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Effectively Detect and Manage: ELDER ABUSE

Nurse Practitioner, Aug 2004 by Brown, Kathleen, Streubert, George E, Burgess, Ann W

Nurse practitioners are often in a position to initiate proper intervention and investigation when elder abuse is detected. Unfortunately, unless there are obvious signs of injury, elder abuse may be difficult to uncover.

Studies indicate that injured elderly persons differ from the injured younger population in terms of cause of injury, response to injury, and outcome.1"1 Nurse practitioners (NPs) are often in contact with older people and are in a position to not only detect abuse, but also initiate proper intervention and investigation. Unfortunately, unless there are obvious signs of injury, elder abuse may be difficult to detect.

* Causes of Injury

More Articles of Interest: Elder Abuse and Neglect Assessment; Elder abuse; Elder abuse: a call to action for forensic nurses; Action stat: Dislodged chest tube; Combating elder abuse

Falls are the most common cause of injury for the elderly, followed by motor vehicle accidents, pedestrian accidents, and stab and gunshot wounds.1'5'6 Unintentional injury is the eighth leading cause of death in all Americans over the age of 65 years.1 In contrast, motor vehicle accidents are the number one cause of injury for the younger population, followed by stab and gunshot wounds, falls, and pedestrian accidents.

Elderly people can also be injured intentionally as victims of assault and sexual abuse. Although not as well published as child assault and abuse, elder assault and abuse occurs in alarming numbers. There are no estimates of the incidence or prevalence of elder sexual abuse, in the general community, but the National Citizens' Coalition for Nursing Home Reform (NCCNHR) counted 1,749 cases of such abuse between 1996 and 1999 in the institutionalized elderly.7 For the fiscal year 2000, of the 15,010 total cases of abuse, gross neglect, and exploitation complaints in nursing homes reported to the NCCNHR, 662 were for sexual abuse. Of the 3,684 cases of abuse, gross neglect, and exploitation complaints in board and care facilities in fiscal year 2000, 201 were for sexual abuse. The Centers for Disease Control and Prevention reports that in 1999,32,219 people over the age of 65 died of unintentional injury. An unknown percentage of these cases were believed to be related to abuse or assault.

* Response to Injury

Because age affects the body's ability to respond to injury and disruptions in physiologic balance, the elderly recover at a slower rate from minor injury than younger people. Elderly persons may have preexisting diseases, but several studies suggest that chronic disease does not influence survival from trauma. The trauma itself creates morbidity and mortality.

* Outcome

Elderly people demonstrate decreased survival rates when compared to younger people with the same or similar injuries.3 A disparity is also noted for minor injury. The elderly are twice as likely as younger people to suffer serious injury in the commission of a crime and they require more hospitalization after a crime than any other age group.8

The nurse practitioner (NP) who conducts a forensic examination of an elderly victim must obtain consent from the victim and/or the victim's caregiver, provide emotional support during the exam, and follow the protocol for an evidentiary examination (photographing injuries and collecting evidence). The victim should be questioned alone, without the caregiver present, followed by questioning with the caregiver present. The reason for this is the possibility that the caregiver is also the abuser.

* Detection of Injury

Skin and Mucous Membrane

As one ages, skin becomes thin, loose, and transparent, and its vascularity decreases. The skin of the elderly is also atrophie, making it more fragile. The lighter the skin, the more it tends to look pale and opaque with age. An older sexual assault victim has more skin and mucous membrane injury than a younger victim due to the fragility of the skin and mucous membranes.

The fragility of the vessels in and under the skin also creates bruising in the elderly. Elderly people bruise under a force or pressure that would not create bruising in younger people.

In younger persons, the color of a bruise changes with time. A purplish red discoloration appears first, often accompanied by swelling. The bruise changes to dark purple within days, followed by a greenish yellow color as the bruise heals. The process of dating an accidental bruise in an elderly victim is currently under investigation. Until that research process is complete, an accurate description of observed bruising should include location, shape, and color of the bruise without any reference to the time or date when the bruise or bruises may have occurred.

It is also important that NPs document each observed injury using the appropriate terminology. An abrasion is a wound caused by rubbing or scraping the skin or mucous membranes. A bruise is caused by a blunt force injury that results in superficial discoloration of the skin due to hemorrhage into the tissue from ruptured blood vessels beneath the skin's surface, without broken skin. A bruise is also called a contusion. Ecchymosis is a hemorrhagic spot or blotch, larger than petechia, in the skin or mucous membranes forming a nonelevated, rounded, or irregular blue or purplish purpuric patch.9

Health Care Industry

Effectively Detect and Manage: ELDER ABUSE

Nurse Practitioner, Aug 2004 by Brown, Kathleen, Streubert, George E, Burgess, Ann W

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