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DiversityNursing Blog

Recognizing the Symptoms of Elder Abuse

Posted by Alycia Sullivan

Wed, Aug 28, 2013 @ 12:20 PM



The seriousness surrounding the problem of elder abuse in our society is often ignored or underrated. People have a tendency to put discussions of elder abuse on the backburner, in favor of more shocking stories that tend to grab the media spotlight.

Despite the lack of attention paid to the phenomenon of elder abuse, the American Psychological Association estimates that “4 million older Americans are victims of physical, psychological or other forms of abuse and neglect” every year. For every reported instance of abuse, experts estimate that 23 more go unreported.

There are many different types of elder abuse, but they can be broken into three categories:

1. Physical Abuse

Some of the most common signs of physical abuse include unexplained marks or injuries, such as bruises, pressure marks, welts, cuts, burns or broken bones. If the caregiver refuses to let you be alone with your loved one, this could also be an indicator of physical abuse. Other possible signs include broken glasses, ripped clothing and signs of restraint (such as rope marks around the wrist).

Remember, neglect is also a form of physical abuse. Some of the most common signs that an older adult is being neglected by a caretaker include sudden weight loss, malnutrition and dehydration. Unsanitary living conditions (like dirty sheets or bed bugs) are also indicators of neglect, as are untreated physical problems, like bed sores.

2. Emotional Abuse

The signs of emotional abuse include characteristics of depression, like uncharacteristic silence, loss of appetite and unexplained withdrawal from normal activities. Likewise, if you witness a caregiver acting in a way that is threatening, belittling or condescending, there’s a possibility that the person they’re charged with taking care of is experiencing emotional abuse. 

There are many people who don’t recognize emotional abuse or don’t think of it as a serious mistake. These individuals operate under the false assumption that emotional scars are somehow less violent or harmful than the physical ones. This is one of the characteristics of emotional abuse that makes it so dangerous—if you don’t recognize a problem as a problem, you can’t take steps to solve it.

3.       Sexual Abuse

                The most common signs of sexual abuse include an unexplained venereal disease or genital infection, unexplained vaginal or anal bleeding and bruises around the breast or genitals. Torn, stained or bloody underwear can also be an indicator of sexual abuse. 

                There are many reasons that sexual abuse can be difficult for many older adults to talk about. For some, it’s an issue of pride—they would rather suffer in silence than face the humiliation of admitting helplessness. Others are afraid of retaliation, and worry that they’ll be punished for speaking up. Whatever the specifics of the situation, it’s important to remember that the subject of sexual abuse is complicated and needs to be handled with sensitivity.


                The most important thing to remember when you suspect that someone you know is being abused is that speaking out is half the battle. The invisibility of elder abuse is what makes it difficult to prevent and punish. By calling attention to the situation, you’ve already laid a foundation for preventing future instances of elder abuse.

Linda Bright is a staff writer and a public relations coordinator for Given her experience as a former hospital administrator, she writes primarily about healthcare reform, patient rights and other issues related to the healthcare industry. In her free time, she enjoys Sudoku, spending time with her family, and playing with her poodle, Max.

Topics: APA, abuse, care, elderly, caregiver

Home care RN helps patient, caregiver balance emotions

Posted by Alycia Sullivan

Fri, Jun 07, 2013 @ 02:29 PM

By Lois Gerber, RN, BSN, MPH

It was my first nursing visit to Thad and Larissa. The three of us sat around their kitchen table discussing how to best manage an exacerbation of Thad’s multiple sclerosis. Tears welled in the corners of Larissa’s brown eyes as she twisted a strand of her strawberry blonde hair around her finger. 

"His MS seemed to get worse overnight," Larissa said. "He can’t walk up the stairs anymore without hanging onto the railing for dear life. [Our doctor] says it’s time for a stair lift." 

"I can beat these new problems," Thad replied. "Prayer, persistence and exercise. My sales manager suggested a disability leave, but I refused. Give me a month here at home. I’ll show him." His hands shook as he hitched his belt over his potbelly. "There will be no damn chair lift in my house. Mind over matter." 

I took a deep breath, remembering that the physician referral documented an exacerbation of an aggressive form of MS that limited the chance of significant recovery. Double vision accentuated his mobility problems. 

Hope and unrealistic expectations — a common but difficult scenario I’d often seen in my work as a home healthcare nurse. But how to best help Thad accept his limitations while keeping hope in his heart? And convince Larissa to encourage her husband to be as independent as possible?

First, I needed to do a complete assessment and work with the couple to develop an effective long-term care plan with an overall goal and the individual steps to accomplish it. Without realistic expectations, Thad and Larissa’s fears and anger would further the family dysfunction.

I paused. "Thad, physical therapy can strengthen your muscles and improve your walking. An occupational therapist can teach you ways to deal with small things like brushing your teeth and shaving."

"I’ve already had two stints with them and learned everything I need to know," he said, clenching his fists.

I looked at Thad. "Let’s make a deal. You agree to have physical and occupational therapy for four weeks and I’ll visit twice a week, communicate with the doctor and follow up on any problems you have. Then we’ll talk about the stair lift." 

Over the next month, I counseled Thad and Larissa, individually and as a couple. "I’m scared what will happen to me if Thad dies," Larissa admitted one day while we were alone, reviewing handouts on managing the disease. 

"That’s understandable, but overprotecting him and not letting him do what he can safely do hurts his rehab potential." I highlighted sections in the pamphlets that pertained to caregiving.

She frowned. "I’m angry at him for getting sick and feel guilty about that, too. We’re only 55. If he got hurt, I’d blame myself. That’s why I’m overprotective. I’m scared."

I nodded. "All your feelings are normal. Most caregivers feel the same."

"No one else I know has to deal with MS. I’m alone, depressed."

"The Multiple Sclerosis Society has a caregiver support group that meets every week at the city library. That’s where you’ll find people who feel just like you. Talking with them will help."

Thad’s fear and anger manifested in denial instead of depression. "It’s hard to get the mind and the body working together sometimes," I told him. "With a chair lift, you could save your energy for things that are important and that you enjoy."

"Like going to work?"

"That could be a realistic goal. What about cutting back to three days a week?" 

He smiled. "I can live with that. And Larissa’s right. The stair lift is a good idea."

Helping clients set realistic goals is important to keep hope alive. Unrealistic goals foster fear, denial, anger and depression. But without hope, clients lose the moorings for their lives. 


Topics: RN, home healthcare, caregiver, counsel

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