1. Elder Abuse/Neglect
    1. Definition: battering, psychological abuse, sexual assault, or any act or omission by personal caregiver, family, or legal guardian that results in harm or threatened harm.
    2. Concepts, principles, and characteristics:
      1. Elders who are currently being abused often abused their abusers—their offspring. Violence is a learned behavior.
      2. Victim characteristics: diminished self-esteem, feeling responsibility for the abuse, isolated.
      3. Abuser characteristics: usually has physical or psychosocial stressors related to marital or fiscal difficulties; substance abuse.
      4. Legal: most states have mandatory laws to report elder abuse, although many cases are not reported because of shame, fear of more abuse, cultural/religious beliefs, optimism, loyalty, financial dependency.
      5. Types of abuse:
        1. Financial abuse, e.g., fraudulent monetary schemes, theft (money, property, or both).
        2. Neglect, e.g., lack of food, clean clothing, medications; no provision for assistive devices (dentures, hearing aids, glasses, canes).
        3. Psychological abuse, e.g., verbal abuse.
        4. Physical abuse, e.g., beating, physical restraints, rape.
    3. Assessment:
      1. Risk factors:
      2. Behavioral clues: agitation, anger, denial, fear, confusion, depression, withdrawal, unbelievable stories about causes of injuries.
      3. Physical indicators: weight loss; unexplained cuts, bruises, puncture wounds; untreated injuries; unkempt; noncompliance with medical plan of care.
      4. Financial matters: e.g., recent changes in will; unusual banking activity; missing checks, personal belongings; forged signatures; unwillingness to spend money on the elder.
    4. Analysis/nursing diagnosis:
      1. Risk for injury related to neglect, abuse.
      2. Fear.
      3. Powerlessness related to dependency on abuser.
      4. Unilateral neglect.
      5. Spiritual distress.
      6. Altered family processes related to use of violence.
    5. Nursing care plan/implementation:
      1. Primary prevention:
        1. Early case finding; early treatment.
        2. Referral to community services for caregiver (e.g., respite care) before serious abuse occurs.
      2. Secondary prevention:
        1. Report case to law enforcement agencies.
        2. Provide elder with phone number for confidential hotline.
        3. Plan for safety of elder (e.g., shelter).
      3. Tertiary prevention:
        1. Counseling, support, and self-help groups for victim.
        2. Legal action against abuser.
    6. Evaluation/outcome criteria:
      1. Elder develops trust in caregivers, without fear of further abuse.
      2. Spiritual well-being is enhanced, with diminished feelings of guilt, hopelessness, and powerlessness.