ELDER ABUSE can be caused by stress, and the parties involved are elderly victims who have cognitive and functional impairments who rely on family caregivers. Research concludes that stress may be a contributing factor in elder abuse, but does not solely explain the phenomenon. Rather, the dependency of the perpetrator and the perpetrator’s mental state are risk factors of elder abuse.

1.What is the role of the nurse in reporting Elder Abuse?

2.Define Elder Abuse.

CASE STUDY 1

For several weeks, church members noticed that Mr. Lyons, 82 years of age, had bruises, cuts and scrapes on his face, hands, and arms. Mr. Lyons always had some plausible explanation and, knowing that he was the sole caretaker for his very ill wife of 61 years, they did not press the issue.  Mr. Lyons drove himself to the hospital emergency room, over 20 miles from his home, with multiple fractures to his left arm. Staff eventually discovered that Mr. Lyons was being attacked by his wife, who was suffering from undiagnosed Alzheimer’s disease and had become combative. Mr. Lyons did not know that his wife’s behaviour was a part of the illness and was protecting her.

What are the symptoms that indicate Elder Abuse in this instance?   

CASE STUDY 2

Mrs. Jay, a long time insulin-dependent diabetic, was admitted to the hospital after being brought to her doctor’s office by a neighbour who became concerned after not seeing Mrs. Jay for several days. Mrs. Jay finally told hospital staff members that she had run out of insulin several days ago and had given her grandson all the money she had to go and refill her prescription. He did not return, and Mrs. Jay did not call family members because she did not want to get him in trouble.

1. What are the consequences for the patient?

2. What documentation is to be completed?

3. What assistance can be offered to Mrs Jay?

4. What is the outcome of reported Elder Abuse?

5. What are common indicators, types, and symptoms of dementia?

6. What are relevant activities and communication in working with people with dementia?

7. List a range of appropriate strategies when working with people with dementia?

8. What are safe physical environments in providing security for people with dementia?  

9. What are behaviours of concern, and triggers?

CASE STUDY 4

Peter is an 85-year-old man who lives in a long term care home. He has been diagnosed with dementia, multiple cerebral vascular accidents and a history of skin breakdown on his coccyx.  He uses a mechanical lift for transfers and requires nursing staff assistance for bed mobility. During the day, he uses a manual tilt wheelchair with an air cushion to facilitate proper positioning and comfort and to assist in shifting his weight to prevent further skin breakdown. Due to the weight and height of the wheelchair, he requires assistance for wheelchair mobility. The wheelchair has a two-point ‘auto-style’ seatbelt, which is not considered a restraint because Peter can unbuckle it as he pleases.

As a result of the dementia diagnosis, Peter is deemed incapable of making his own health care decisions. Peter’s wife is his power of attorney and has made an informed decision against using a wheelchair restraint. Staff begin to observe Peter frequently unbuckling the seatbelt, which causes him to slide forward on the cushion and nearly fall out of the wheelchair. They also report that he is restless and agitated at times in the wheelchair. In an effort to protect him, the staff decide to use a temporary padded belt that can be fastened behind him. This belt is a form of restraint since he cannot physically reach the buckle to unfasten it.

The staff communicate their concerns regarding Peter’s safety and the lack of restraint to the occupational therapist who initially provided him with the wheelchair. After discussions with staff and reviewing the documentation in his chart regarding the number and details of these sliding occurrences, the OT decides to contact his wife. During their discussion, Peter’s wife is made aware that her husband is frequently sliding in the wheelchair—at times unbuckling the seatbelt—and is at risk for falls. The occupational therapist suggests reasons why this may be happening based on staff feedback, documentation and her professional opinion. Peter’s wife also provides helpful information about him, stating that he used to be a very active man. She reports that he is upset about being in a wheelchair and being prevented from moving around independently. She worries that the use of a seatbelt that he cannot unbuckle might make him more upset or agitated. His wife also reports that Peter sometimes complains of pain in his legs and back after being in the wheelchair throughout the day. She is also concerned about Peter wanting to get out of the wheelchair to get to the toilet. After reviewing all of the risks and benefits, his wife decides, for quality of life reasons, that staff should not use a wheelchair seatbelt. Even though she has made this decision, she is concerned about her husband’s overall safety from sliding.

Together, the OT and Peter’s wife come up with restraint alternatives that can be trialled.

Knowing that feedback from the rest of the staff is also very important, the occupational therapist calls an interdisciplinary team meeting to discuss alternatives to restraints and the SDM’s informed decision to not use a wheelchair restraint.  

What alternative restraint options are available for Peter?

What education is required for all staff caring for Peter?

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