Lesson 13: Elder Abuse & Capacity

Attention

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Identify the risk factors and "red flags" associated with elder abuse
  • Identify potential barriers to interventions in elder abuse
  • Identify the processes associated with assessment for capacity
  • Identify the legal and ethical differences between POA and Guardianship

Teaching

Defining Elder Abuse

  • Physical abuse, the intentional infliction of physical pain or injury
  • Sexual abuse, nonconsensual sexual contact
  • Psychological abuse, the intentional infliction of emotional distress
  • Financial exploitation, inappropriate and nonconsensual use of assets for another's benefit
  • Neglect, refusal or failure of caregivers to provide necessary care
  • Self-neglect, behaviors that threaten an older person's health, safely, and well-being
  • Miscellaneous forms of abuse, violations of personal rights (e.g. respect for dignity and autonomy, medical abuse, and abandonment)
  • Click HERE to visit the website of the National Committee for the Prevention of Elder Abuse

Most victims of elder abuse are frail and chronically ill...they are vulnerable to the abuse.

Older women are more often abused, but possibly because they are more likely to report it.

As with any form of abuse, you are required to report.

Risk Factors

  • Transgenerational family violence theory assumes that violence is a learned behavior
  • Stress of caregiving and caregiver psychopathology
  • Person is physically dependent on caregiver, caregiver is financially dependent on person
  • Perpetrator's characteristics

Review the Signs of Abuse

Read website article: Detecting Elder Abuse and Neglect: Assessment and Intervention

  • Physical Abuse
  • Sexual Abuse
  • Emotional or Psychological Abuse
  • Financial Exploitation
  • Self Neglect
  • Violations of Human Rights
  • Undue Influence

Assessment of Patient Safety and Care Planning

  • Immediate safety
  • Health and need for treatment
  • Resources
  • Cognitive functioning
  • Psychological functioning
  • Suspected perpetrators
  • Social and financial resources
  • Intervention---the care plan of the Case Manager

Read info on Statistics of Elder Abuse

Read list of Barriers to getting help

Mistreatment in Long-term Care Settings

Information about abuse of residents in Long-Term Care facilities - Elder Abuse Long Term Care Fact Sheet (2012)

Here are the next steps if you ... suspect abuse, neglect or exploitation

Capacity

"The concepts of capacity and competency embody complex value systems about liberty, personal choice, autonomy, and aging as well as clinical, ethical, and legal concerns" (Cohen & Eisdorfer, 2011, p. 183).

Assumptions about Age and Competence

  • Legal statutes exist related to persons under 18
  • No legal statutes exist related to older persons vs. younger persons
  • Ageism is a destructive influence
  • Beliefs that advancing age inevitably leads to a general decline in the abilities to function independently
  • Personal expectations by older people to participate in their own decisions

Measuring Mental Capacity

  • Physical and mental state
  • Medication effects
  • Individual's attitude
  • Setting of the examination
  • Attitude and approach of the examiner

There are six pillars to assessing capacity. The Maine Capacity Assessment document below shows how capacity may be assessed using the six pillars (or domains): Maine Capacity Assessment

Issues related to Capacity

  • Capacity to Consent to Treatment
  • Capacity to Consent to Research
  • Testamentary Capacity
  • Conservatorship and Guardianship
  • Alternatives to Guardianship
    • Mediation
    • Advanced Planning / Advanced Directives (Patient Self Determination Act)
  • Health Care Decision Making

Click HERE to visit the State of Maine Guide to Guardianship (and alternatives to guardianship)

Review the material HERE to introduce yourself to the processes involved in determining guardianship.

Click HERE to view the forms used for Advanced Directives

Read the article about Assessment of Capacity in Older Adults

Assessment

Lesson 13 Discussion (online course only)

The role of a Power of Attorney (POA) is often overstated in long-term care settings. Individuals with a Health Care POA can access medical records of the client and can participate in decision making, but it is not guardianship or a Durable Power of Attorney. Discuss how you might work with an individual who is "demanding" more information or decision making ability but only possesses a Health Care POA. Consider also that as a professional we always want the family members, including the one with the Health Care POA to be involved in their family member's care, maybe just not quite so much. You may relate personal experience in these types of situations to this discussion.

Lesson 13 Quiz

  1. Summarize (briefly) the "six pillars" involved in the assessment of capacity.
  2. Research the web/internet for resources as to the differences between a Health Care Power of Attorney (POA), a Durable POA, and a Guardian. In your answer make it clear when you are talking about each and include a reference (or references) to where you got the information.