Aspects of Maltreatment Towards Elders 1

Aspects of Maltreatment Towards Elders In The Community and Long Term Care
Amanda Moores
810-283-101
February 26, 2014
NURS 260 Practical Nursing Theory
Franklin Gorospe

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Aspects of Maltreatment Towards Elders

Maltreatment is a broad term used when discussing the many forms of abuse, this paper
will focus on abuse towards the elderly. The various forms of maltreatment include 5 main
behaviours, physical, psychological and sexual abuse, financial exploitation and neglect (CNO
2006). According to the World Health Organization elder abuse can be defined as an act or
omission of an act perpetrated by a family member, caregiver or anyone else that is held in a
trusting position towards the elder person, with intent to harm or cause distress to the elderly
person (Murphy, Waa, Jaffer, Sauter, Chan 2013). Abuse can also take place in different settings
such as in a private home or Long Term Care (LTC) facility. All forms of abuse no matter the
severity are perverse and should not be tolerated. As a student nurse that works with a large
population of elderly, I believe this topic to be particularly important and that having a good
knowledge base will be beneficial to my future practice. First this paper will take aim at the
theoretical causes of abuse, including the social and environmental factors, in an attempt to gain
a better understanding of why people would exert certain behaviours that may lead to abuse.
Secondly, this paper will review manifestations in a patient suspected of being abused and how
to treat the situation. Finally, the paper will discuss the implementation of policies and
techniques on how to maintain quality of life by trying to lower incidence, or preferably,
completely eliminate elder maltreatment.
Body
Theoretically there are many causes of maltreatment, including variables that need to be
considered such as the environment in which work is performed and the character of both
caregiver and patient. These variables can stand alone or be interrelated but in the end they all

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lend reasoning to the risk and performance of elder abuse. When considering caregivers, the
greatest perpetrators of elder abuse are young female nursing aides (Natan, Lowenstein,
Eisikovits et al. 2010). This statistic surprised me, as a young female I believe that when you
begin your career that you would do so with the best of intentions and care, but everyone is
different, and have beliefs and intentions that affect their behaviour. When working in a large
facility, theoretically, the caregiver to client ratio is higher but reality shows that this is not true.
This can lead to staff being over worked and having increased pressure to perform. The largest
population of elders at risk are found to be females with dementia. In this case neglect was the
most prevalent form of abuse (Natan et al. 2010). As a nursing student I have learned to be
compassionate and advocate for my client when they are unable to do so for themselves. I
believe this should be practiced diligently and every person treated with respect and dignity. Also
there are large staff turnovers in nursing aide and practical nurse positions, when this happens
caregivers do not know the patients very well and patients do not recognize the staff. This can
lead to staff becoming frustrated as well as patients being uncomfortable with the caregiver
(Natan et al. 2010). Elderly in LTC facilities are vulnerable because they are dependent upon the
caregivers and many are isolated with no one to advocate for them. All of the above mentioned
variables are factors that can lead to the risk and cause of elder maltreatment. Further on in this
paper reasons to prevent these types situations will be discussed.
Furthermore, there is no clear cut method or tests that can be done to detect or diagnose
elder abuse and it is difficult to distinguish between accidental and non-accidental injuries in
reguards to physical abuse. The elderly do have age related diseases that lend to accidents
becoming more prevalent such as osteoporosis. With osteoporosis elderly can fall and break a
bone more easily, we need to be able to differentiate between fractures and be able to notice

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when there are multiple incidences or if the fractures do not coincide with the fall. (Murphy et al.
2013). There are many tell-tale signs of all forms of abuse that can be detected by the health care
provider through subjective and objective data collection. Therefore it is important to be able to
notice the signs of elder abuse and know what to do when you suspect it. The main priority of the
caregiver is to ensure the elder person is safe and has resources to ensure their safety and to also
make sure the perpetrator of the abuse is safe and distanced from the victim (Murphy et al. 2013)
Finally, with the elderly population projected to rise worldwide from 542 million in 1995
to 1.2 billion in 2025 and the rate of elderly abuse already on the rise according to a Statistics
Canada report (Murphy et al. 2013), the need for effective measures to combat elderly abuse has
to be attained. I believe prevention is the best defence and educating caregivers is the best place
to start. Facilities can offer workshops on how to effectively deal with patients with dementia in
order to better understand the disease and skills on interacting with effected patients. Also
workloads should be reviewed on a regular basis to ensure the correct ratio of staffing and to
prevent worker burnout. It would also be desirable to have support groups where staff can share
information on patients and support each other in their efforts to provide quality patient centered
care (Natan et al. 2010). Furthermore, it is important that systems are put in place both within a
facility and government agencies to enforce strict guidelines and periodic assessments of a
facilities patient satisfaction and orientation to elder abuse (Natan et al. 2010). Other resources to
help prevent elder abuse is offered through the College of Nurses of Ontario which believes in
speaking out to stop abuse. It is believed that elderly abuse will not continue if nurses begin to
intervene and stand up for their patients when they see abuse happening. If more people spoke up
others would be less inclined to mistreat an elder for fear of being ousted (CNO 2011). It is
stated (Natan et al. 2010) that if people do not speak up about abuse when they witness it that it

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becomes a norm because the actions are repeated and people get used to it. If these techniques
would get utilized more efficiently then it could help to lower or even prevent elder
maltreatment.
Conclusion
After reading the article I have learned that abuse can come in many forms and that not
everyone interprets behaviour the same. Some people may suffer from neural impairments or be
under pressure in the work environment and not know how to deal with certain situations that
arise. As a caregiver you are trusted by the elderly patient and they are dependent upon you.
Learning how to advocate for them and being able to provide quality care can begin to improve
(lower) the incidences of elderly abuse. I believe that if you have compassion, empathy and hold
yourself to a high moral standard that it will be portrayed in your nursing practice and any
elderly patient will be content and feel empowered to have a nurse like you!

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Reference
College of Nurses of Ontario. (2011). Preventing Client Abuse. Retrieved (February 24, 2014),
from http://www.cno.org/Global/docs/ih/47008_fsPreventAbuse.pdf?epslanguage=en

College of Nurses of Ontario. (2006). Therapeutic Communication & Client-Centered Care.

Retrieved (February 24, 2014), from http://www.cno.org/learn-about-standardsguidelines/educational-tools/learning-modules/therapeutic-nurse-clientrelationship/protecting-the-client-from-abuse/

Murphy, K. Waa, W. Jaffer, H. Sauter, A. Chan, A. (2013). A Literature Review of Findings in

Physical Elder Abuse. Canadian Association of Radiologists Journal, 64, 10-14.
Retrieved February 21, 2014 from CINHAL database.

Natan, B. Lowenstein, A. Eisikovits, Z. (2010). Psycho-social factors affecting elders

maltreatment in long-term care facilities. International Nursing Review 57, 113-120.
Retrieved February 21, 2014 from CINHAL database.