Elder abuse is defined in the amendment to the Older Americans Act (1987). It includes physical abuse, neglect, exploitation, and abandonment of adults 60 years and older and is reportable in most states. The reporting agency varies by state but generally includes social service agencies, welfare departments, and nursing home personnel. As in the case of child abuse, the person reporting the abuse is, in most states, protected from civil and criminal liability.
Residents of nursing home facilities must be protected from abusive healthcare workers. To do so, some states have made “resident abuse” a crime. In the case of Brinson v. Axelrod, a nurse’s aide was prosecuted for resident abuse for causing injuries to the hands and face of an elderly resident (Brinson v. Axelrod, 499 N.Y.S.2d 24, App. Div. 1986). Another medical employee in a New York case was found guilty of resident abuse when she “held the patient’s chin and poured the medication down her throat” after the patient had refused medication (In re Axelrod, 560 N.Y.S.2d 573, App. Div. 1990).
The elderly are also protected by the Older Americans Act from financial abuse or exploitation. This is considered a crime in many states.
One of the most difficult situations that healthcare providers confront is when they suspect that a patient suffers from spousal abuse. Laws governing the reporting of spousal abuse vary from state to state. The local police may have to become involved when spousal abuse is suspected, and in some cases a court will issue a restraining or protective order prohibiting the abuser from coming into contact with the victim. Questions that are frequently asked of a suspected abused spouse include:
· Are you or your children afraid of your spouse?
· Does your partner threaten, grab, shove, or hit you?
· Does your partner prevent you from spending time with your family or friends?
· Do you stay with your partner because you are afraid of what he or she would do if you broke up?
· Has your partner ever abandoned you in a dangerous place?
Abused spouses are warned that in most relationships the cycle of abuse happens many times. The abuse does not stop.
All medical offices and hospital emergency rooms should have access to a 24-hour abuse hotline, such as a women’s support services hotline.
Signs of Abuse
Healthcare workers, social workers, daycare personnel, and nursing home staff should all be on the lookout for victims of abuse. However, physical signs in children, spouses, the elderly, and the mentally incompetent vary. These signs of abuse are found in Table 7.4 .
TABLE 7.4 Signs of Abuse
|· Repeated injuries|
· Bruises such as blackened eyes and unexplained swelling
· Unexplained fractures
· Bite marks
· Unusual marks, such as those occurring from a cigarette burn
· Bruising, swelling, or pain in the genital area
· Signs of inadequate nutrition, such as sunken eyes and weight loss
· Venereal disease and genital abrasions and infections
· Makeup used to hide bruises
· Sunglasses worn inside a building or hospital to hide blackened eyes
Healthcare workers must do everything possible to gain the victim’s confidence. However, it is not possible to assure the victim that all information will be held in confidence, as abuse cases are reportable by law. This should be clearly explained to the victim at the time of the initial visit.
It is difficult to discuss the abuse with the victim when the suspected abuser is present. Always attempt to speak to the victim in private. If possible, have another healthcare professional present during the interview to act as a witness.