Question

What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family? Discuss your facility's procedure for reporting these types of abuse.

Answer 1

Domestic Violence (Intimate partner violence, Spousal Abuse) is defined as Physical, psychological, and/or sexual abuse in the home

Child abuse is defined as Physical or emotional injury/neglect or sexual acts inflicted upon a child

Elder abuse is defined as any form of mistreatment that results in harm or loss to an older person (Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable older person)

As a health care provider, we have to assess and suspect these types of violence within a family and take necessary actions to prevent or avoid this.

As a health care provider first of all, before occurring violence, we have to suspect the characteristics of a vulnerable person and characteristics of a Perpetrators

*Characteristics of a Perpetrators:

• Their needs are more important than the needs of others
• Low Self Esteem
• Extreme pathological jealousy/possessiveness
• May control family finances
• Likely to abuse alcohol or drugs
• Poor social/coping skills
• Relationship with partner enmeshed and co-dependent

*Characteristics of a Vulnerable person:

• Represent all age, racial, religious, cultural, educational, and socioeconomic groups
• Often have low self-esteem
• Poor mental/physical health
• Maybe without adequate support systems
• Many grew up in abusive homes
• Dependent on perpetrator
• Increased risk for violence when Independence is sought
• The greatest risk for violence when the partner attempts to leave the relationship

*Elder Abuse - Physical Abuse - Warning Signs:

• Elder's report of being hit, slapped, kicked, etc.;
• Findings of medication over or under-utilization
• Signs of being punished or restrained
• Elder's sudden change in behavior
• Caregiver's refusal to allow visitors to see an elder alone

Impact of abuse :

• Earlier morbidity (predictable downward spiral for victims);
• Loss of belief in own ability to make decisions, trust in others, trust in "the system", ability to develop intimate relationships; Physical problems related to stress;
• Loss of financial resources needed for health needs;
• Depression
• Suicide and attempted suicide

-Children who witness violence :

• After age 5-6 show an indication of identifying with the aggressor and losing respect for the victim
• Are at greater risk for developing behavioral and emotional problems throughout their life

-Adolescents are more likely to exhibit :

• Failing grades
• Difficulty forming relationships;
• Increased incidence of theft, arrest, and violence
• Promiscuous behaviors
• Running away from home

*Why abuse is not reporting :

• Ageism
• Disbelief, lack of knowledge of signs of abuse
• Lack of knowledge of reporting procedures
• Reluctance or fear of confronting the offender
• Fear of jeopardizing the relationship with elder or elder's family
• Mistreated person requests it not be reported

*Facility's procedure for reporting abuse :

If you suspect abuse, follow the chain of command: instructor, charge RN, case manager, security, (Adult Protective Services)APS, police; APS will consult with you about the case: if they believe a report needs to be made, they will take the necessary information from you;

Majority of states have mandatory reporting laws in place.

*Role of Adult Protective Services (APS ):

• Receives and investigates incidents of abuse, neglect, or exploitation of an incapacitated or vulnerable adult
• Offer services to consenting elders
• Can involve a Public Guardian to seek court involvement, mandatory placement, the appointment of decision maker for the person without capacity.

*Information to Report:

• Victim (name, address, DOB, telephone
• Description of problem
• Alleged perpetrator (name, address, phone
• Relationship to victim
• Police report numbers if available