Abuse and Neglect

Older people, who for a variety of reasons must rely on others for their care, are at risk for a variety of things including neglect (physical or social), abuse (physical or psychological), or being restrained (chemically or physically). However, even elders who are independent "may be trapped by circumstances into becoming victims of mistreatment" (Rosenblatt, 1997, p. 184).

Fulmer and Paveza (1998) note that a person who is neglected might have poor access to care. They recognize that a lot more work has to be done on defining what constitutes abuse and neglect. Until this research is done it is probable that only the more severe cases will be recognized as such. However, Rosenblatt (1997) notes that the most prevalent form of abuse is neglect. Neglect will almost always, sooner or later, lead to the need for hospitalization. While there are no comprehensive tools that accurately measure neglect and abuse, Fulmer & Paveza (1998) suggest evaluating both risk and vulnerability.

Many states now have laws mandating that health care providers report suspected elder abuse. The nurse should be aware of the guidelines in his or her state. The State Agencies on Aging will have this information or know where to access it. Once abuse is reported, an investigation is initiated by Social Services or Adult Protective Services. Good documentation of your assessment is crucial for informing a suspected abuse or neglect investigation.

Additionally, since nurses, especially home care nurses, see patients in their home environments they should be alert during these occasions for preventive opportunities. For example, if a caregiver seems more than usually irritated, then an assessment should be made of the need for respite. In most cases the elder will be better served by staying in their own environment. However, appropriate measures must be taken by the nurse advocate to help alleviate or diffuse situations that have a potential to become abusive. When severe harm is likely, there is more urgency to initiate an investigation.