Elderly Population as Vulnerable Population - Term Paper Example

Elderly Population as Vulnerable Population” The concept of vulnerability has been widely used to de a condition in which the physical and mentalwell being required for normal productive life is impaired and is at a constant risk. “Vulnerability is defined as susceptibility to negative events” (Stanhope & Lancaster, 2006, p. 406). Elderly abusive population are more vulnerable as they face multiple risks e.g. dysfunctional family lives, cultural issues, caregiver’s inadequacies factors and many more which make them to have limited control, disenfranchisement, and disadvantaged status, powerlessness and health risks. One of the article states that, “Abused older people are disenfranchised segment of society” (Bergeron, 2006, p. 82). The purpose of the paper is to discuss the various risk factors which lead elderly abusive population to become vulnerable. The paper will also discuss the impact of these issues, on the health of the elders and community and the role of the community nurse to improve and eliminate health inequities for this population. There are number of factors which predispose elders towards abuse e.g. dependency issues, family issues, financial issues and institutional concerns. Cognitive and ADL impairment make them to have limited control and dependency on their caregiver or caregiver’s dependency on them which leads them to become abusive. The study shows that higher rates of physical abuse occur in older adults with dementia (Podnieks, 2008). In the article, elder abuse and mistreatment, one of the caregiver’s, who is taking care of client with dementia   said,” you receive a blow, they hit you , pinch you , throw anything at you , then you just lose temper and then say something that you should not say”.(Buzgova & Ivanova , 2009). A number of situations appear to put the elderly at risk. In some cases, strained family relationships may worsen as a result of stress and frustration as the older person become more dependent. In others, a caregiver’s dependence on an older person for accommodation or financial support may be a source of conflict. In a way, misappropriate use of elders’ pension by family members cause a psychological strain One of the article illustrates that,” Some of the family members came to see their close relatives only on the day they received their pension, took the money and left” (Buzgova &Ivanova, 2009).Sometimes environmental settings predispose elders towards abuse such as poor organization of work, regimen in an institution, staff shortages in the institution and prejudiced attitude. For example all group of employees realized that an institutional regimen rarely allows residents to choose when they get up, go to bed or eat, and they have to comply with this… (Buzgova & Ivanova, 2009). In addition to it in an institution, the ones who are immobile need more nurses to be here, to take more care… (Buzgova & Ivanova, 2009). Social isolation is another factor for an older person to suffer mistreatment. Many elderly people are isolated because of physical or mental infirmities, or through the loss of friends and family members. One of the articles affirms this by pointing out that elders who had very few or no visitors at all were more likely to experience elder abuse from the employees than other clients (Buzgova & Ivanova, 2009). Research done in multicultural communities’ shows that language barriers and socio cultural factors are associated with abuse in and of themselves and it leads to difficulties adapting to life in Canada and intergenerational differences in expectations, values and beliefs (Podnieks, 2008). At times, caregivers disregard elder’s dignity, predisposing them towards abuse. It is like violating their rights when their dignity is not respected, mainly when they are infantilized. One of them described their experience as, “you go outside and can hear: ‘Do not stumble, there is a bad pavement here.’ You just feel as if you are five years old and your mother is letting you to go to playground…” (Buzgova & Ivanova, 2009). Federal, provincial and territorial governments are responsible legislation addressing elder abuse and neglect. The focus is to stop the abuse, or reduce the consequences once the abuse has taken. There are some legal approaches in Canada to address elder abuse e.g. criminal law, adult guardianship law, but still there are barriers within the justice system which predispose elders to abuse. These barriers include lack of police training to recognize and appropriately respond to elder abuse, lack of appropriate skills in interviewing older people and underutilization of special skills for lawyers regarding the needs of older clients and aging issues. (Podnieks, 2008).  Abuse has a significant impact on the health of people at any age, but older adults can be especially vulnerable. In general, older adults have less physical strength and less physical resilience than younger persons. Abuse and neglect are a major source of stress and can have long-term effects on the health and well-being of older adults. High blood pressure, breathing problems, stomach problems (ulcers), and panic attacks are common stress-related symptoms among older people who experience abuse .The stress of abuse may trigger chest pain or angina, and may be a factor in other serious heart problems. (Abuse of older adults, website). Some older adults may be very frail, or already have disabilities or impairments that leave them particularly vulnerable. Older bones break more easily and take longer to heal. An injury or accumulation of injuries over time can lead to serious harm or death. These medical issues have a huge impact on the health of elderly people, as it is very hard to identify if these are due to aging or abuse. In the article elder abuse and neglect it is stated that,” Older adults experiencing abuse may be unable to communicate clearly; their bruises may be attributed to the aging process, or may be fearful and hesitant to report abuse” (Muehlbauer &Patricia, 2006). Even minor injury can cause serious and permanent damage. Person develops deep, open pressure sores on back and heels because of lack of repositioning. In the article one of the staff member said,” …a women recently abused at home care came here; she had many bruises, bedsores, other such signs (Buzgova & Ivanova, 2009). When abusers steal or control older adults money or other property, older adults may have fewer resources to take care of their own health, housing, good nutrition, and activities. An older adult may also feel shame, guilt, or embarrassment that someone in the family or someone close has harmed them. As well, the victim may feel shame that their trust was violated by a trusted caregiver (Payne, 2005). This leads to affect the health of older people as they are not able open up due to some kind of fear, threat or a feeling of shame. As a result of abuse or neglect, older adults often experience worry, depression, or anxiety. Neglect by caretakers affect health of elders seriously in many cases. One of the article state that,” A caretaker may withhold water when elder is incontinent to decrease the number of beddings and clothing changes” (Collins, 2006). But not giving water to elderly has a direct affect on their health by leading them to die of dehydration. Another issue that impact their health is issue of self determination, means that older people has the right-to-choose. One of the study said that ,” sometimes they make real bad decisions but as long as they are able they can choose .But at what point depressed, or sick or abused person unable to choose?”(Bergeron, 2006). When social workers, nurses or physician recognize the abuse, it is hard for them to take action because of the self determination issue and elders don’t want action due to some kind of fear or shame. However, it is justified that abusive and neglecting behaviors are harming the health of older people. “The stress of living in an abusive situation shortens older people’s lives by several years on average “(WHO). The elderly abusive population has significant impact on the health of the community in which they live. As already discussed, living in abuse and neglect increases the person’s chance of becoming ill or may make other health problems worse such as depression, anxiety etc. Each year in United States 1 to 2 million adults older than age 65 are injured, exploited or mistreated by their caregivers. (Muehlbauer &Crane, 2006, p. 45). These affects the healthcare system and leads to an increase in the healthcare costs. Healthcare costs include professional fees, inpatient and outpatient care cost and costs of medicines used. A study shows that abusive people visit frequently in emergency and healthcare providers can expect to see a steady increase in the number of cases of elder maltreatment as the older adult population rapidly increases (Muehlbauer &Crane, 2006, p. 45). The effects of abuse and neglect can carry from generation to generation. For example, grandchildren who witness such abuse may come to view negative behaviors toward older adults as acceptable and perpetuate disrespect. Abuse and neglect of older adults is not a private matter. It affects individuals, families, communities and ultimately society at large. One of the articles stated that, “Abused ethno-cultural older people often do not know about their legal and human rights or about community resources (Podnieks, 2009, p. 142). Knowing its importance, the growing issue of elder abuse has now come to the attention of healthcare providers, law enforcement agencies, and protective services (Muehlbauer &Crane, 2006, p. 45). This increasing awareness about elder abuse is making communities healthier by the help of professional bodies and general public. Elder abuse may be minor issue that can be easily resolved or it can result in severe and life threatening debilitation. No matter how minor or severe the abuse is, nurses have a duty to assess elderly patients according to recommended protocols and report suspected abuse to designate authorities. One of the article state that,” nurses can effectively intervene with accurate assessments and documentation of findings prior to reporting suspicious findings” (Muehlbauer & Crane, 2006, p.48). The first step of community nurses towards preventing abuse is to be aware of possible risk factors in the community that can lead to elder abuse. Creating a trusting environment, showing respect, compassion and concern are helpful in gathering information to plan care. A community nurse should know what resources are available and when to “walk beside” the client and when to encourage the client to “walk ahead” (Stanhope & Lancaster, 2006).During the assessment process, CHNs need to be aware of an incongruence between injuries and the explanation of the cause, dependency issues between the client and caregiver and substance abuse by the caregiver. CHNs need to be alert for signs of caregiver’s stress and assist caregivers to reduce stress or refer caregiver to community resources for support and assistance in dealing with their stress and their care giving responsibilities. According to Mueulbauer and Crane clinical setting should have a protocol for the detection and assessment of elder maltreatment. Protocols should consist of a narrative, checklist, or standardized forms that enable rapid screening for elder abuse and provide guidelines for sound documentation that may help disclose patterns for abuse over time and will withstand scrutiny in court (Muehlbauer& Crane, 2006, p. 47). CHN nurse should start the interview from general questions that assess the patient’s sense of well being. These Nursing Best Practice guidelines by the RNAO are clinical and educational resources providing specific evidence-based strategies to guide nurses work with senior. These include guidelines to assess and manage delirium, dementia and depression , preventing falls one of the primary cause of admissions in hospitals(RNAO , 2006). Routine questions related to elder abuse and neglect can be incorporated into daily nursing practice. Nurses should conduct interviews and examinations with the patient first, in a private setting separate from caregiver (Muehlbauer& Crane, 2006, p. 47). There is lack of general awareness among public about the elder abuse. Nurses can work as members in intersectoral collaboration to increase awareness among public, e.g. how to identify and report the abuse and with whom to contact (hotline number). Protocols for elder abuse screening, assessment of risk factors, and documentation should be posted in all health care facilities. In conclusion, it is justified from the researches and information discussed above that older people are more vulnerable to physical and psychological abuse. The current situation and future estimates reveal that there is a need to consider more steps to stop this pace of increasing abusive behaviors. Nurses can play a vital role in spreading the knowledge about the causes and consequences of abusive and neglecting behaviors with elderly population. These issues are properly addressed with the local, national and international level yet the pace of improvement is slow and requires more efforts and concentration. Read More