Red Flags
Approximately what proportion of older adults experience abuse worldwide?
Approximately 1 in 10 older adults
An older adult is slapped, pushed, restrained, or given inappropriate meds. What type of abuse is this?
Physical Abuse
You suspect an older adult may be experiencing abuse. What is one of the first things you should try to create?
Privacy and an opportunity to speak with them alone.
Why might speaking with an older adult privately change the quality of your assessment?
Privacy may make it easier for the person to speak openly, express concerns, disclose information, and communicate without fear or influence from another person.
When documenting suspected elder abuse, should the nurse document what they observed or what they concluded?
Observed
True or False: An older adult having dementia is, by itself, evidence of elder abuse.
and Why?
False. Cognitive impairment is a risk factor, but it is not evidence that abuse is occurring.
A caregiver repeatedly humiliates an older adult, threatens them, and prevents them from seeing friends. What type of abuse is this?
Emotional Abuse
An 84-year-old has unexplained bruising on both upper arms. Her husband says, "She tripped again," and answers every question for her. Should you immediately confront the husband?
No. Create an opportunity to speak with the patient privately and assess further.
Name three principles of trauma-informed communication.
Name two interprofessional team members who may be involved in a suspected elder abuse situation and describe one role for each.
A patient has bruises in different stages of healing, gives inconsistent explanations for injuries, and appears fearful around their caregiver. What do these findings represent?
Red flags that warrant further assessment. They don't prove abuse.
An older adult's grandson controls their bank account, makes unexplained withdrawals, and pressures them to sign financial documents. What type of abuse should the nurse consider?
Financial Abuse
A patient says, "Please don't tell my daughter." What should the nurse avoid doing?
Avoid pressuring, judging, interrogating, or immediately telling the patient what you think is happening. Listen and explore the concern while following appropriate safety and reporting processes
An older adult becomes visibly uncomfortable when you begin asking questions about their home situation. Which response best demonstrates trauma-informed care?
A. “We need to get through these questions before I can finish your assessment.”
B. “Would you like to take a break, or would you prefer to continue?”
C. “There’s nothing to be nervous about.”
D. “These questions are routine, so just answer them.”
B. “Would you like to take a break, or would you prefer to continue?”
What's the problem here: “Patient's daughter is very controlling and doesn't let her mother make any decisions.”
Controlling is an interpretation
Name 3 factors that can increase an older adult's vulnerability to abuse
Fraility
Cognitive impairment
disability
chronic illness
high dependence on caregivers
poverty
An older adult is dehydrated, malnourished, has poor skin integrity, and has missed medications. Their caregiver says they are overwhelmed and "can't keep up anymore." What type of concern is present?
Neglect
True or false: A nurse must prove that abuse occurred before reporting a concern.
False. Reporting a concern is not the same as personally determining that abuse occurred. Nurses gather information, protect safety, document objectively, and follow organizational processes.
A patient requires assistance with bathing. Before beginning, which approach best supports autonomy?
A. “I'll just get this done quickly for you.”
B. “Your daughter said you need help, so we'll do it this way.”
C. “Would you like me to explain what we're going to do before we start?”
D. “You don't need to worry about the details.”
C. “Would you like me to explain what we're going to do before we start?”
A nurse notices that an older adult has lost 8 kg and has several missed appointments.
Which is better documentation?
A. “Patient's family is neglecting her.”
B. “8 kg weight loss documented since June. Patient has missed three scheduled appointments. Patient reports difficulty arranging transportation.”
B
Fill in the blank: Abuse can be ________ or ___________
Intentional or unintentional
An older adult tells a nurse, "I don't want him helping me anymore. He doesn't listen when I say no." What type of abuse must the nurse consider?
Sexual
A caregiver admits, "I'm exhausted. I work full-time and I can't keep up with everything my mom needs." Name two things the nurse should consider doing.
Assess the older adult's safety and unmet needs and assess/support the caregiver's needs, such as respite, home care, education, counselling, or community resources
A student says, "But if the patient has dementia, how can we know whether what they're telling us is reliable?" What is the key concept you should remind them of?
Cognitive impairment does not automatically mean a person lacks capacity or cannot express preferences or concerns. Capacity is decision-specific and must be assessed rather than assumed.
A patient has unexplained bruising, appears anxious around her caregiver, and quietly tells you, "I'm afraid when he gets angry." Give 3 nursing actions that demonstrate the approach from today's lecture.