Elder Abuse In Patients With Dementia By Cares - Dissertation Example

Elder Abuse In Patients With Dementia By Cares Introduction Dementia is a general term used to mean progressive situations that grow as a result of degenerative modifications in the brain. Dementia predominantly affects older people and is described by the loss of cognitive, social and behavioral meanings that impacts a person’s attitude and temperament and the capability to reason, speak, figure out, reason, talk and recall and accomplish basic self-care functions like wearing and eating (Means & Langan, 1996). As dementia develops, the related behavioral and functional incapacities demand the provision of improved daily assistance and care to the person. Therefore, the role of family caregivers in providing care can be important. Literature review An assessment carried out for Ireland’s National Dementia Strategy (Cooper, Manela, Katona, & Livingston, 2008) offers evidence on the dominance of dementia and on the provision of dementia care in Ireland. Results point out that there are 41,740 individuals with dementia in Ireland, most of who are over 65 years of age. A substantial percentage of these older people, 23,058, live in the community where care is available, in the main, by household caregivers, largely by women, within an embryonic and fragmented community support services frame (Pillemer & Suitor, 1992). Family caregivers of elder people with dementia may be uninformed of activities that are offensive (Beech et al. 2005). Additionally, such activities may have negative or positive effects for the older person. For instance, in a study titled Caring for Relatives with Dementia (CARD), over half of caregivers self-reported committing physical or psychological mistreatment of their care-recipient and one third met the benchmarks of substantial abuse. Elder abuse has received substantial consideration in public addresses, policy reports and study as the issue has progressively been debated and studied and efforts have been made to address it (Naughton, Drennan, Treacy, Lafferty, Lyons, Phelan, O’Loughlin & Delaney, 2010). At the same time, new angles have exceeded the outdated, medical perception of dementia, permitting new considerations from other disciplines to arise, which draw attention to the economic and social inferences of the disorder (Alzheimer’s Association, 2012). In this context, a connection between dementia and a higher threat of elder abuse has been proven. It is extensively accepted that the outcomes of dementia can render older people more vulnerable to mistreatment by others and can strictly impair their capability to search for help, campaign for themselves or remove themselves from possibly abusive positions (Cooney, Howard, R., & Lawlor, 2006). Additionally, the higher risk of elder abuse for this population group may be connected to a number of interrelating and fortifying factors, together with the greater possibility of cognitive damage, unhappiness, behavioral problems, social separation and dependency (Coyne, Reichman & Berbig, 1993). Several authors confirm to the exclusive challenges, anxieties, pressures and burdens connected with caregiving in dementia. These aspects, in combination, may place an older person with dementia at amplified risk of mistreatment (O’Connor, Hall & Donnelly, 2009). Similar to worldwide approximations, it is anticipated that the occurrence of dementia in Ireland will increase melodramatically in coming eras with the most marked increase predictable among those aged 85 years and over (VandeWeerd & Paveza, 2005). With the current rise in the number of older people with dementia and the acknowledgment of their specific susceptibility to abuse and inattention, it is significant to look at the subject of abuse of this subgroup of the older population. Furthermore, in the current Irish National Positive Ageing Strategy (Yan & Kwok, 2011), the national goals give emphasis to protecting the health of older people during the course of the life-course, enabling older people to live in self-assurance, security and self-respect in their own homes and by means of evidence-based research to react to population ageing issues in Ireland (Mosqueda, Mulnard, Liao, Gibbs & Fitzgerald, 2010). Within these emphases, determining the scope of elder abuse in people with dementia, the hazardous causes for its happening and the particular encounters that the existence of dementia presents when dealing with doubted cases of elder abuse are essential steps in the improvement of best practice methodologies to identifying, averting and handling abuse of older people with dementia and for informing forthcoming research (Paveza, Cohen, Eisdorfer, Freels, Semla, Ashford, 1992). Aims of dissertations The generally aim of this evaluation of literature was to gather, examines and outlines printed literature on abuse of community-dwelling older people with dementia, in order to enlighten forthcoming research in this expanse. The purposes of the review were to pinpoint published proof relating to: The dominance and risk causes for the abuse and negligence of older people with dementia. The individualities of guilty party who abuse older people with the means of identifying abuse and disregard of older people with dementia. The approaches for stopping and managing instances of abuse of older people with dementia. Search strategies A all-inclusive search of peer-reviewed printed works indexed in the databases Cochrane, Medline, PsychInfo, PubMed and CINAHL was conducted (Paul, Mike & Hillary, 2009). This was complemented by a search of Google Scholar in order to ascertain appropriate grey collected works on the subject. The search keywords used either singularly or in several combinations were: ‘elder abuse’, ‘elder mistreatment’, ‘cognitive function and impairment’ and ‘dementia’ (Department of Health, 2013). Bibliographies of retrieved articles were scrutinized for the important search terms in their titles and family searching of the reference lists of retrieved items was also steered to pinpoint additional items not identified over the keyword searches (Phelan & Treacy, 2011). Inclusion and exclusion criteria The emphasis of the literature review is mistreatment of community dwelling older people with dementia. Initial database searches showed that there was a comparatively small body of literature that dealt precisely with abuse and mistreatment of community-dwelling older people with dementia (Drossel, Fisher, & Mercer, 2011). Consequently, it was essential to take in studies on the overall topic of elder abuse that emphasized aspects related to dementia. The emphasis of this review was on ‘older people’ who were operationally distinct as those aged 60 years and over, in line with the United Nations and the World Health Organization’s frequently used description of an older person (Peter & Sila, 1992). Nevertheless, five studies which comprised older adults below this age verge were involved since the mean age of people in these studies was beyond 70 years (Dyer, Pavlik & Murphy, 2000). The assessment comprised studies of older people with some form of dementia, together with clinically-diagnosed dementia and dementia where no locus to diagnostic criteria was made. ‘Elder abuse’ was operationally defined using the Irish policy description (Flannery, 2003) as: ‘a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights’ (Pisani & Walsh, 2012). The material carefully chosen for review incorporated primary research, review articles and policy documents. Studies, theories, case histories and meeting abstracts were disqualified. The search was narrowed to English language publications and the review historical was 1985 to April 2013. Self-neglect was omitted as this category is not documented as elder abuse within Irish policy (Government of Ireland, 2008). Ethical and legal issues Caregivers working in dementia-care settings face hard times in making ethical decisions every day (Plassman, Langa & Wallace, 2007). They must ensure that the day-to-day autonomy and dignity against the patient, is well balanced. Caregivers must also ensure that the balanced needs for multiple residents are met (Ploeg, Fear, Hutchison, MacMillan, & Bolan, 2009). They must put into consideration issues like confidentiality, the potential for elder abuse, the importance and dangers of medication and procedures (Hansberry, Chen & Gorbien, 2005). When an individual completely loses the ability to express their will, a designated decision maker ought to intervene and make tuff decisions (Pot, Dyck, Jonker, & Deeg, 1996). The decision made by the caregiver should, however, reflect what the person with dementia would do if able to. This section is going to analyses six ethical issues in medicine, otherwise referred to as bioethics, as far as people with dementia are concerned and some legal issues respectively. The principles are (1) justice, (2) autonomy, (3) veracity, (4) beneficence, (5) non-maleficence and (6) fidelity. Justice involves employment of equity in treatment and medical resources allocation. As people age, they tend to demand more medical attention (Homer & Gilleard, 1990). As a result, caregivers should ensure that they equally distribute healthcare services through the society. In addition to that, caregivers should ensure that they deliver healthcare to every individual with equal measure (Johannesen & Logiudice, 2013). However, this is not the case in this study; old people in some instances are neglected and abused. Autonomy is respecting individual rights, meaning that autonomy simply stands for individual’s freedom (Kilburn, 1996). Patients suffering from dementia can be categorized into those who are conscious in what they are doing and those who are unconscious. It is therefore important to uphold the rights of the conscious patients as they make decisions about their own healthcare (Rowe, Davies, Baburaj, & Sinha, 1993). However, unto them who are unconscious of what they are doing, they should be told the truth about their health conditions and appropriate counseling and relay of information related to their medication, risks of the condition and benefits of treatments, should be given to them (King, Wainer, Lowndes, Darzins & Owada, 2011). In case a patient refuses medication, even though it would be beneficial to them, they should be left if and only if that action does not have a negative implication on the well-being of another patient (Schulz, & Martire, 2004). Veracity is the decision by caregivers to withhold certain information about the patient and only give out information that the individual want to know (Selwood, & Cooper, 2009). Dementia is a medical condition that affects the brain.it is important to know that these people need to be encouraged always and as a result the caregivers are not at any point allowed to say anything to them that would otherwise compromise their health more (Kishimoto, Terada, Takeda, Oshima, Honda, Yoshida, Yokota & Uchitomi, 2013). It is hard to deal with old people with dementia and therefore caregivers ought to show high levels of beneficence, that is they should be kind as possible. This can be achieved in the caregiver providing care that is in the best interest of the dementia patient (Kohn & Verhoek-Oftedahl, 2011). The fifth ethical issue is non-maleficence, which is the act of avoiding harm to the patient. According to this principle, the actions of the caregiver are ‘right’ as long as they are done in accordance to the interest of the patient (Lachs & Pillemer, 2004). However, the caregiver is supposed to exercise some control over the decisions given by the patient. Take an instance when the patient chooses to ‘die with dignity’ yet there are other available means through which the patient can be treated (Selwood, Cooper, Owens, Blanchard, & Livingston, 2009). In such a case, high level of wisdom from the caregiver will be applicable as long as negative consequences will be avoided (Langan, 1997). Finally, caregivers should keep to their promises they have made to their patients as it is the highest level of fidelity they can offer. Legally, it is important to report instances of dementia to law enforcement as opposed to the victim autonomy and safety (Setterlund, Tilse, Wilson, McCawley & Rosenman, 2007). Through various acts like the Mental Capacity Act, meant to protect such people, are very instrumental as compared to allowing the dementia patient execution their own decisions (Lee & Kolomer, 2005). In addition to that, legal documents like Durable Power of Attorney, Living Trust, Living Will and Will, are put in place to protect the welfare and the assets of the victim (Shaffer, 2007). If autonomy were to be disposed at the hands of that person, he or she may not be in a good position to manage the property well, whether while they are still alive or when they pass away (Lichtenberg & Strzepek, 1990). Conclusion Dementia is a disorder that has substantial medical, economic and social consequences for the individual, his or her family and society (Lingler, 2003). Older people with dementia are predominantly susceptible to the risk of abuse and mistreatment. This is authenticated by studies enlightening a higher occurrence of abuse among older people with dementia, as equated to the general population of community living older people (Singal, 2010). The predominant data of abuse in older people with dementia are to some extent reinforced by the reported readiness of their caregivers to reveal abusive behavior; however, the concealed and discreet nature of abuse makes it possible that any prevalence figures are exaggerations of the true magnitude of the problem (Marson, Sawrie, Snyder, McInturff, Stalvey, Boothe, Aldridge, Chatterjee & Harrell, 2000). Additionally, the wide discrepancy in the prevalence records due to different procedural styles makes it hard to ascertain a true picture of the degree of abuse among community-dwelling older people with dementia (Straus, 1979). On the other hand, since abuse is evidently higher when equated to the general population of older people, methods of stopping abuse of at-risk older people with dementia need to be established and effected. In conclusion, the literature involving to elder abuse of community-dwelling older people with dementia remains meager (Teitelman, 2002). Even though some studies have spread the awareness of abuse in people with dementia, there is a significant gap in knowledge associated to elder abuse in this cohort of at-risk older people. This assessment offers an significant source of obtainable research on the abuse of older people with dementia in the community (Wrigley, 1991). It is incomplete by the focus of the study which prohibited self-neglect and the abuse of older people with dementia in institutional surroundings (Walter, 2010). 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