Home Safety

Elder Abuse/Neglect/Exploitation

Background

  • Affects up to 10% of community dwelling older adults and over 20% of older adults living in nursing homes
  • Only 1 in 24 cases are reported
  • Adult Protective Services (APS) investigates reports and will make appropriate referrals to resources within the community to help keep the individual in a safe environment. APS helps adults (18 and older) who are unable to care for themselves due to physical or mental impairment or advanced age (cannot manage own resources, carry out ADLs, protect themselves from neglect (including self-neglect), avoid abusive situations without assistance from others)
  • APS is not a police force and has 72 hours or more before beginning an investigation. If APS is concerned a crime has occurred, they will contact police
  • If concern for a patient's immediate safety, consider contacting local police department

Evaluation

  • Recognize the signs o Physical abuse:
    • bruising (especially on torso or head)
    • frequent injuries (“accidents”)
    • signs of being restrained (marks on wrist)
  • Emotional abuse:
    • isolation of vulnerable adult or refusal to allow visits with vulnerable adult alone
    • threatening, belittling, or controlling behavior by caregiver
    • Behavior that mimics dementia (rocking, sucking, mumbling)
    • Outbursts or extreme anger
    • Punishments like silent treatment
  • Sexual abuse:
    • Frequent GU irritation or infections
    • Indication of bruising to genitals, upper torso, or upper thighs
    • Vulnerable adult indicates discomfort with caregiver while bathing, dressing, or toileting
    • Vulnerable adult has little or no privacy for bathing or dressing which bothers him or her
  • Neglect (including self neglect) - most common APS referral
    • Unusual weight loss, malnutrition, dehydration
    • Untreated physical problems (bed sores)
    • Unsanitary living conditions (bed bugs, soiled bedding, clothes)
    • Being left un-bathed
    • Unsuitable clothing for weather
    • Unsafe living conditions (no heat or running water, faulty electrical wiring, other fire hazards)
  • Financial exploitation
    • Sudden changes in vulnerable adult’s financial condition
    • Financial activity vulnerable adult couldn’t have done
    • No food in home, utilities cut off, home not maintained

Management

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