Transcript Slide 1
Elderly abuse and neglect
دکتر احمد باقری مقدم
متخصص پزشکی ورزشی
سرپرست پژوهشی پزشکی قانونی
مقدمه
روند رو به تزاید جمعیت سالمندان
پدیده جدید
حوزه پیچیده ومشکل
در ایران
سال 1375جمعیت سالمندان 3977000معادل 6/6درصد
سال 1385جمعیت سالمندان 5119000معادل 7/3درصد
What is elder abuse?
تمام اشکال سوء رفتار با سالمند را سالمند آزاری
میگویند
در تعریف دیگر فعل یا ترک فعل آسیب رسان به سالمند را
گویند
Elderly abuse was defined as an act or
omission which results in harm or threatened
harm to the health or welfare of an elderly
person.
Incidence of elderly abuse
Abuse in institutional settings is difficult to
measure, yet is thought to exceed that in
community settings.
In the USA,10% of nursing staff in
institutional settings admitted committing
physical and 40% psychological abuse against
residents .
میزان گزارش بسیار متغیر است و بستگی به تعاریف دارد
“mistreatment of adults, including abuse, neglect,
and exploitation, affects more than 1.8 million
older Americans” (Pavlik, Hyman, Festa, Bitondo, andDyer, 2001,
p. 45)
self-neglect accounts for one-third to one-half of all
abuse cases (Gray-Vickrey, 2000, 2004; Levine, 2003; Paris, 2003)
است کهself neglect شایع ترین نوع آن خود غفلتی است
تشخیص آن نیز بسیار مشکل است
سالمند آزاری فیزیکی در شهر اصفهان پایین است و بیشترین نوع
آزار به سالمندان از نوع استفاده از اموال بدون رضایت سالمند
میباشد.
Distribution of Abuse
تقریبا بین زنان و مردان مساوی است ولی برخی تحقیقات
نشان داده در مردان بیشتر بوده است.
الگوی آزار بسیار فرهنگی است و در بین جوامع مختلف و
محل های مختلف متفاوت است (.خانه یا بیمارستان و شهر
های مختلف)
Perpetrators of Abuse
آزار رسان ها چه کسانی هستند؟
elder abuse can be perpetrated by nearly
anyone including:
paid or volunteer caregivers
medical and long-term care employees,
family members
strangers such as a person who befriends an
elderly person for the purpose of exploiting
them
Who is Committing the Abuse?
SON
1% 1%
2%
DAUGHTER
24%
HUSBAND
2%
4%
24%
5%
WIFE
BROTHER
SISTER
16%
21%
NIECE
NEPHEW
GRANDCHILD
UNRELATED
CAREGIVER
Risk factors for elderly abuse
factor related to the abused elderly:
The
intensity of an elderly person’s illness
or dementia
Social isolation
The elder’s role, at an earlier time, as an
abusive parent or spouse
A history of domestic violence( (خشونت خانگیin
the home
Dependency
factors related to the abuser:
Inability to cope with stress (lack of
resilience)
Depression, which is common among
caregivers
Lack of support from other potential
caregivers
The caregiver’s perception that taking care
of the elder is burdensome and without
psychological reward
Substance abuse
Greatest Risk Factors for Causing Abuse
being male
being related
history of mental
illness
recent decline in
mental health
abusing alcohol
primary caregiver
change in family
roles from being
cared for to being
the care provider
prior history of
violence
Types of elder abuse
Abuse by others
Frequency
Physical
16%
Sexual
2%
Financial
29%
Neglect
27%
Abandonment ترک
1%
Isolation
2%
Abduction ربایش
0.2%
Psychological
24%
Physical abuse
Physical abuse means at
least one act of physical
violence against the elderly
Forms of physical abuse
Direct beatings
Hitting
Slapping
Cutting
Burning
shaking
Unreasonable physical
restraints
Maltreatment of medical
conditions
Sexual assault
Prolonged deprivation of
food or water.
Sings of physical abuse
bruises
Broken bones, sprains, or dislocations
Report of drug overdose or apparent failure
to take medication regularly
Broken eyeglasses or frames
Signs of being restrained, such as rope
marks on wrists
Caregiver’s refusal to allow you to see the
elder alone
Bruising
A bruise, or contusion, occurs when blunt
forces distort soft tissues to an extent sufficient
to result in disruption and leakage of blood
vessels
Escape of blood from blood vessels produces
discoloration
When is bruising suspicious
trauma versus accidental
trauma? Which looks more like
abuse: A or B?
A
B
Accidental or Inflicted? You
decide
Accidental or Inflicted? You
decide
Bruising Study con’t
Location of Bruises Caused by
Abuse
Patterned Injury
An injury that possesses features or
configuration with objects or surfaces that
produced it
Bruising
Physically
abused older adults had
significantly larger bruises than
those in comparison group who
were not abused and more knew the
cause of their bruises
Patterned Injury
Grip marks around arms or neck
Rope marks or welts on wrists or
ankles
Imprints from belts, belt buckles,
straps, cords, hangers, hairbrushes,
combs, cigarettes and cigarette
lighters
Handprints, fingerprints, knuckle
prints and footprints
o
o
More on strangulation…
More on burns…
Fracture
Broken bones
Includes severing of the bone or
compression of intact bone
Avulsion
The tearing away of a structure or part;
often seen as a partial avulsion
Abrasion
A
wound in which the
outermost layer of the skin is
removed by a compressive or
sliding force
Laceration
Blunt force injuries resulting from tearing,
ripping, crushing, overstretching, pulling
apart, bending and shearing soft tissue.
Lacerations are usually found over a bony
surface and are ragged or irregular in
appearance
Incision
Incision, known as a cut, is a wound made by a
sharp instrument or object, such as a scalpel,
knife, razor or paper coming against the skin
with pressure to cause an injury
35
Stab Wound
Result whenever a sufficiently sharp and narrow
object is forced upward
Unlike a cut, depth exceeds width in stab wounds
Mechanical Restraints
Means of controlling behavior, especially in
hospitals and nursing facilities
Only acceptable reason for temporarily restraining
someone is to prevent significant harm
Sexual abuse is unwanted sexual contact
with an elder including touching, sexual
assault, and rape or sodomy
Sexual Abuse
Sexual abuse is unwanted
sexual contact with an
elder including:
touching , Fondling
نوازش کردن
sexual assault(rape or
sodomy)
Verbal or suggestive
behavior
Unnecessary help with
dressing/hygiene
Signs of sexual abuse
Signs Bruises around breasts or genitals
Unexplained venereal disease or genital infections
Unexplained vaginal or anal bleeding
Torn, stained, or bloody underclothing
Neglect
The failure of a designated
caregiver to meet the needs
of an elderly person, and
withholding of physical,
material, or emotional
necessities of physical and
mental health, whether
intentionally or
unintentionally.
This
includes failure to assist in
personal hygiene or the provision
of clothing for an elder, failure to
provide medical care for the
physical and mental health needs of
an elder, and failure to protect an
elder from health and safety
hazards.
NEGLECT
Denial of care:
–
–
–
food, water, shelter
personal hygiene, clothing, bedding
medical care, medicines, assistive devices
Isolation:
–
–
–
control of time, activities, contacts
disinformation tactics
false imprisonment
Minimal
personal care
Passive Neglect
ناتوانی غیر عمدی به انجام
تعهدات مراقبت
اعمال دیسترس بدون قصد آگاهانه
و یا عمدی
Active Neglect
شکست عمدی به تعهدات مراقبت،
اعمال استرس جسمانی یا عاطفی و یا
آسیب
رها کردن ،محرومیت از غذا ،دارو،
بهداشت شخصی
SELF-NEGLECT
Basic activities of daily living are
neglected, threatening personal health
and safety:
hygiene
food, water
clothing and bedding
shelter and surroundings
finances
health care
Signs of neglect
Malnutrition, dehydration
Lack of personal care
Inadequate heating
Unclean clothes or bedding
Lack of needed medications, eye glasses, hearing
aids, or dentures
Contractures, decubitus ulcers, wasting and
muscle atrophy
Psychological abuse or emotional abuse
o
Psychological abuse is more
difficult to define and
operationalize.
Usually defined as an act carried
out with the intention of causing
emotional pain or distress.
Psychological abuse often
accompanies physical abuse.
Emotional abusers can use verbal
and non verbal to inflict elder
damage.
Psychological Abuse
Humiliationتحقیر
Isolationانزوا
Intimidationارعاب
Threatsتهدید
Removal of decision
making powers
Verbal insults,
yelling فریاد،توهین کالمی
Verbal forms of emotional elder abuse
تهدید و ارعاب از طریق فریاد
فحش
دستورات سخت
تحقیر و تمسخر
سرزنش
Nonverbal psychological elder abuse :
نادیده گرفتن
جدا کردن از دوستان
جلوگیری از مالقاتی
Signs of psychological abuse
Anxiety (mild to severe) .
Depression, hopelessness, helplessness,
thoughts of suicide
Confusion, disorientation
Trembling((لرزش دست و بدن
lack of eye contact
Agitation
Abandonment ترک و رها کردن
In addition to an actual complaint by older person of being
deserted,
signs of possible abandonment include:
A vulnerable older adult with cognitive and physical
impairments is left at a hospital emergency department
without caregiver contact information
A vulnerable older adult with cognitive impairments is put on
a bus with a one-way ticket to another town or state
A vulnerable older adult with cognitive impairments is left at
a public building
Financial or material abuse
از دست دادن غیر قابل توضیح درآمد ،دارایی ها،
اموال ،کمبود غذا ،از دست رفته پرداخت وام ها
هر سرقت یا سوء استفاده از پول یا اموال افراد
مسن توسط فرد مورد اعتماد
اختالس یا سوء استفاده از منابع مالی و یا اموال
Forms of financial abuse :
سوء استفاده های شخصی چک ،کارت های
اعتباری ،و یا حساب های سالمندان
سرقت پول نقد ،چک ،درآمد ،و یا کاالهای خانگی
جعل امضا سالمندان
Institutional elder abuse
Refers to abuse that occur in
residential institutions such
as nursing facilities usually
by someone who is paid
caregiver, such as nursing
facility staff member.
Residents at the greatest
risk for institutional abuse
or neglect includes resident
with dementia, resident who
seldom have visitors
Domestic abuse
Refer to forms of
maltreatment by someone
who has a special
relationship with the elder
such as family member or
caregiver
recognition of elder abuse: examination
Detection and Treatment
Barriers
detection of elder abuse is difficult because denial is
an integral feature of abuse, victims may feel too
ashamed to disclose maltreatment or believe they
are to blame for or deserve the abuse
dependence on an abuser can make a victim
reluctant to report for fear of how he/she will
survives without the perpetrators help
Detection/Treatment Barriers
)(continued
ممکن است این آزار ها در یک جامعه ،نرمال تلقی شود
ممکن است سالمند به دلیل مشکالت بینائی یا شنوائی یا ادراکی
و یا به دلیل زندانی و محدود شدن قادر به گزارش سوء رفتار
نباشد
Detection/Treatment Barriers
(continued)
گذر زمان و بروز اختالالت شناختی گزارش آزار را دشوار
.میکند
physical injuries may be masked by clothing or
by isolating the victim
Detection/Treatment Barriers
)(continued
وجود یک سرویس مشخص و حمایتی است که میتواند به
گزارش سوء رفتار بینجامد.
عدم وجود آمار های کافی نیز مانع شناخت این پدیده است
Preventing elder abuse and neglect
Preventing elder abuse means doing three
things:
Listening to elderly and their caregivers
Intervening when you suspect elder abuse
Educating others about how to recognize and
report elder abuse
Reporting elder abuse
If you are an elder who
is being abused, neglected,
or exploited, tell at least
one person. Tell your
doctor, a friend, or a
family member whom you
trust.
Protective Measures
توصیه هایی به سالمند
Stay sociable and active
Stay
involved with neighbors, friends, church
or musque or community activities
Get regular medical and dental care
Open and post your own mail
Increase social network as you age
Have friends visit you at home
Have a “best friend” with whom you can
confide in
Keep in touch with old friends if you move
Instructions to a concerned friend or
family member
Watch for warning signs that might indicate elder abuse. If you
suspect abuse, report it.
Take a look at the elder’s medications. Does the amount in the
vial matched with the date of the prescription?
Watch for possible financial abuse. Ask the elder if he may scan
bank accounts and credit card statements for unauthorized
transactions.
Call and visit as often as you can. Help the elder consider you a
trusted confidante.
Offer to stay with the elder so the caregiver can have a break —
on a regular basis, if you can.
Instructions to the elderly
Make sure your financial and legal affairs are in order. If they
aren’t, enlist professional help to get them in order, with the
assistance of a trusted friend or relative if necessary.
Keep in touch with family and friends and avoid becoming
isolated, which increases your vulnerability to elder abuse.
If you are unhappy with the care you’re receiving, whether it’s
in your own home or in a care facility, speak up. Tell someone
you trust and ask that person to report the abuse or neglect.
با سپاس از توجه شما
Forms of Abuse
فیزیکی :پرت کردن،
زدن ،هل دادن ،بستن،
به زور غذا دادن
روانی :تمسخر کردن،
ارعاب ،خشونت کالمی
جنسی :هر گونه تماس
بدن رضایت
)Forms of Abuse (continued
مادی :دزدیدن پول یا اموال،
قرارداد های اجباری ،سوء
استفاده از اموال سالمند
تجاوز به حقوق فردی:
پیشگیری از هر گونه حق
انسانی مثل آزادی ،حریم
خصوصی ...
طبی :ندادن دارو یا درمان یا
درمان بیش از حد
OVERMEDICATION
Forms of Abuse (continued)
ترک کردن سالمند در شرائط: ترک
بحرانی در حالی که فرد مسئولیت وی
را بر عهده گرفته است
Neglect - failure to provide
necessary physical or mental
care of an elderly person
Self-neglect - behavior that
threatens one’s own health or
safety
Indicators of Abuse
Physical - multiple fractures or bruises at various stages of
healing, burns, patterned injuries, patchy hair loss, frequent
visits to ER, delay in seeking medical treatment for injuries
Psychological - withdrawn behavior, wasting or failure to
thrive, depression
Sexual - genital injury, vaginal or rectal bleeding, bruises,
chipped teeth, sexually transmitted disease or infestations
Indications of Abuse (continued)
، کمبود غذا، اموال، دارایی ها، از دست دادن غیر قابل توضیح درآمد:مالی
از دست رفته پرداخت وام ها
Violation of Rights - isolation, failure to attend religious
vices or community events as one did previously
Medical - no improvement in condition for which one was
prescribed medication, blood tests indicate greater or lower
than expected levels of medications, sleepiness, groggy
Indications of Abuse (continued)
Abandonment - isolation, not seen outside home, disrepair or
unkempt environment, missed medical or other appointments or
engagements, wandering, being left somewhere to fend for self
Neglect - uncared for appearance, inappropriate clothing, failure
to thrive, lack of medical or dental care, isolation
Self-neglect – (similar to neglect)
Thank you
Elder Abuse
The Forgotten Side of
Domestic Violence
Kay Hurd, RN, MSN
Who Is Being Abused
The US has:
44 million persons age 60+.
36 million people with disabilities.
364,512 cases of people living at home were reported with
43% confirmed.
In the last 10 years abuse of elder persons has increases
150+%.
Domestic Elder Abuse is a family problem, almost 90% of
the abusers were family members.
Who Are The Abusers
More
than 2/3rds of the abusers are
family members of the victims and
are typically serving in the caregiving role.
Risk Factors
Domestic Violence grown old.
A partnership in which one member of the couple has
traditionally exerted power and control over the other
through emotional abuse, physical violence and threats,
isolation and other tactics.
Risk Factors - Continued
Personal problems of the abusers.
Adult children who are still dependant upon parent for
financial assistance, housing or other means of support.
Mental Illness.
Substance Abuse.
Risk Factors - Continued
Caregiver stress.
Cycle of violence is learned behavior transmitted
from one generation to the next.
Personal characteristics of the elder.
Dementia.
Disruptive behavior.
Problematic personality traits.
Significant needs of assistance.
Amendments
to Older Americans Act
First appeared in 1987
and
Provided Definitions
Domestic Elder Abuse
Domestic Abuse Grown Old.
Maltreatment of an older person by someone who has a
special relationship with the elder. (e.g. spouse, sibling, child,
friend, caregiver).
Spouses make up a large % of elder abusers. Partnerships in
which one member of a couple has traditionally tried to exert
power and control over the other.
Institutional Elder Abuse
Abuse that occurs in residential facilities for older
persons. (e.g. nursing homes, foster homes, group
homes, board and care facilities.
Abusers are persons who have legal or contractual
obligation to provide elder victims with care and
protection. (e.g. staff, professionals, paid
caregivers).
Self-neglect – Self-abuse
Self Neglect is behavior of an elderly person that
threatens his/her own health/safety.
*Self-neglect EXCLUDES a situation in which a mentally
competent person who understands the consequences of
his/her decisions, makes a conscious and voluntary decision
to engage in acts that threaten his/her safety as a matter of
personal choice.
Signs of Self-Neglect
Dehydration, malnutrition
Untreated medical conditions
Lack of necessary medical aids
Hazardous or unsafe living conditions
Unsanitary or unclean living quarters
Inappropriate and/or inadequate clothing
Homelessness
Physical Abuse
Physical force that may result in bodily injury,
physical pain or impairment.
Striking with or without an object.
Signs of Physical Abuse
Bruises, black eyes, welts, lacerations.
Rope/restraint marks.
Open wounds, cuts, punctures, untreated injuries in
various stages of healing.
Sprains, dislocations, internal injuries.
Signs of Physical Abuse –
continued
Laboratory findings of medication overdose.
An elder’s report of being hit, slapped kicked or
mistreated.
An elder’s sudden change in behavior.
The caregiver’s refusal to allow visitors to see and
elder alone.
Sexual Abuse
Sexual abuse is non consensual sexual contact of
any kind with an elderly person.
It includes unwanted touching
Sexual assault or battery such as rape, sodomy,
coerced nudity and sexually explicit photographing.
Signs of Sexual Abuse
Bruises around breasts or genital area.
Unexplained venereal disease or genital infections.
Unexplained vaginal or anal bleeding.
Torn, stained, or bloody underclothing.
An elder’s report of being sexually assaulted or
raped.
Emotional or Psychological
Abuse
The infliction of anguish, pain, or distress through
verbal or nonverbal acts.
Includes, verbal assaults, insults, threats,
intimidation, humiliation, harassment
Treating the older person like an infant
Isolating an elderly person from his/her family,
friends or regular activities.
Giving an older person the “silent treatment” or
enforced social isolation.
Signs of Emotional/Psychological
Abuse
Emotionally upset or agitated
Extremely withdrawn
Non-communicative or non-responsive
Unusual behavior usually attributed to
“dementia” )e.g. sucking, biting, rocking)
Neglect
The refusal or failure to fulfill any part of a
person’s obligations or duties to an elder.
Failure of a person who has fiduciary
responsibilities to provide for an elder.
Failure to provide an elderly person with
necessities, food water, clothing, shelter, personal
hygiene, medicine, comfort, personal safety.
Abandonment
The desertion of an elderly person by an individual
who has assumed the responsibility for providing
care to the elder, or by the person who has physical
custody of the elder.
Financial or Material
Exploitation
The illegal or improper use of an elder’s funds,
property, or assets.
Cashing an elder’s checks without authorization or
permission.
Forging an elder’s signature,
Misusing or stealing an elder’s money or possessions,
Coercing or deceiving an elder into signing any
document, (contracts or wills).
Improper use of guardianship or power of attorney.
Signs of Financial or Material
Exploitation.
Sudden changes in bank account or banking
practice.
Inclusion of additional names on a bank signature
card.
Unauthorized banking, remaking of wills, advanced
directives, or other legal matters of any kind.
Is Elder Abuse a Crime?
Physical, sexual, and financial/material abuses are
considered crimes.
Certain emotional abuse and neglect are subject to
criminal prosecution.
SELF-NEGLECT IS NOT CONSIDERED A
CRIME.
Where to Find Help
Adult Protection Services.
Somerset County Adult Protective Services.
Board of Social Services.
Somerville, 08876.
908-526-8800.
Someone from the Agency will investigate reported cases.
Provide victims with treatment and protective services.
Local Police, sheriff’s offices and prosecuting attorneys will
investigate and prosecute abuse.
Long distance caregivers can call a nationwide toll-free
number. (1-800-677-1116).
Health education to prevent elder
abuse
Instructions to a caregiver:If the caregiver overwhelmed by the
demands of caring for an elder, instruct
(he /she ) to do the following:
Request help, from friends, relatives, or local
respite care agencies, so you can take a break, if
only for a couple of hours.
Find an adult day care program.
Stay healthy and get medical care for yourself
when necessary.
Adopt stress reduction practices.
Seek counseling for depression, which can lead to
elder abuse.
Find a support group for caregivers of the elderly.
If caregiver is having a problems with drug or
alcohol abuse, get help.
Protective Measures (continued)
Keep your possession organized
Tell someone you trust where your important paperwork and
bank account information is kept
Have checks direct deposited into your account
Use an answering machine to screen phone calls
Don’t leave cash or valuables visible
Notify the police if you will be away from home for an
extended time period
Protective Measures (continued)
Consult with an attorney
Make arrangement for the future such as power of
attorney
Get legal advise before making/signing agreements
regarding your care or possessions
Be aware of your financial situation
Protective Measures (continued)
Know where to ask for help
Find out about community resources before you need them
such as rape and abuse hotlines, senior centers, and adult
protective services
mental health service centers
crisis centers
private counselors
clergy
local police