Age Specific Care Inservice

INTRODUCTION

Elder abuse and neglect is all too common in our society.  It is estimated that hundreds of thousands of elders are abused at home and in institutions each year.  Sadly, the number of victims is expected to rise as the population ages.

Our picture of elder abuse is limited due to the problem’s hidden and complex nature.  Often, a shroud of secrecy surrounds those involved.  Many times victims remain unnoticed and untreated, because they are isolated.  Another challenge for healthcare workers is that subtle forms of mistreatment can be hard to spot.Whether you work in lone-term care, acute care, outpatient care or home care, you may have to face the abuse and neglect of elders.  Show you care by committing yourself to safeguarding the elders in your care.  When you learn how to recognize and respond to mistreatment, you prepare yourself to break the cycle of abuse and neglect.

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WHAT IS ABUSE AND NEGLECT?

The American Medical Association defines elder abuse and neglect as physical, psychological, or financial mistreatment of an elderly person.  It may or may not be intentional and an older adult will often suffer several forms of abuse and neglect at the same time.

Physical Abuse is an act that results in bodily harm, injury, impairment or disease.  It usually takes the form of hitting, slapping, pushing, punching, pinching, burning or striking with objects.  It may also include sexual coercion or assault, incorrect positioning of the elder, forced feeding, and improper use of physical restraints.  Physical abuse is the most obvious form of abuse, because it often leaves behind telltale physical signs.  Some forms of physical abuse are hard to spot such as:

  • Rushing an elder or pulling him or her too fast when helping them walk.
  • Tying a wandering senior to a chair, so she or he won’t get lost while you are busy.
  • Roughly assisting a senior to a chair, so you can once again change wet sheets.
  • Giving an elder too much or too little medication.

It is never acceptable to use chemical or physical restraint for discipline or convenience.

Psychological Abuse inflicts emotional pain or distress on its victims.  If comprises verbal scolding, harassment or intimidation, threatening punishment or deprivation, treating the victim like a child or infant, or isolating the elder from family, friends or activities.  It often goes hand-in-hand with physical abuse.  When it doesn’t it’s harder to spot unless you witness it.  Generally, the victim’s demeanor and behavior offer clues.  Depression, fear, hopelessness, withdrawal or isolation can signal psychological abuse.

You may not recognize some of the more subtle forms of psychological abuse such as: taking something away from a patient or resident when you’re angry, scolding someone in front of others when he’s done something embarrassing like soiled his pants, or isolating someone. 

These acts create an environment where the person may feel shame, insecurity or lack of control and can be psychologically damaging. 

 Financial Abuse occurs when people take control of the elder’s resources through misrepresentation, coercion or outright theft for their own gain.  Financial abuse may include stealing money or possessions, forcing the elder to sign contracts or assign durable powers of attorney to someone, or charging the older adult for unnecessary services or services never rendered.  Financial abuse can be difficult to identify, because there are often no obvious indicators, and the victim may be unaware it’s happening.

Physical Neglect involves failure to provide goods and services necessary for the health and well-being of the elder.  Physical neglect may include withholding adequate meals or hydration, physical therapy or hygiene, as well as failure to provide physical aids such as hearing aids, glasses and false teeth, or safety precautions such as night light or safety bars.

You are neglecting elders if you take your time answering a call bell, if you move the button out of reach or if you unplug it, even if the patient or resident uses the call button inappropriately sometimes.  You are also neglecting someone if you leave that person on the toilet for an extended time, even if you just forgot.  If you remove an elder’s cane or walker from the side of the bed, and it keeps the person from getting around, you are neglecting that senior.  It is also physical neglect if you mark the chart that the elder was repositioned in bed as ordered in the plan of care, then fail to do so.

Psychological Neglect is failure to provide social stimulation.  That may mean leaving the older person alone for long periods of time, ignoring him or giving him “the silent treatment”, or failing to provide companionship, changes in routine, or links to the outside world.

Financial Neglect consists of failure to use available resources to sustain or restore the health and security of the older adult.  Signs may include: a family seeking care that does not meet the senior’s needs even though money is available to provide the proper level of care, an elder’s confusion about her financial situation or a sudden transfer of assets.

VIOLATION OF RIGHTS 

Elders suffer abuse when their patient or residents rights are violated, in other words, when a caretaker ignores the older person’s right and abilities to make decisions.  Rights violations may include denying the elders a right to privacy, not allowing the elder to make decisions about healthcare or personal issues or treating the person disrespectfully.  For example, an elder’s rights are violated if forced to bathe or use the toilet or turn off the television at your convenience, without being given a choice.

WHICH ELDERS GET ABUSED?

Research indicates that older adults from all walks of life can be victims of abuse---men and women from all racial, ethnic and economic groups.  Seniors who are alert, full of life and independent are more dependent on others because they are physically or mentally frail also experience abuse.  According to the National Elder Abuse Incidence Study and other research, more than half of reported elder abuse victims are women, possible because they often live                                                                                 longer than men.  Among these reported cases, elders aged 80 and older and those with physical mental impairments are more likely to be abused than are others.

Many senior victims are relatively isolated from society with little, if any, outside support.  They are often dependent on their abusers and are reluctant or even too embarrassed to complain.  Victims may have mixed feelings about their abusers and thus find it difficult to consider removing themselves from the abuser’s grasp. Remember, any elder may fall victim to abuse.

WHO ARE THE ABUSERS?

Abusers are family members, caregivers, strangers, men and women.  In more than half of reported cases the abusers are male, according to the National Center on Elder Abuse.

Family members are most often the abuser outside healthcare facilities.  They may continue abusing elders even after the person has entered a long-term care facility or a hospital.  You should keep careful records if any patient or resident develops injuries routinely after a visit from a certain family member.  This may reveal a pattern of abuse you need to assess.

Strangers can also be abusers in healthcare facilities.  In one study, forty percent of healthcare staff who participated in the survey admitted committing psychological abuse in the preceding year, while ten percent admitted physically abusing residents.

WHY DO ABUSE AND NEGLECT OCCUR?

Abuse and neglect can arise from misunderstanding or ignorance.  Sometimes people feel frustrated with the elderly, because they don’t really understand the effects of aging.  They fail to give elders answers to their questions or perform tasks.  Those people may not mean to abuse anyone, but they do.  Several risk factors that have been identified as contributors to abuse and neglect follow:

  • A caregiver’s pattern of dealing with stress is important.  Caregivers with an abusive history may continue that behavior at work.  Some caregiver’s, particularly those with little or no formal training or support, can be overwhelmed by the strain of caring for a dependent elder.
  • Seniors who are abusive to their caregivers compound the stress factor.  Some seniors may have abrasive personalities, or they may have Alzheimer’s disease and so lack self-control. It’s important to step away from the patient or resident if you feel angry or extremely frustrated. Return only after you’ve calmed down.
  • Unresolved conflicts between family members or an elder’s history of abusive relationships are warning signs.
  • Mental illness, alcoholism or drug abuse --- in elders or caregivers --- signal the potential for abuse and neglect.
  • Inadequate building and grounds security can leave an elder vulnerable to abuse from strangers.

Whatever the cause, elder abuse and neglect are NEVER acceptable.

WHAT SHOULD BE DONE IF ABUSE OR NEGLECT IS SUSPECTED?

Anytime you suspect abuse or neglect you must take action.  It is your ethical and legal responsibility.  Follow your facility’s assessment and reporting policies, which are designed to protect elders.  When necessary, the proper authorities will conduct a complete investigation.  Here are some general guidelines.

Intervene immediately when you see abuse or neglect, even when you just suspect it.Your primary concern is to protect the victim.  Take immediate steps to ensure the elder’s safety.

  • Any time abuse is witnessed it must be documented and further investigated.  
  • The incident must be recorded accurately.  The report must be written detailing victim and witness statements and should be signed by all parties.  The incident must be reported to the proper people.
  • When abuse or neglect is suspected the elder should be assessed without the suspected abuser present.  Questions should be direct, but not threatening or judgmental.  The interviewer should encourage the suspected victim to talk about the situation, including their relationship with the person who may be the abuser.  The elder should be asked directly if someone hurt them, or threatened them, or took anything without asking and who it was.  Then, roommates, caregivers and anyone who may have seen what happened are interviewed.  Any differences between what the elder reports and what others are saying must be noted.  All interviews must be documented.
  • A health assessment must also be conducted.  The medical history helps to assess when, where and how any injuries occurred and whether any inconsistencies exist between descriptions of events and physical evidence.  Physical evidence must be collected and documented both in writing and with photographs to indicate, size, placement and severity of injuries.  Remember that bruises alone do not confirm abuse, as the elderly often have frail, thin skin which bruises or tears easily.  Accurate, detailed and objective records are crucial.  Patient’s exact words should be noted in quotations.
  • You must report the suspected abuse either to the designated person in your facility (which is the Safety Officer) or directly to an appropriate agency.  Every state has an office of protective services to guide you.  You may be required by state law to report observed or suspected elder abuse.
  • Failure to report can result in a claim of negligence.  Most states will not release the names of people who report elder abuse or neglect.

SUMMARY

Elder abuse or neglect is a common problem you are likely to encounter in healthcare.  Be alert for signs of abuse or neglect, document any risks or evidence and report any suspicions or incidents.  Do your part to bring this hidden problem into the open.  Show you care.  Become an advocate for elders you encounter at work or anywhere.

AGE-SPECIFIC COMPETENCIES FOR INFANTS, TODDLER AND YOUNG CHILDREN

Infants and toddlers (birth to age 3) 

Healthy growth and development

  • Physical growth and development are rapid, especially in infancy.  Building muscle skills is important --- from rolling and standing as an infant to running and drinking from a cup as a toddler.
  • Developing trust and a sense of being loved is important in infancy.  It helps the toddler’s attempts at independence.  Play is important to help build social and other skills.
  • Infants communicate by crying and making simple sounds.  Toddlers learn simple sounds.  Toddlers learn simple word and sentences.

Ways to provide age-specific care

  • Educate parents about the need for checkups, screenings and immunizations.
  • Ensure the child’s safety and comfort.  For example, keep crib rails up, offer age-specific appropriate toys, cuddle an upset child and talk in soothing tones.
  • Explain procedures to parents and the child in simple terms.  Allow time for questions.  Let the child touch equipment, or try it on a doll or stuffed animal.
  • Keep the child with parents if possible.  Involve parents in care (for example, have them choose their child’s food).   Have parents demonstrate procedures back to you to show understanding.
  • Discuss parents’ questions and concerns about caring for their child.  Teach about feeding, hygiene, safety and other ways to promote healthy development.

Young children (age 4 to 6)

Healthy growth and development

  • Children grow more slowly during these years.  They are active, and develop strength and coordination.  They are able to dress themselves and are toilet-trained.
  • Young children are aware of others’ feelings.  They may have fears (for example, about being separated from parents or being injured).  They enjoy playing with other children and make friends.  They begin to develop a sense of privacy.
  • Young children are curious and imaginative.  They ask lots of questions and enjoy conversations.  They like stories and make-believe play.

Ways to provide age-specific care

  • Continue to stress to parents the need for checkups, screenings and immunizations.
  • Explain procedures and objects in ways the child can understand.  Avoid words that might be scary.  Show how equipment is used.  Use toy equipment or other visual aids.  Give the child chances to help.
  • Reassure the child that the procedure is not a punishment.
  • With a younger child, explain the procedure just before you perform it.
  • Give the child chances to express feelings and ask questions (through talk and play).
  • Encourage a younger patient to bring a security object , such as a blanket.
  • Ask parents about any concerns they may have (for example, with setting limits).  Ask the child questions, too (about school or friends, for example).  Teach about healthy eating, hygiene and safety as the child grows more independent. 

Age-specific competencies for older children and adolescents

Older children (ages 7 to 12)

Healthy growth and development

  • Growth continues at a slower pace until a “spurt” at puberty.  Muscle skills continue to develop.  Older children can do a variety of activities, from sports to crafts.
  • Older children can accept rules and responsibilities (such as caring for pets).  Completing tasks, mastering new skills and having achievements recognized help build self-esteem.  Older children enjoy doing things with friends (generally of the same sex).  They want more privacy.
  • Older children enjoy riddles, plays on word, etc.  They can read, write, do math and memorize.  They have a better understanding of time.  They enjoy collecting and classifying things.

Ways to provide age-specific care

  • Continue to remind parents about the need for immunizations, check-ups and screenings.
  • Ask the child about friends, interests, accomplishments and concerns (for example, body changes).  Ask for parents’ views, too.  Allow time for the child and parents to ask questions.
  • Explain procedures and equipment in advance.  Use correct terms and visual aids.  Give the child a tour.  Respect privacy (for example, by keeping the child covered during exams).  Give the child chances to help.  Praise cooperative behavior.
  • Teach the child about healthy and safe behavior (including not using alcohol, tobacco or other drugs).  Encourage parents to talk with their child about these and other important issues (including age-appropriate discussion about sexuality).

Adolescent (ages 13 to 20):

Healthy growth and development

  • Girls generally begin puberty about 2 years earlier than boys (it may start in older childhood for girls).  A growth spurt may affect coordination for a time.  Sex features develop (such as breast in girls and facial hair boys).
  • Adolescents are developing an identity.  They may have emotional swings and face peer pressure.  They may be self-conscious (about body image, for example).  They become interested in close relationships.  Eating disorders may be a concern.
  • Adolescents can solve problems better.  They think about the future (for example, their career).
  • They can think more abstractly (for example, about values and about concepts such as justice).  They may still not think about long-term consequences of their actions.

Ways to provide age-specific care

  • Emphasize the continued need for checkups, screenings and immunizations.
  • Provide privacy for procedures and teaching.  Teach using correct terms and visual aids.    
  • Discuss concerns.  Encourage involvement in care and decisions.  Know the age at which an adolescent can legally authorize his or her own treatment.
  • Encourage hospital patients to keep in contact with friends and family.
  • Teach about healthy habits (nutrition, exercise, hygiene and safety).  Also teach about avoiding pregnancy and heath risks, such as sexually transmitted diseases and alcohol, tobacco and other drug use.
  • Encourage parents to stay involved in their child’s life.  Give parents and the child information about normal changes of adolescence.

Age-specific competencies for adults age

Young adults (ages 21 to 39):

Healthy growth and development

  • Young adults reach sexual maturity and their adult height and weight.  They are more comfortable with their body image.
  • Young adults develop a personal identity and self-reliance.  They may experience sexual intimacy, choose a mate and raise a family.  They establish a career.
  • Young adults reflect on changes in their bodies and their lives.  They can look at problems from different points of view.  They establish values and use them to make life choices.  They evaluate new information in terms of their experience.

Ways to provide age specific care

  • Continue to encourage immunizations, checkups and screenings.
  • Encourage hospital patients to keep in contact with family and friends.
  • Assess the patient for stress related to new adult roles.  Encourage him or her to talk about feelings and concerns, and about how an illness or injury may affect plans, family and finances.
  • Involve the patient and close family members in decision making and education.  Educate about injury prevention and a healthy lifestyle (though exercise, weight control, hygiene, etc.)  Explain the benefits of knowing this information.  Use appropriate teaching materials.  Encourage the patient to take part in group learning situations, such as support groups. 

Middle adults (ages 40 to 64):

Healthy growth and development

  • Adults ages 40 to 64 begin to experience physical changes, such as decreased endurance.                   
  • Women experience menopause.  Illness or injury may interfere with plans.  Chronic illness may develop.  However, many middle adults stay in good health.
  • Adults of these ages develop a concern for the next generation.  They help their children gain independence.  They may become active in the community (for example, though volunteering).  They develop new roles with aging parents and plan for retirement.  They begin emotionally preparing for death.                                                    
  • These adults may seek further education, possibly to make a career change.  They are interested in learning.  They reflect on their lives and accomplishments.

Ways to provide age-specific care

  • Continue to encourage checkups, screenings and immunizations.
  • Encourage as much self-care as possible.
  • Allow time to talk about frustrations, accomplishment, dreams and any concerns about illness.  Talk about stress.  Provide help with finding resources to meet health-care costs.
  • Educate about healthy lifestyles (stress management, weight management, etc.).  Educate about procedures and safe use of medications.  Use appropriate materials.
  • Involve the patient and close friends in decisions about care.  Start teaching about advance medical directives.

Age-specific competencies for adults ages 65 and older

Adults ages 65 to 79

Health growth and development

  • Adults ages 65 to 79 experience changes in skin, muscles and sensory abilities.  They have a higher risk of health problems, such as infection and chronic illness.  They may sleep more, often by napping during the day.  Many older adults stay in good health.
  • These adults need to adapt to changes.  They take up new activities and roles.  They may experience loneliness and anxiety over changes or about the future.
  • Adults of these ages may have a reduced attention span.  They may make decisions and remember things (such as names) more slowly.  They may need more time to learn.

Ways to provide age-specific care

  • Stress the need for immunizations, checkups and screenings.  Encourage healthy habits (nutrition, exercise, hygiene, etc.) and social activity.
  • Educate about safety measures (including fall prevention, safe medication use and using caution with hot water).
  • Provide a safe, comfortable environment (night light, proper temperature, etc).  Allow time to rest. Adapt procedures to physical changes (fragile skin, for example).
  • Give the patients chances to reminisce, to help promote a positive self image.
  • Speak clearly and avoid background noise during teaching.  Use larger-print materials and ensure enough light.  Give information in short segments and repeat as needed.
  • Avoid rushing.
  • Encourage the patient and family to take an active role in care.  Discuss concerns.  Talk about family and other support systems.

Adults ages 80 and older:

Healthy growth and development

  • Adults ages 80 and older have a higher risk of infections, dehydration, poor nutrition and chronic illness.  Effects of chronic illness may be more severe.  Mobility becomes harder.
  • These adults may feel isolated or upset due to loss --- of family, friends, sensory abilities or financial independence.  They may lose self-confidence as their abilities decline.
  • Adults of these ages reflect on their lives and come to an acceptance of death.  They can still learn, but at slower rates.  They may have reduced attention spans.

Ways to provide age-specific care

  • Continue to stress the need for screenings, checkups and immunizations.
  • Encourage physical and social activity.  Encourage reminiscing.
  • Promote, and assist with, self-care and independence as much as possible.  Assist with end –of-life planning.
  • Monitor age-related risks, such as skin problems.  Adapt techniques as needed (for example, using extra caution when moving or touching the patient, to avoid bruising).  Allow for frequent periods of rest.
  • Ensure safety measures to prevent falls and burns. Educate about home safety and safe medication use.
  • Educate in an appropriate environment with suitable materials.  Involve the patient and family or other caregiver(s).  Teach while the patient is at peak energy.  Avoid rushing.