Nurses As Mandatory Reporters Of Elder Abuse

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Across the United States, the elderly — defined as people over 65 with infirmities — face emotional, physical, sexual, and financial abuses, neglect, and abandonment. Every month, an estimated one in six vulnerable senior citizens is a victim of some form of maltreatment.

Smiling nurse with smiling older patient

While every state and the federal government have laws aimed at protecting the elderly, the effort to stop abuse begins on the frontlines of care. Among the group of mandatory reporters are family nurse practitioners (FNPs) who are positioned to help mistreated elderly patients.

As primary care providers, FNPs are trained to combat elder abuse by recognizing the signs and helping victims. FNPs are required by law to report abuse, in many cases even if they just suspect it. Failure to report can mean fines and possible jail time, depending on state law.

All FNPs need to understand the types of abuse, the risk factors, and the intervention process.

Recognizing Abuse

The National Center on Elder Abuse (NCEA) and the Centers for Disease Control and Prevention (CDC) broadly define elder abuse as intentional injuries or actions that risk injuries to a person age 65 and older.

Researchers found abused adults have a 300 percent higher risk of death compared to those who have not been abused. Women who are verbally abused have greater mental decline than those who are subjected to physical abuse.

Clinicians often detect elder abuse during regular office visits. Since victims are typically not forthcoming with information about abusive relationships, clinicians must be observant to signs of maltreatment. Abuse is classified in five groups but can happen in combination, called polyvictimization. The individual types of abuse are:

Physical Abuse

The use of non-accidental physical force on an elderly person, such as hitting, shoving, and punching, and the inappropriate used of restraints and confinement, are classified as physical abuse. Signs of physical abuse include bruises, burns, and injuries that appear to have been caused by ropes or restraints. Other indicators include a history of hospitalizations or emergency room visits for similar and unexplained injuries.

Sexual Abuse

Physical acts such as unwanted touching, intercourse, and other sexual activities that make the victim an unwilling participant are sexual abuse. Signs of sexual abuse can include pelvic injuries, sexually transmitted diseases, and social withdrawal.

Emotional/Psychological Abuse

Emotional abuse that causes distress includes humiliation, ridicule, intimidation, isolation, and terrorizing threats. Elderly victims also face verbal abuse that includes yelling, insulting remarks, and mocking.

Financial Abuse

Financial elder abuse includes stealing or using the victim’s financial resources without permission, such as forging checks, identity theft, and investment fraud. Vulnerable seniors are often victims of financial cons that use deceptive tactics.

Neglect or Abandonment

Failure to fulfill caregiving obligations, either intentionally or unintentionally, that denies elderly of required care is neglect. Elder neglect constitutes more than half of all reported cases of elder abuse.

Even with definitive types of abuse, researchers in a New England Journal of Medicine study said screening and identifying abuse present unusual challenges for several reasons:

  • Victims conceal the circumstances around the abuse or are unable to articulate them because of cognitive impairments.
  • Chronic illnesses in older people create both false negative (fractures misattributed to osteoporosis) and false positive (bruising misattributed to physical abuse) findings.
  • Cultural and language barriers.
  • Conclusive determinations of abuse may take weeks.

Experts say providers who are trying to determine abuse has occurred should review risk factors and use all available assessment strategies.

Determining The Risk Factors

For FNPs, a vital component to stopping elder abuse is to identify it before it starts. Contributing factors, also called risk factors, highlight the likelihood of abuse and understanding them can identify opportunities to prevent abuse. Experts identify the following as risk factors that contribute to the possibility of maltreatment:

  • Isolation – Seniors who have little contact with family, friends, or a social support system are more susceptible to abuse.
  • Substance abuse  Drug and alcohol abuse by caregivers can lead to elder abuse.
  • Declining physical and mental health – Elderly adults in declining health are more susceptible to abuse.
  • Shared living situations – Abuse risks increase when seniors and caregivers live together.

When elder abuse is identified, providers are obligated to help. Experts say successful interventions do not happen through a single provider or one-time help. Successful interventions come as a part of cooperative care.

Successful Elder Abuse Interventions

Researchers with the New England Journal of Medicine, in a study titled Elder Abuse, said successful interventions “rarely involve the swift and definitive extrication of the victim of abuse from his or her predicament.

“Instead, successful interventions in cases of elder abuse are typically interprofessional, ongoing, community-based, and resource-intensive,” study authors Dr. Mark S. Lachs, and Karl A. Pillemer, PhD, stated. “The most promising response to the complex nature of cases of elder abuse has been the development of interprofessional teams.”

When a provider reports abuse, adult protective services visit the home to confirm the mistreatment. The resulting intervention is highly individualized. Abuse does not have to be definitively proven for targeted geriatric services, including home healthcare, mental health services, and physical therapy, to be initiated.

Victims of abuse who have cognitive impairments from dementia or Alzheimer’s disease may require legal interventions that include a court-appointed guardian.

Regardless of which intervention is appropriate to the situation, the most appropriate care involves a team that includes social workers, law enforcement and attorneys, study authors said.

FNPs also play a significant role in successful interventions. As primary caregivers, FNPs have the education and skills to help victims of elder abuse by reporting incidents, providing treatment for injuries, and coordinating interprofessional teams. In most states, FNPs are permitted by law to practice without physician oversight and prescribe medications.

About Duquesne University’s Online Master Of Science in Nursing FNP Program

Nursing students who pursue an online Master of Science in Nursing (MSN) degree at Duquesne University to become an FNP learn more than the necessary clinical skills. They also learn about evidenced-based nursing practice that can help elderly patients.

The university’s online MSN program prepares students for the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC) certification exams. The university boasts a 95 percent pass rate for the AANPCP exam and has repeatedly been ranked among the best higher-education institutions in the nation by U.S. News & World Report. Contact us today for more information about Duquesne University’s MSN program.