بدرفتاری و غفلت در سالمندان

بدرفتاری و غفلت در سالمندان

اسلاید 1: Elderly abuse and neglect دکتر احمد باقری مقدممتخصص پزشکی ورزشیسرپرست پژوهشی پزشکی قانونی

اسلاید 2: مقدمهروند رو به تزاید جمعیت سالمندانپدیده جدیدحوزه پیچیده ومشکل

اسلاید 3:

اسلاید 4: در ایرانسال 1375 جمعیت سالمندان 3977000 معادل 6/6 درصدسال 1385 جمعیت سالمندان 5119000 معادل 7/3 درصد

اسلاید 5: What is elder abuse?تمام اشکال سوء رفتار با سالمند را سالمند آزاری میگوینددر تعریف دیگر فعل یا ترک فعل آسیب رسان به سالمند را گویندElderly abuse was defined as an act or omission which results in harm or threatened harm to the health or welfare of an elderly person.

اسلاید 6: Incidence of elderly abuse Abuse in institutional settings is difficult to measure, yet is thought to exceed that in community settings. In the USA,10% of nursing staff in institutional settings admitted committing physical and 40% psychological abuse against residents .

اسلاید 7: میزان گزارش بسیار متغیر است و بستگی به تعاریف دارد“mistreatment of adults, including abuse, neglect, and exploitation, affects more than 1.8 million older Americans” (Pavlik, Hyman, Festa, Bitondo, andDyer, 2001, p. 45)self-neglect accounts for one-third to one-half of all abuse cases (Gray-Vickrey, 2000, 2004; Levine, 2003; Paris, 2003)شایع ترین نوع آن خود غفلتی است self neglect است که تشخیص آن نیز بسیار مشکل است

اسلاید 8: سالمند آزاری فیزیکی در شهر اصفهان پایین است و بیشترین نوع آزار به سالمندان از نوع استفاده از اموال بدون رضایت سالمند می‌باشد.

اسلاید 9: Distribution of Abuseتقریبا بین زنان و مردان مساوی است ولی برخی تحقیقات نشان داده در مردان بیشتر بوده است.الگوی آزار بسیار فرهنگی است و در بین جوامع مختلف و محل های مختلف متفاوت است.( خانه یا بیمارستان و شهر های مختلف)

اسلاید 10: Perpetrators of Abuse آزار رسان ها چه کسانی هستند؟ elder abuse can be perpetrated by nearly anyone including: paid or volunteer caregivers medical and long-term care employees, family membersstrangers such as a person who befriends an elderly person for the purpose of exploiting them

اسلاید 11: Who is Committing the Abuse?

اسلاید 12:

اسلاید 13: Risk factors for elderly abuseThe intensity of an elderly person’s illness or dementia Social isolationThe elder’s role, at an earlier time, as an abusive parent or spouse A history of domestic violence((خشونت خانگی in the homeDependency factor related to the abused elderly:

اسلاید 14: Inability to cope with stress (lack of resilience) Depression, which is common among caregivers Lack of support from other potential caregivers The caregiver’s perception that taking care of the elder is burdensome and without psychological reward Substance abuse factors related to the abuser:

اسلاید 15: Greatest Risk Factors for Causing Abuse being malebeing relatedhistory of mental illnessrecent decline in mental healthabusing alcoholprimary caregiverchange in family roles from being cared for to being the care providerprior history of violence

اسلاید 16: Types of elder abuseAbuse by others FrequencyPhysical16%Sexual2%Financial29%Neglect27%Abandonmentترک 1%Isolation2%Abduction ربایش0.2%Psychological24%

اسلاید 17: Physical abuse Physical abuse means at least one act of physical violence against the elderly

اسلاید 18: Forms of physical abuse Direct beatingsHittingSlappingCuttingBurningshakingUnreasonable physical restraintsMaltreatment of medical conditionsSexual assaultProlonged deprivation of food or water.

اسلاید 19: Sings of physical abusebruises Broken bones, sprains, or dislocations Report of drug overdose or apparent failure to take medication regularly Broken eyeglasses or frames Signs of being restrained, such as rope marks on wrists Caregiver’s refusal to allow you to see the elder alone

اسلاید 20:

اسلاید 21: BruisingA bruise, or contusion, occurs when blunt forces distort soft tissues to an extent sufficient to result in disruption and leakage of blood vesselsEscape of blood from blood vessels produces discoloration

اسلاید 22: When is bruising suspicious trauma versus accidental trauma? Which looks more like abuse: A or B?AB

اسلاید 23: Accidental or Inflicted? You decide

اسلاید 24: Accidental or Inflicted? You decide

اسلاید 25: Bruising Study con’t

اسلاید 26:

اسلاید 27: Location of Bruises Caused by Abuse

اسلاید 28: Patterned InjuryAn injury that possesses features or configuration with objects or surfaces that produced it

اسلاید 29: BruisingPhysically abused older adults had significantly larger bruises than those in comparison group who were not abused and more knew the cause of their bruises

اسلاید 30: Patterned InjuryGrip marks around arms or neckRope marks or welts on wrists or anklesImprints from belts, belt buckles, straps, cords, hangers, hairbrushes, combs, cigarettes and cigarette lighters Handprints, fingerprints, knuckle prints and footprints More on strangulation…More on burns…

اسلاید 31: FractureBroken bones Includes severing of the bone or compression of intact bone

اسلاید 32: AvulsionThe tearing away of a structure or part; often seen as a partial avulsion

اسلاید 33: AbrasionA wound in which the outermost layer of the skin is removed by a compressive or sliding force

اسلاید 34: LacerationBlunt force injuries resulting from tearing, ripping, crushing, overstretching, pulling apart, bending and shearing soft tissue. Lacerations are usually found over a bony surface and are ragged or irregular in appearance

اسلاید 35: Incision, known as a cut, is a wound made by a sharp instrument or object, such as a scalpel, knife, razor or paper coming against the skin with pressure to cause an injuryIncision35

اسلاید 36: Stab WoundResult whenever a sufficiently sharp and narrow object is forced upward Unlike a cut, depth exceeds width in stab wounds

اسلاید 37: Mechanical RestraintsMeans of controlling behavior, especially in hospitals and nursing facilitiesOnly acceptable reason for temporarily restraining someone is to prevent significant harm

اسلاید 38: Sexual abuse is unwanted sexual contact with an elder including touching, sexual assault, and rape or sodomy

اسلاید 39: Sexual Abuse Sexual abuse is unwanted sexual contact with an elder including: touching , Fondling نوازش کردنsexual assault(rape or sodomy)Verbal or suggestive behavior Unnecessary help with dressing/hygiene

اسلاید 40: Signs of sexual abuse Signs Bruises around breasts or genitals Unexplained venereal disease or genital infectionsUnexplained vaginal or anal bleeding Torn, stained, or bloody underclothing

اسلاید 41: Neglect The failure of a designated caregiver to meet the needs of an elderly person, and withholding of physical, material, or emotional necessities of physical and mental health, whether intentionally or unintentionally.

اسلاید 42: This includes failure to assist in personal hygiene or the provision of clothing for an elder, failure to provide medical care for the physical and mental health needs of an elder, and failure to protect an elder from health and safety hazards.

اسلاید 43: NEGLECTDenial of care: food, water, shelterpersonal hygiene, clothing, beddingmedical care, medicines, assistive devices Isolation:control of time, activities, contacts disinformation tacticsfalse imprisonment

اسلاید 44: Minimal personal care

اسلاید 45: Passive Neglectناتوانی غیر عمدی به انجام تعهدات مراقبتاعمال دیسترس بدون قصد آگاهانه و یا عمدی

اسلاید 46: Active Neglectشکست عمدی به تعهدات مراقبت، اعمال استرس جسمانی یا عاطفی و یا آسیب رها کردن، محرومیت از غذا، دارو، بهداشت شخصی

اسلاید 47: SELF-NEGLECTBasic activities of daily living are neglected, threatening personal health and safety:hygienefood, waterclothing and beddingshelter and surroundingsfinanceshealth care

اسلاید 48: Signs of neglect Malnutrition, dehydrationLack of personal careInadequate heatingUnclean clothes or beddingLack of needed medications, eye glasses, hearing aids, or dentures Contractures, decubitus ulcers, wasting and muscle atrophy

اسلاید 49: Psychological abuse or emotional abusePsychological abuse is more difficult to define and operationalize. Usually defined as an act carried out with the intention of causing emotional pain or distress. Psychological abuse often accompanies physical abuse. Emotional abusers can use verbal and non verbal to inflict elder damage.

اسلاید 50: Psychological AbuseHumiliationتحقیرIsolationانزواIntimidationارعابThreatsتهدیدRemoval of decision making powersVerbal insults, yellingتوهین کلامی، فریاد

اسلاید 51: Verbal forms of emotional elder abuse تهدید و ارعاب از طریق فریاد فحشدستورات سختتحقیر و تمسخرسرزنشNonverbal psychological elder abuse :نادیده گرفتنجدا کردن از دوستان جلوگیری از ملاقاتی

اسلاید 52: Signs of psychological abuseAnxiety (mild to severe) .Depression, hopelessness, helplessness, thoughts of suicide Confusion, disorientationTrembling((لرزش دست و بدن lack of eye contact Agitation

اسلاید 53: Abandonment و رها کردن ترکIn addition to an actual complaint by older person of being deserted, signs of possible abandonment include:A vulnerable older adult with cognitive and physical impairments is left at a hospital emergency department without caregiver contact informationA vulnerable older adult with cognitive impairments is put on a bus with a one-way ticket to another town or state A vulnerable older adult with cognitive impairments is left at a public building

اسلاید 54: Financial or material abuse از دست دادن غیر قابل توضیح درآمد، دارایی ها، اموال، کمبود غذا، از دست رفته پرداخت وام هاهر سرقت یا سوء استفاده از پول یا اموال افراد مسن توسط فرد مورد اعتماداختلاس یا سوء استفاده از منابع مالی و یا اموالForms of financial abuse :- سوء استفاده های شخصی چک، کارت های اعتباری، و یا حساب های سالمندانسرقت پول نقد، چک، درآمد، و یا کالاهای خانگیجعل امضا سالمندان

اسلاید 55: Institutional elder abuse Refers to abuse that occur in residential institutions such as nursing facilities usually by someone who is paid caregiver, such as nursing facility staff member. Residents at the greatest risk for institutional abuse or neglect includes resident with dementia, resident who seldom have visitorsDomestic abuse Refer to forms of maltreatment by someone who has a special relationship with the elder such as family member or caregiver

اسلاید 56: recognition of elder abuse: examination

اسلاید 57: Detection and Treatment Barriers detection of elder abuse is difficult because denial is an integral feature of abuse, victims may feel too ashamed to disclose maltreatment or believe they are to blame for or deserve the abusedependence on an abuser can make a victim reluctant to report for fear of how he/she will survives without the perpetrators help

اسلاید 58: Detection/Treatment Barriers (continued)ممکن است این آزار ها در یک جامعه ، نرمال تلقی شودممکن است سالمند به دلیل مشکلات بینائی یا شنوائی یا ادراکی و یا به دلیل زندانی و محدود شدن قادر به گزارش سوء رفتار نباشد

اسلاید 59: Detection/Treatment Barriers (continued)گذر زمان و بروز اختلالات شناختی گزارش آزار را دشوار میکند.physical injuries may be masked by clothing or by isolating the victim

اسلاید 60: Detection/Treatment Barriers (continued)وجود یک سرویس مشخص و حمایتی است که میتواند به گزارش سوء رفتار بینجامد.عدم وجود آمار های کافی نیز مانع شناخت این پدیده است

اسلاید 61: Preventing elder abuse and neglect Preventing elder abuse means doing three things:Listening to elderly and their caregivers Intervening when you suspect elder abuse Educating others about how to recognize and report elder abuse

اسلاید 62: Reporting elder abuse If you are an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust.

اسلاید 63: Protective Measures توصیه هایی به سالمندStay sociable and activeStay involved with neighbors, friends, church or musque or community activitiesGet regular medical and dental careOpen and post your own mailIncrease social network as you ageHave friends visit you at homeHave a “best friend” with whom you can confide inKeep in touch with old friends if you move

اسلاید 64: Instructions to a concerned friend or family memberWatch for warning signs that might indicate elder abuse. If you suspect abuse, report it. Take a look at the elder’s medications. Does the amount in the vial matched with the date of the prescription? Watch for possible financial abuse. Ask the elder if he may scan bank accounts and credit card statements for unauthorized transactions. Call and visit as often as you can. Help the elder consider you a trusted confidante. Offer to stay with the elder so the caregiver can have a break — on a regular basis, if you can.

اسلاید 65: Instructions to the elderly Make sure your financial and legal affairs are in order. If they aren’t, enlist professional help to get them in order, with the assistance of a trusted friend or relative if necessary. Keep in touch with family and friends and avoid becoming isolated, which increases your vulnerability to elder abuse. If you are unhappy with the care you’re receiving, whether it’s in your own home or in a care facility, speak up. Tell someone you trust and ask that person to report the abuse or neglect.

اسلاید 66: با سپاس از توجه شما

اسلاید 67: Forms of Abuse

اسلاید 68: Forms of Abuse (continued)

اسلاید 69: Forms of Abuse (continued)

اسلاید 70:

اسلاید 71: Indicators of Abuse

اسلاید 72: Indications of Abuse (continued)

اسلاید 73: Indications of Abuse (continued)

اسلاید 74: Thank you

اسلاید 75: Elder AbuseThe Forgotten Side of Domestic ViolenceKay Hurd, RN, MSN

اسلاید 76: Who Is Being AbusedThe US has:44 million persons age 60+.36 million people with disabilities.364,512 cases of people living at home were reported with 43% confirmed.In the last 10 years abuse of elder persons has increases 150+%.Domestic Elder Abuse is a family problem, almost 90% of the abusers were family members.

اسلاید 77: Who Are The AbusersMore than 2/3rds of the abusers are family members of the victims and are typically serving in the care-giving role.

اسلاید 78: Risk FactorsDomestic Violence grown old.A partnership in which one member of the couple has traditionally exerted power and control over the other through emotional abuse, physical violence and threats, isolation and other tactics.

اسلاید 79: Risk Factors - ContinuedPersonal problems of the abusers.Adult children who are still dependant upon parent for financial assistance, housing or other means of support.Mental Illness.Substance Abuse.

اسلاید 80: Risk Factors - ContinuedCaregiver stress.Cycle of violence is learned behavior transmitted from one generation to the next.Personal characteristics of the elder.Dementia.Disruptive behavior.Problematic personality traits.Significant needs of assistance.

اسلاید 81: Amendments to Older Americans ActFirst appeared in 1987 and Provided Definitions

اسلاید 82: Domestic Elder AbuseDomestic Abuse Grown Old.Maltreatment of an older person by someone who has a special relationship with the elder. (e.g. spouse, sibling, child, friend, caregiver).Spouses make up a large % of elder abusers. Partnerships in which one member of a couple has traditionally tried to exert power and control over the other.

اسلاید 83: Institutional Elder AbuseAbuse that occurs in residential facilities for older persons. (e.g. nursing homes, foster homes, group homes, board and care facilities.Abusers are persons who have legal or contractual obligation to provide elder victims with care and protection. (e.g. staff, professionals, paid caregivers).

اسلاید 84: Self-neglect – Self-abuseSelf Neglect is behavior of an elderly person that threatens his/her own health/safety.*Self-neglect EXCLUDES a situation in which a mentally competent person who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her safety as a matter of personal choice.

اسلاید 85: Signs of Self-NeglectDehydration, malnutritionUntreated medical conditionsLack of necessary medical aidsHazardous or unsafe living conditionsUnsanitary or unclean living quartersInappropriate and/or inadequate clothingHomelessness

اسلاید 86: Physical AbusePhysical force that may result in bodily injury, physical pain or impairment.Striking with or without an object.

اسلاید 87: Signs of Physical AbuseBruises, black eyes, welts, lacerations.Rope/restraint marks.Open wounds, cuts, punctures, untreated injuries in various stages of healing.Sprains, dislocations, internal injuries.

اسلاید 88: Signs of Physical Abuse – continuedLaboratory findings of medication overdose.An elder’s report of being hit, slapped kicked or mistreated.An elder’s sudden change in behavior.The caregiver’s refusal to allow visitors to see and elder alone.

اسلاید 89: Sexual AbuseSexual abuse is non consensual sexual contact of any kind with an elderly person.It includes unwanted touchingSexual assault or battery such as rape, sodomy, coerced nudity and sexually explicit photographing.

اسلاید 90: Signs of Sexual AbuseBruises around breasts or genital area.Unexplained venereal disease or genital infections.Unexplained vaginal or anal bleeding.Torn, stained, or bloody underclothing.An elder’s report of being sexually assaulted or raped.

اسلاید 91: Emotional or Psychological AbuseThe infliction of anguish, pain, or distress through verbal or nonverbal acts.Includes, verbal assaults, insults, threats, intimidation, humiliation, harassmentTreating the older person like an infantIsolating an elderly person from his/her family, friends or regular activities.Giving an older person the “silent treatment” or enforced social isolation.

اسلاید 92: Signs of Emotional/Psychological AbuseEmotionally upset or agitatedExtremely withdrawnNon-communicative or non-responsiveUnusual behavior usually attributed to “dementia” (e.g. sucking, biting, rocking)

اسلاید 93: NeglectThe refusal or failure to fulfill any part of a person’s obligations or duties to an elder.Failure of a person who has fiduciary responsibilities to provide for an elder.Failure to provide an elderly person with necessities, food water, clothing, shelter, personal hygiene, medicine, comfort, personal safety.

اسلاید 94: AbandonmentThe desertion of an elderly person by an individual who has assumed the responsibility for providing care to the elder, or by the person who has physical custody of the elder.

اسلاید 95: Financial or Material ExploitationThe illegal or improper use of an elder’s funds, property, or assets.Cashing an elder’s checks without authorization or permission.Forging an elder’s signature,Misusing or stealing an elder’s money or possessions,Coercing or deceiving an elder into signing any document, (contracts or wills).Improper use of guardianship or power of attorney.

اسلاید 96: Signs of Financial or Material Exploitation.Sudden changes in bank account or banking practice.Inclusion of additional names on a bank signature card.Unauthorized banking, remaking of wills, advanced directives, or other legal matters of any kind.

اسلاید 97: Is Elder Abuse a Crime?Physical, sexual, and financial/material abuses are considered crimes.Certain emotional abuse and neglect are subject to criminal prosecution.SELF-NEGLECT IS NOT CONSIDERED A CRIME.

اسلاید 98: Where to Find HelpAdult Protection Services.Somerset County Adult Protective Services. Board of Social Services. Somerville, 08876. 908-526-8800.Someone from the Agency will investigate reported cases.Provide victims with treatment and protective services.Local Police, sheriff’s offices and prosecuting attorneys will investigate and prosecute abuse.Long distance caregivers can call a nationwide toll-free number. (1-800-677-1116).

اسلاید 99: Health education to prevent elder abuse Instructions to a caregiver:- If the caregiver overwhelmed by the demands of caring for an elder, instruct (he /she ) to do the following:Request help, from friends, relatives, or local respite care agencies, so you can take a break, if only for a couple of hours. Find an adult day care program. Stay healthy and get medical care for yourself when necessary. Adopt stress reduction practices. Seek counseling for depression, which can lead to elder abuse. Find a support group for caregivers of the elderly. If caregiver is having a problems with drug or alcohol abuse, get help.

اسلاید 100: Protective Measures (continued)Keep your possession organizedTell someone you trust where your important paperwork and bank account information is keptHave checks direct deposited into your accountUse an answering machine to screen phone callsDon’t leave cash or valuables visibleNotify the police if you will be away from home for an extended time period

اسلاید 101: Protective Measures (continued)Consult with an attorneyMake arrangement for the future such as power of attorneyGet legal advise before making/signing agreements regarding your care or possessionsBe aware of your financial situation

اسلاید 102: Protective Measures (continued)Know where to ask for helpFind out about community resources before you need them such as rape and abuse hotlines, senior centers, and adult protective servicesmental health service centerscrisis centersprivate counselorsclergylocal police