The identification and dealing with abuse among elder clients is difficult and comes with its challenges. The abuse is in most cases carried out by close family members. Elders’ abuse is in most cases closely knitted to family-related issues. This makes the victim to deny or make attempts to protect the abuser as a way of protecting the public image of a caring and loving family. The client being abused may fail to report due to the fear of engaging the criminal justice system and due to cognitive incapacity. The various forms of elder abuse include physical abuse, emotional abuse, and exploitation of material assets, sexual abuse and meditational abuse.
Comprehensive Geriatric Assessment
The assessment tool is a multidimensional, multidisciplinary diagnostic tool that is used to gather data regarding the medical, psychological, and functional levels as well as the limitation of elderly patients. The geriatric assessment is different from the normal standard medication as is mainly concentrated on the elderly individuals with complex problems. It also concentrates on determining the functional levels and quality of life. The assessment is comprehensive as it entails a team of providers. Such an assessment captures the prevalent problems including abuse that would have been missed during the standard medical evaluation. The primary care practitioner is normally resolves to use this assessment method upon detection of a problem (Ward & Reuben, 2016)
Elder assessment Instrument (EAI)
This is a 41-item Likert Scale assessment scale that has been in existence since 1984. The cases of elderly abuse and neglect in the hospital setting have been a serious case that has, in most cases, gone underreported by the clinical professionals due to lack of necessary and appropriate screening instruments. The EAI is made up of seven actions that review signs, symptoms, and subjective complaints related to elderly abuse, neglect, exploitation, and abandonment. The instrument has no definite score.
The assessment tool requires the forwarding of the patient to the social services when the conditions of evidence of mistreatment with no ample clinical explanation, subjective complaints from the elderly patient, symptoms of high risk or probable abuse, neglect, exploitation, and abandonment. The elderly assessment instrument is applicable in all clinical settings and should be completed by the clinicians in charge of the screening process. The assessment tool has been proved to reliable. The main strengths of the EAI are based on its rapid assessment potential (Fulmer, 2004).
Neglect among the elderly clients is a form of abuse that is perpetuated through failure to offer to an elderly person the care and help required for health, safety, and their wellbeing. Neglect is said to include failure to act or consistent inaction that puts the health and safety of the elderly person at a risk. Neglect may occur through failure to offer medical attention, failure to listen and respond to the expressed needs and concerns of the elderly, offering improper nutrition, not responding to calls for help, denying the elder an opportunity to get involved in activities and programs of socialization. The indicators of elderly neglect include inability to thrive, malnutrition, dehydration, poor living conditions, odor, and under or over medication.
Elder Abuse Suspicion Index
This assessment tool comprised of six questions aimed at raising a medical officer’s suspicion of elder abuse and evaluate whether the case warrants any further action such as reporting to the authority. For the questions, any “Yes response” to is an indicator and should prompt further enquiry. The EASU is a quick assessment tool that helps strengthen the reporting requirement. The assessment tool is useful in detection of risk, neglect, psychological, emotional, financial factors. The process of data collection takes about 2 minute. It is validated in family practices and ambulatory care settings.
Nursing interventions for Client Abuse and Neglect
Interventions for Abuse
This intervention is dependent on the acuity of the presentation. Hospitalization is important to provide treatment and protection for the victim while undergoing the evaluation process as well as legal investigation. Where positive results are acquired from the screening tests, actions taken are guided by the statutory reporting requirements. The nurses may be required to involve the local social services and APS to determine the alternative for disposition. The nurse is requires to make use of a safety in the care plan where carrying out interventions for abuse victims.
The law in most states places a mandate that requires the reporting of elder abuse. Mandatory reporting is considered a crucial prevention tool. The act of reporting brings the case of elder abuse to the attention of the relevant agency, service or authority charged with preventing the victimization. Having the nurses adhere to mandatory reporting works also as a means of increasing public awareness on the issue of elder abuse and also enhance the process of lookout for the suspect. The practitioners may however be faced with a dilemma of violating the trust with the clients that may hinder the therapeutic relationship. The process of mandatory reporting should be followed by commitment of resources to the designated reporting agency.
Interventions for Neglect
Preventing nursing home neglect. The nurses have a responsibility of preventing the falls and bed suffocations that occurs due to physical negligence in the nursing homes. The nursing staff should make sure they are readily available to assist the patients deal with mobility. There should also be a risk assessment to establish the patients at high risk for nursing home falls. These patients should be checked frequently.
Another intervention relates to improving sanitary and safety concerns. The nursing home residents’ nurses are required to ensure that the mattress should be flush with the bed frame or bed rails. This is necessary to prevent a scenario of a patient suffocating between the mattress and the railing. There should be a schedule for monitoring the changes in mobility and mental capability as well as other developing medical concerns.
Medical Complications that can occur due to Substance Abuse
Alcohol Abuse and Cardiovascular Disease
Excessive alcohol consumption has been found to be linked to increased risk of hemorrhages in the blood vessels of the brain. The excessive alcohol use has been associated with cardiomyopathy. It has also been said to create problems leading to increased risk of high blood pressure. It has been noted that the alcohol abuse has been considered as a risk factor in the development of hypertension which may also have an element of genetic susceptibility. This implies that the development of hypertension has been affected by differences in the gene for aldehyde dehydrogenase, which is an enzyme produce during the process of alcohol metabolism.
There is need to advice and education for cardiovascular disease patients especially those at increased risk of the disorders on the possible effects of drug abuse on the heart and blood vessels. It is necessary to carry out screening of cardiovascular disease and integrate this with patient education. The methods available diagnosing cardiovascular disorders include electrocardiography, echocardiography, magnetic resonance imaging, and angiography. It is highly important for patients with cardiovascular disorders should be advised on the potential dangers of alcohol and tobacco abuse. It is therefore important to let these individuals understand the importance of reducing the intake of these substances and discontinue their usage. Drugs useful in reducing pressure and cholesterol levels have adverse effects which tend to be magnified by alcohol abuse. The users of drugs need to be enlightened on the effects of the risk of cardiovascular disease.
It is no question that most of the abused drugs and other substances have divesting consequences on oral health. Cocaine, one of the most commonly abused drugs has been known to lead to movement disorder and buccolingual dyskinesia also referred as twisted mouth. Most heroine abuses are found to have more decayed, missing, and filled teeth in their mouths. Abuse of marijuana has been associated with an acidic erosion to enamel as a result of cannabinoid hyperemesis. Substance abusers have increases cases of dental carries, inflammation and hyperplasia. Abuse of meth causes the “Meth Mouth” phenomena, indicated by large carious lesions in the buccal smooth surface areas (Saini & Gupta, 2013).
Periodontal diseases involve inflammation of tooth supporting tissue. The major etiological agent for periodontal disease is identified as the dental plaque. . Dental caries and periodontal disease are said to occur more among the addicts as opposed to the general population. The addicts are known to ignore the dental visits. They also experience high rate of plaque accumulation as they are not keen on their oral hygiene.
The prevalence of periodontal diseases among the alcoholics has been connected to poor oral hygiene and lack of dental care. Alcohol has also been associated with contributing to effects on oral cavity such as oropharynx cancer, dental carries and missing teeth. This has been known to expose the user to greater risk of developing periodontal problems such as gingival infection.
Substance abusers should be encouraged to make regular visits to the dentists. The lifestyle of an addict makes this quite difficult to maintain the regular appointments. The vital signs need to be observed during every appointment. Oral health providers are required to ensure that anyone suspected of drug abuse to sign a statement to show that drugs have not been taken within the previous one day. Management depends on whether the patient is intoxicated to simply indicate signs of alcohol abuse. The dental hygienist requires the use of medical history information on top of extra-oral observation and clinical examination to identify the patient with substance abuse problems. Anti-carries agents need to be recommended where need be and antifungal therapy should also prescribed by dentist. When the patient is in recovery, an opioid-containing analgesic can lead to recovery failure and stimulate the person to resume abusing opiates. The alcohol users should not prescribed with acidic drugs such as aspirin and non-steroidal anti-inflammatory drugs to avoid the risk of bleeding in the stomach.
DePanfilis, D. (2006). Child Neglect: A Guide for Prevention, Assessment, and Intervention. US Department of Health and Human Services.
Lipovsky, J., & Hanson, R. (2014). Treatment of Child Victims of Abuse and Neglect . Child Law.
Saini, G., & Gupta, N. P. (2013). Drug Addiction and Periodontal Disease. Journal of Indian Societal Periodontol, 587-591.
Strachan, M., & Durfee, M. (2003). Child Abuse and Negelect: Guidelnines for Identification, Assessment, and Case Management. Volcano Press.
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