients refusing interventions have the cognitive capacity to do so.
33. R6059-4
Lantz, M.
Elder Abuse: Making a Difference
Clinical Geriatrics; Vol. 12 (2), 37-40; December 2004.
By focusing on a case study of an older patient, the author provides an overview of how physicians, social workers and other health care professionals may encounter elder mistreatment and successfully intervene. Practitioners are reminded that red flags indicating all types of abuse and neglect may be observed in the clinical setting. Reporting suspected abuse is considered the most valuable intervention that a clinician can make, and information for accessing the appropriate local reporting agency is provided.
34. P5750-6
Mosqueda, L., Burnight, K., Liao, S. & Kemp, B.
Advancing the Field of Elder Mistreatment: A New Model for Integration of Social and Medical Services
The Gerontologist; Vol. 44 (5), 703-708; 2004.
Journal article (research)
This article reviews the development and function of a model program for the integrated delivery of medical and social services to vulnerable adults. The Vulnerable Adult Specialist Team (VAST) was introduced in Orange County, California, in 2000, with the purpose of providing the county's APS, law enforcement, and district attorneys' offices access to trained medical expertise when addressing cases of elder mistreatment. The team is comprised of two geriatricians, a psychologist, a gerontologist, and a project coordinator. The authors analyzed the data concerning cases referred to VAST during the first two years of its existence. Ninety-eight referrals were made during the first year, increasing to 171 during the second year. The most common reason for referrals was mental status evaluation (35 percent), followed by medical evaluation (22 percent), a combination of mental status and medical evaluation (27 percent), medical information or referral (10 percent), review of records and/or photos (5 percent), and vague needs (6 percent). According to follow-up evaluation, the team's services were considered most helpful in confirming abuse, in documenting impaired capacity, and in reviewing medications and clarifying medical problems.
35. P5684-18
Nelson, H., Nygren, P., McInerney, Y. & Klein, J.
Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force
Annals of Internal Medicine; Vol. 140 (5), 387-404; March, 2004.
Literature review (online)
This literature survey reviews the research used in the U.S. Preventive Services Task Force (USPSTF) recommendation regarding the effectiveness of screening for family violence, including elder abuse. Three studies were identified that evaluated the performance of elder abuse instruments (Reis and Nahmiash, 1995; Neale et al., 1991; and Moody et al., 2000) that could be adapted for use in clinical settings. The Caregiver Abuse Screen (CASE) and the Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) were the subjects of these studies, which received fair quality ratings from the reviewers. (For an explanation of quality ratings, see article appendix, also online.) No studies based within health care settings were identified that examined the effectiveness of elder abuse interventions in health outcome measures, or provided assessment of adverse effects of screening or intervention. In addition to quality rating criteria, the appendix includes a description of the literature search methods and several of the tools. (Note: This article is accessible online at: http://www.annals.org/cgi/reprint/140/5/387.pdf . For more information on the USPSTF recommendation on screening for family and intimate partner violence, see CANE file #P5683-5, item # 41 of this compilation.)
36. P6002-14
Nikolova, R., Carignan, M., Moscovitz, N. & Demers, L.
The Psychogeriatric and Risk Behavior Assessment Scale (PARBAS): A New Measure for Use with Older Adults Living in the Community
Archives of Gerontology and Geriatrics; Vol. 39 (2), 187-200; 2004.
Journal article (research)
This article describes the development and testing of the Psychogeriatric and Risk Behavior Assessment Scale (PARBAS), for use in assessing frail, older, community-dwelling adults with severe mental illness. The PARBAS includes 34 items examining the following categories of risk: self-neglect; non-compliance; substance abuse; risk toward self and others; aggressive behavior; emotional distress; suicidal behavior; personal security; risk of victimization by others; and financial security. The tool was developed based upon the results of focus groups with mental health clinicians and researchers. While content validity appeared acceptable, inter-rater reliability was poor for several items. The authors recommend ongoing testing of the psychometric properties of the instrument, but suggest that it can provide valuable information to community-based health and social services practitioners involved in prevention and intervention.
37. R6029-14
Oswald, R., Jogerst, G., Daly, J. & Bentler, S.
Iowa Family Physician's Reporting of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 16 (2), 75-88; 2004.
Journal article (research)
This study was designed to analyze family practitioner's knowledge of elder abuse and reporting laws in the state of Iowa, to identify perceived barriers to reporting suspected mistreatment, and to examine factors associated with reporting suspected abuse in this clinical setting. Of the 1,030 members of the Iowa Academy of Family Practice Physicians solicited for the survey, 378 completed a mailed questionnaire regarding their general knowledge concerning elder abuse, and their experiences with suspected elder abuse cases during the past year. Overall, the participants appeared knowledgeable about elder abuse. Over three-fourths of the respondents knew where to report suspected domestic elder abuse; 63 percent knew where to report suspected institutional elder abuse; twelve percent routinely asked direct questions about elder abuse during physical assessments. Nearly half had observed at least one case of elder abuse during the past year, and 54 percent of those had made a report to the Iowa Department of Human Services. Neglect and self-neglect were the most commonly observed types of mistreatment. Respondents indicated that victims' denials, reporting by other officials, unrecognized signs of mistreatment at the time of examination, and the victim not being a dependent adult were the most common reasons for not reporting. The practice of routinely screening for elder abuse by asking direct questions and the presence of a reporting protocol were significantly associated with observing at least one case of elder mistreatment. Direct questioning and knowledge regarding elder abuse were also significantly associated with reporting suspected mistreatment.
38. P5677-8
Saliga, S., Adamowicz, C., Logue, A. & Smith, K.
Physical Therapists' Knowledge of Physical Elder Abuse - Signs, Symptoms, Laws, and Facility Protocols
Journal of Geriatric Physical Therapy; Vol. 27 (1), 1-10; April 2004.
Journal article (research)
In this random sample study, 400 licensed physical therapists from Michigan were surveyed regarding their knowledge of elder abuse signs and symptoms, current state laws, and the protocols in place at their clinics to address the handling of suspected abuse. One-hundred-eighteen surveys were returned and completed, representing a response rate of 31 percent. One-quarter of the sample had suspected a client had been abused, but less than half reported their concerns. Fifty-eight percent reported that their facility did not provide any training or information on elder abuse and only 44.1 percent were aware of their facility's protocol for addressing suspected abuse. Twenty-one percent were unaware of their legal mandate to report. Facility training appears to be associated with greater awareness of clinical signs and symptoms of physical abuse, and also appears to have a significant impact upon knowledge of legal duty to report. The article discusses the importance of the recent APTA's publication entitled, "Guidelines for Recognizing and Providing Care for Victims of Elder Abuse."
39. P5732-7
Tierney, M. et al.
Risk Factors for Harm in Cognitively Impaired Seniors Who Live Alone: A Prospective Study
Journal of the American Geriatrics Society/JAGS; Vol. 52 (9), 1435-1441; 2004.
Journal article (research)
This study was designed to identify risk factors for harm caused by self-neglect or behaviors attributed to disorientation related to cognitive impairment. The sample included 139 participants, aged 65 and over, who were identified as cognitively impaired and were referred by health care and/or community service agency representatives. At baseline, participants were assessed for dementia, social resources, medical diagnosis, and medication use. The sample was monitored for 18 months for incidence of harm. Incident of harm was described as a physical injury to self or other (or property loss or damage) related to issues of self-neglect due to disorientation, which resulted in emergency intervention. The three factors that appeared to most significantly predict incidence of harm were fewer social resources, poor performance on the Mini-Mental Status Exam (MMSE), and the presence of chronic obstructive pulmonary disease (COPD). Such predictors can be identified in the primary care setting, and therefore could be used by physicians to identify patients at greatest risk.
40. P5727-141
U.S. Department of Justice Office on Violence Against Women
A National Protocol for Sexual Assault Medical Forensic Examinations Adults/Adolescents
September 2004.
Protocol, online
This publication presents detailed guidelines for the health care and criminal justice professionals who respond to victims of sexual assault. The protocol is intended to instruct responders in the effective collection of forensic evidence necessary to prosecute sexual abuse crimes, while being sensitive to the personal and emotional needs of the victims. Topics considered include the need for a victim-centered approach to examination, issues surrounding informed consent and confidentiality, reporting, documentation, evidence integrity and collection procedures, and court
appearances. One segment is dedicated to the specific needs of older victims. (Note: This publication is available online at http://www.ncjrs.org/pdffiles1/ovw/206554.pdf .)
41. P5683-5
U.S. Preventive Task Force (USPSTF)
Screening for Family and Intimate Partner Violence: Recommendation Statement
Annals of Internal Medicine; Vol. 140 (5), 382-386; March, 2004.
Journal article (scholarship, online)
This article summarizes the statement of the U.S. Preventive Task Force (USPSTF) on screening for family and intimate partner violence, which updates the previous recommendation of 1996. The USPSTF "found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, of women for intimate partner violence, or of older adults or their caregivers for elder abuse." The task force found no studies that examined the effectiveness of interventions with older adults, therefore could not "determine the balance between the benefits and harms of screening" for domestic elder abuse. (Note: This summary is accessible online at http://www.annals.org/cgi/reprint/140/5/382.pdf. See also CANE file #P5684-18, item # 35 of this compilation.)
42. P6008-7
Wei, G. & Herbers, J.
Reporting Elder Abuse: A Medical, Legal, and Ethical Overview
Journal of the American Medical Women's Association; Vol. 59 (4), 248-254; Fall 2004.
Journal article (scholarship)
This overview is intended for physicians and other health care professionals. Barriers to the identification and reporting of elder mistreatment are addressed. Shame, denial, and fear on the part of patients may inhibit disclosure, while limited awareness and time constraints may prevent physicians from observing signs and symptoms of elder abuse and neglect. A summary of mandatory reporting legislation throughout the U.S. is provided, and several key aspects of state-to-state variations are highlighted. Such differences concern which practitioners are identified as mandatory reporters, whether adult protective services (APS) statutes cover only community-dwelling elders, and which individuals are considered vulnerable, among other issues. Commonalities are also highlighted, and include themes such as the provision of immunity from liability for those who report in good faith, and the need to report "suspected" abuse, not only substantiated abuse. Guidelines for appropriate clinical management are also offered.
43. S6123-9
Zink, T., Regan, S., Goldenhar, L., Pabst, S., & Rinto, B.
Intimate Partner Violence: What are Physicians' Perceptions?
Journal of the American Board of Family Practice; Vol. 17 (5), 332-340; October 2004.
Journal article (research)
In order to assess primary care providers' (physicians, nurses, nurse practitioners, etc.) awareness of intimate partner violence (IPV) among older women, a convenience sample of focus groups was convened throughout southwestern Ohio. Forty-four professionals representing 20 practices participated. In addition to thirteen focus groups, three interviews were conducted. Three themes emerged from the content analysis: methods and procedures used for detecting and managing IPV; barriers to identification and treatment; and strategies to enhance awareness and services. Practitioners displayed a wide range of styles in addressing the problem, from those who did not screen, to those who vaguely or partially attempted to screen, to those who screened for and managed treatment, to those who also provided referral to appropriate services. It was recommended that physicians be encouraged "to adopt a 'chronic disease management' mindset" in screening for IPV, and that both practitioners and adult protective services professionals should receive cross-training in identification and referral. (Note: This article is accessible through Medscape, online at: http://www.medscape.com/viewarticle/489079 .)
2003
44. P5392-6
Berreth, M.
Nursing Care of Transgendered Older Adults - Implications from the Literature
Journal of Gerontological Nursing; 44-49; July 2003.
Journal article (scholarship)
This article is intended to raise awareness in nurses and other health care professionals regarding treatment and care issues that may impact the lives of transgendered elders. One area of significance is the likelihood of limited support systems, as research indicates that they often do not feel part of either the homosexual or heterosexual community, and may have strained relationships with family members. It is estimated that one-third of all transgendered individuals have attempted suicide, and problems with substance abuse and depression are not uncommon, while the risk of abuse and neglect due to prejudice and insensitivity is increased. Health related complications of sexual reassignment surgery may be compounded by factors of aging and increased medication usage. Health screenings, such as PAP smears, breast examinations, and screening for prostate cancer pose particular challenges (and insurance concerns) for health care providers of this population.
45. P5344-8
Fisher, C.
The Invisible Dimension: Abuse in Palliative Care Families
Journal of Palliative Medicine; Vol. 6 (2), 257-264; 2003.
Journal article (scholarship)
The ultimate goal of palliative care is to enable the terminally ill patient to have a "good death," often within the context of home and family. While elder abuse research indicates that approximately 4.6 percent of Australia's elderly population experience some form of mistreatment, palliative care research does not reflect the likelihood that most caregiving families are abusive. This article serves as an overview of elder abuse and neglect for palliative care professionals. Acknowledging that traditional interventions (such as family meetings) may exacerbate family dysfunction, nurses and other health care professionals are urged to be alert to potential risk factors or indicators of abuse. Multidisciplinary approaches are particularly valuable. Issues of control, which are central to both abuse and dying, are considered.
46. P5435-8
Fulmer, T. et al.
Themes From a Grounded Analysis of Elder Neglect Assessment by Experts
The Gerontologist; Vol. 43 (5), 745-752; 2003.
Journal article (research)
This exploratory research highlights the program used by the Mount Sinai Medical Center's Neglect Assessment Team (NAT), an interdisciplinary team that is comprised of a geriatric nurse practitioner, a social worker and a geriatrician. Patient data collected using the Elder Assessment Instrument from 19 cases of neglect and 4 practice cases from the literature were analyzed. Four themes emerged that became the framework for further analysis: "...understanding the underlying health status of the elder and caregiver, understanding the socioeconomic and life circumstances of the dyad, credibility of data collected by others, and the consequences of the assessment outcome..." While the screening for neglect with instruments such as the EAI is important in clinical settings such as the emergency room, the review by an interdisciplinary team provides a more in-depth assessment and is a valuable tool for case disposition. (The EAI narrative summary form is included in the article.)
47. P5342-62
Karp, N. & Wood, E. for the American Bar Association Commission on Law and Aging
Incapacitated and Alone: Health Care Decision-Making for the Unbefriended Elderly
American Bar Association Commission on Law and Aging, with funding by Fan Fox and Leslie R. Samuels Foundation, in collaboration with the Samuel Sadin Institute on Law, Brookdale Center on Aging; Washington, D.C.; July 2003.
Report
This report presents the findings of a study of one of the most vulnerable groups of patients in society, the decisionally-incapacitated unbefriended elderly. This patient is defined as one who does not have the capacity to make decisions regarding his or her treatment, who has not executed an advance directive regarding the treatment at hand, and has no legally authorized surrogate or family or friends to assist in the decision-making process. Such patients are often subjected to legal processes that lead to "over-treatment, under-treatment, or treatment that does not reflect their values or best address their well-being." The purpose of this research was to identify the current state of law addressing this issue and to make recommendations for developing practical procedures to assist these patients and guide professionals charged with providing health care. Research methods included statutory and literature surveys, surveys of target groups, in-depth interviews, site visits and focus groups, and an interdisciplinary symposium and state strategy session. Currently, four legal approaches to addressing the decision-making needs of the unbefriended elder exist: statutory authorization for health care decisions; laws that authorize standing committees of trained volunteers to act as surrogates when needs arise; public guardianship for health and financial decision-making; and a court process for seeking consent or authorization of a surrogate. When states do not have such a process, health care providers are often on their own to determine the best course of treatment. The report presents policy recommendations, including the need for procedures in long-term care facilities to investigate and record resident values and preferences, the improvement and enhancement of the health care providers' assessment of decisional capacity, and the development of state and local temporary medical treatment guardianship programs. (Note: Key findings of this report are available online at: http://www.abanet.org/irr/hr/spring04/incapacitated.html .To obtain a copy of the entire report, please contact the American Bar Association Commission on Law and Aging, 740 15th St., N.W., 8th floor, Washington, D.C. 20005-1022, telephone 202/662-8690 or by internet at www.abanet.org/aging .)
48. R6014-11
Koin, D.
A Forensic Medical Examination Form for Improved Documentation and Prosecution of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 15 (3), 109-119; 2003.
Journal article (scholarship)
This article describes the process of developing the "Forensic Medical Report: Elder/Dependent Adult Abuse and Neglect" form, a tool intended to enhance the documentation, and ultimately the prosecution, of elder abuse and neglect cases. Although the tool was designed to meet the legislative requirements of the state of California, it is adaptable for use in other locations. Members of the health care system, law enforcement, criminal justice system, social services, and forensic technology were represented on the multidisciplinary development team. Among the more complex issues raised was the need for an instrument that could be utilized in a number of health care settings; who would complete which portions of the form; what demographic data would be collected (and how this may advance further research in elder abuse). The most controversial issues were related to the assessment of cognitive ability, and to the length of the examination form. Revisions of the draft form were completed with input from approximately 200 reviewers throughout the state. The first part of the instrument documents demographic information, and includes a checklist to document concurrent forms of abuse. It also includes an assessment of independent and cognitive functioning. The second part provides detailed documentation of the physical status of the victim in terms of symptoms and injuries. Training will be conducted to develop a nucleus of skilled elder abuse forensic examiners throughout the state.
49. P5644-5
Lafata, M.
Addressing Elder Abuse and Neglect
OT Practice; Vol. 8 (12), 12-16; July 2003.
Journal article (scholarship)
This article presents an overview of elder abuse and neglect and describes the reporting
responsibility of the occupational therapist. The author indicates that the Occupational Therapy Code of Ethics "compels" all practitioners to report suspected abuse, regardless of an individual state's statutory mandate. A case study is provided that highlights a number of the ethical difficulties that the practitioner faces when deciding to report. Sidebars include recommendations for therapists working in institutional care settings.
50. M99-401
Snyder, D. & Christmas, C., eds., for the American Geriatrics Society, and the National Council of State EMS Training Coordinators
Geriatric Education for Emergency Medical Services
Jones and Bartlett Publishers, Sudbury, MA; 2003.
This text, part of a national continuing education program, is designed to provide pertinent geriatric knowledge, including knowledge regarding elder abuse and neglect, to emergency medical service professionals (EMTs, EMS, paramedics, pre-hospital personnel, first responders, etc.). The chapter devoted to elder abuse and neglect covers the following topics: risk factors; physical, psychological, and social indicators of abuse, neglect and self-neglect; interviewing strategies; and interventions (such as reporting and documentation). The text includes case studies, advanced life support alerts, guidelines for communication, medication, and attitude, and detailed procedures. The GEMS diamond is an acronym that serves to remind health care professionals that geriatric patients are unique, and environmental, medical, and social issues require assessment. (Note: This book is available from Jones and Bartlett Publishers, Sudbury, Massachusetts, 978-443-5000, email info@jbpub.com. Price: $38.95. For more information regarding the GEMS program, visit the Web site at http://www.gemssite.com/ .)
51. P5367-4
Turkoski, B.
Is This Elder Abuse?
Home Healthcare Nurse; Vol. 21 (8), 518-521; August 2003.
Journal article (scholarship)
This article explores an ethical dilemma encountered by a home health care nurse. In the case scenario, an older, somewhat physically incapacitated man is being cared for by his grandson's family. Concerns over neglect arise as the primary caretaker is not changing his dressing daily and he is left alone with a ten year old great-grandchild on occasion. The patient reports that he is happy and wants to continue in his family's care. The nurse reviews the case with her agency's ethics committee, where the concepts of beneficence, nonmaleficence, justice, and autonomy are considered. Rather than report the family to adult protective services, a meeting is arranged for the nurse, social worker, grandson, and his wife. The clinical and social needs of the client are emphasized and a viable care plan is devised, including more detailed training in the procedure of dressing changes and in developing respite care alternatives.
52. P5468-8
Yeaw, E. & Burlingame, P.
Identifying High-Risk Patients from the Emergency Department to the Home
Home Healthcare Nurse; Vol. 21 (7), 473-480; July 2003.
Journal article (research)
This article discusses the development of the High Risk Discharge Assessment Instrument (HRDAI) for use in the emergency department (ED) as well as in home care services. The tool identifies eight areas of potential risk: impaired mobility, living alone, mental status changes, the possibility of domestic violence or elder abuse, substance abuse, non-compliance, inadequate resources, and repeat visits to the emergency room (ER). Composite scores indicate the suggested level of intervention, which range from further inquiry to social service referral (prior to or post-discharge) to the need for temporary nursing home placement. Early results indicate that the tool is effective in identifying patients in need of post discharge services, as researchers continue to test the tool in the Rhode Island hospital where it was developed. A copy of the HRDAI is included, along with guidelines for the adaptation of this process to home care nursing services.
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