Page 173 - Encyclopedia of Nursing Research

140 n ELDER MiSTREATMENT

the elder, or EM is the failure by a caregiver the amount of care an elder person requires
to satisfy the elder’s basic needs or to pro- and is related to stressed caregiver research,
E tect the elder from harm. There are several which describes overwhelmed caregivers
types of EM described in the NRC report. who lose their control or stop providing rea-
Abuse is generally understood as physical sonable care. Conversely, there are data that
assault inflicted on an older adult resulting reflect the caregiver’s dependency on the
in harmful effects. Abusive behavior may elder (for shelter, money, etc.), which puts
include hitting, kicking, punching, and other the elder at risk. Transgenerational violence
physical contact. Neglect is the refusal or fail- theory refers to children who learn violent
ure to fulfill any part of a caregiver’s obliga- behavior as normal and then become violent
tions or duties to an older adult. Neglect may and abusive as they grow older. This might
be intentional or unintentional. Self-neglect be viewed from a learning theory perspec-
occurs when an older adult either knowingly tive, although some have looked at it as a ret-
or unknowingly lives in such a manner that ribution act; an adult child may strike back
is deleterious to his or her health. Exploitation at a parent or a caregiver who was once abu-
is fraudulent activity in connection with an sive. The psychopathology of the abuser the-
older adult’s property or assets, and abandon- ory refers to any nonnormal caregiver, such
ment is defined as the deliberate or abrupt as substance abusers (alcohol, drugs), psy-
withdrawal of services in caring for an older chiatrically impaired individuals, or men-
adult. Self-neglect has received a great deal tally retarded caregivers. The number of
of recent attention given its deleterious out- mentally retarded elders older than 65 years
comes on the older person and the opportu- has grown substantially over the past decade,
nity to intervene (Dong et al., 2009; Mosqueda creating situations where mentally retarded
et al., 2008; Poythress, Burnett, Naik, Pickens, or disabled offspring become caregivers for
& Dyer, 2006). Further, resident-to-resident very elderly parents (NRC, 2003).
EM in long-term care settings is an impor- Early studies looked at the prevalence of
tant syndrome that nurses need to under- EM from a variety of perspectives: acute care,
stand (Rosen et al., 2008). Evidence suggests community nursing care, and nursing home
that only 1 in 14 EM cases is reported to some setting. Differences in operational definitions
public agency. Nurses can do much to help and methodological approaches and the lack
in the screening and detection process of of national prevalence studies have made it
EM by doing a careful history and physical difficult to understand the conditions under
assessment with attention to the subjective which EM is likely to occur. Although EM
complaint of EM, along with any signs or education and training has improved, there
symptoms of the same. Underreporting of is still a great need for more systematic nurs-
EM is a serious concern because older adults ing assessment, care planning, and follow-up
may have disease symptoms or age-related with the older adult. The need for researchers
changes that imitate or conceal mistreatment who can contribute to this area of inquiry is
symptoms, making the assessment process great.
complex. Few clinicians have been trained in There is no Denver Developmental
EM assessment and intervention, which has screen for older adults that enables clinician
also led to underreporting. With an unprece- to understand what an 80-year-old looks like
dented number of individuals living beyond and what conditions are likely to represent
the age of 65 years and even beyond the age EM. The signs and symptoms of EM might
of 85 years, nurses must be sensitive to the include unexplained bruises, fractures, burns,
possibility of EM. poor hydration, reports of hitting or any other
Theories for EM causality have been violent behavior against the older adult, sex-
posited. The dependency theory refers to ually transmitted disease in institutionalized