Question

Family Violence in Later Life, Elder Mistreatment in Institutional Settings and Elder Sexual Abuse

Examples of family violence in later life, institutional elder mistreatment and elder sexual abuse.[i]

1. APS was called because Mr. Felipe, age 63, was abandoned by his son at a local motel. The son did not pay his father’s motel bill, but continued to cash his father’s Social Security checks. Mr. Felipe was taken from the motel to the hospital for stabilization and treatment. He had uncontrolled hypertension and muscle weakness on his right side with contractures. He had mild dementia and severe depression. He also had a history of seizures and right-sided paralysis due to a stroke. He was completely unable to care for himself. He has a caring brother and sister-in-law, but his son denied him access to all other family members.
2. At age 96, Mr. Connell was living in a nursing home. He was in the last stage of Alzheimer’s disease, was totally bedridden and could not feed or toilet himself. When his daughter visited him, she often found him lying in his own excrement. He had advanced pressure ulcers on his tailbone and heels, as well as bruises around his mouth.
3. After a neighbor’s report, APS found Mrs. Stott, age 78, in her home. She was bedridden and sleeping on a urine-soaked cot. She was brought to the hospital by medics. While she was in the hospital, her adult son visited regularly. Staff described him as “creepy” and would cover their nametags when they saw him coming to avoid having to deal with him. A night nurse walked in to Mrs. Stott’s room and found her son with his head between his mother’s legs. He said he was “cleaning his mother” because staff members were not doing it properly.

Questions related to the above examples:

• For each case, what is the alleged perpetrator’s relationship with the victim? Where did the mistreatment occur (community or institution)? What types of mistreatment do you think occurred? How does the perpetrator use the victim’s vulnerabilities to control or exploit him/her? Is the victim able to reach out for help?
• What are challenges that nurses might face when presented with these different types of cases?

[i] Examples excerpted either directly or with slight adaptation from B. Brandl, C. Bitondo Dyer, C.J. Heisler, J. Marlatt Otto, L. Stiegel & R. Thomas, Elder abuse detection and intervention: A collaborative approach (New York: Springer Publishing Company, 2007), 64-71.

Answer 1

1.Mr.Felipe's case

• The perpetrator is the victim's son
• The mistreatment occured in the institution because the victim is living in the motel
• It is a form of domestic violence (financial abuse by not paying the motel bill,emotional abuse by not allowing the family members to ses him)
• The perpetrator used the vulnerability of the victim to control him of his social security checks
• The victim was able to get help from the motel owner
• The nurses challenge are
  • To advocate on behalf of victim
  • To treat and care for his mwdical long term illness

2.Mr.Connnel

• The perpetrator is the staff's in the nursing home
• The mistreatment occurred in the institution (nursing home)
• The type of mistreatment occurred here is medical negligence or medical malpractice by not treating and caring for the patient and causing harm or injury
• The perpetrator used the victim's vulnerabilities to exploit by causing known harm
• The nurse challenges are
  • To provide the patient with the basic care
  • To ensure proper medical treatment
  • To prevent injuries, infection and manage pain

3.Mrs.Stott

• The perpetrator is the victim's son
• The mistreatment occurred in the institution by the victim's son in the hospital
• This is a type of sexual abuse by the son
• The perpetrator used the victim's vulnerabilities to exploit her sexually
• The victim in the home was bedridden and as a result of it ,was not able to reach for help
• The challenge which can faced by the nurse are
  • To handle the son who is sexually exploiting his mother
  • Advocate on behalf of patient
  • Provide her basic care
  • To provide psychological support