Elder abuse and neglect - International Federation on Ageing
Transcription
Elder abuse and neglect - International Federation on Ageing
Elder abuse and neglect: Discussion around comprehensive assessment Louise Belzile, Ph.D. student Nicole Dubuc, Ph.D. 4 October, 2013 IFA - Istanbul (Turkey) Background • Elder abuse and neglect (EA): an important public social and health concern (Québec, Ministère de la Famille et des Aînés, 2010) • An important question: how support practitioners in Elder abuse detection process? • Education • Tools • Clinical supervision • Interprofessionnal collaboration pactice • Etc. Tools • What we know: • 15 validated screening tools (Laforest, Maurice, Beaulieu & Belzile, 2013) • Few of these tools are actually in use • Some ones in use are not validated or translated ones • APS (USA): have integrated detection tools in protocols and take as important to complete a general assessment. Comprehensive assessment tools are they an interesting way to detect EA? Comprehensive assessment tools • Characteristics: • Global approach • Bio-psycho-social dimensions (multidimensional) • Collect information for planning clinical interventions • Selected tools criteria • Presented as comprehensive assessment tool • Actually in use • Large or prescriptive diffusion • Analysed tools • RAI • GEVA-A • OÉMC-bonifié (Dubuc, in cours) Methodology • 1- EA indicators identification • 2- tracking in tools • 3- comparison between 3 identified tools 1- EA indicators • Sources: • Cohen, et al., (2006): Expanded Indicators of Abuse Questionnaire (E-IOA) • Fulmer (1984): Elder abuse indicators (EAI) • Anetzberger et al.,(2001). Screening tools and referral protocol for Stopping Abuse Against Older Ohioans (STRP): • 1) Actual Abuse Screening Abuse Tool • 2) Suspected Abuse Screening Tool • 3) Risk of Abuse Screening Tool EA indicators Abuse (physical mistreatment) (6 + 2) • Unexplained injuries or unsatisfactory explanations • • • • • • • for them Injuries/internal hemorrhage Bruises or fractures (various stages of healing) New and old scars (on upper parts of both arms) Burns (on not usually parts of the body) Unusual burn or shape of burn (matching certain objects such as cigarette or flatiron), or dipping burns Subjective complaint of abuse Disclosure of episodes of physical abuse Sexual abuse (5 + 2) • Torn or stained underwear • Difficulties walking or sitting (for no evident reason) • Sexual organs—pain/bleeding/burns • Urinary tract infections • Sudden changes in behavior, demeanor, or affect. • Subjective complaint of sexual abuse • Disclosure of sexual abuse Psychological abuse (13 + 2) • Confusion (if not a symptom of cognitive deterioration) • Exaggerated fears • Loss of interest in self and in social activities • Ambivalence toward family members • Apathy • Extreme stress symptoms • Being called derogatory names, treated as a child, being frightened, humiliated, intimidated, threatened or isolated. • Elder states being left alone for long periods of time or being ignored • Sense of resignation and hopelessness with vague references to mistreatment • Behavior that is passive, helpless, withdrawn • Anxious, trembling, clinging, fearful, scared of someone/something • Self-blame for current situation and partner/caregiver behavior • Elder states failure to receive companionship, news, changes in routine, information • Subjective complaint of psychological abuse • Disclosure of maltreatment, shouting, cursing, threatening, coercing EA indicators • Financial or material exploitation • • • • • • (6 + 2) Sudden inability to pay bills, purchase food or other commodities Refusal, by the older person or a family member, of any treatment or assistance involving financial expense Transfer of money, property or materials from the older person to family members Exaggerated interest by a family member in the older person’s financial situation A family member forces or persuades the elder person to give him/her money A family member takes charge of the older person’s financial affairs when this is not required or seems not to be the older person’s wish • Subjective complaint of financial or material exploitation • Disclosure of material exploitation • • • • • • • • • • • • • • • • • Neglect (14 + 2) Dehydration Poor nutrition Poor hygiene Hypo/hyperthermia Unsuitable clothing Lack of teeth, spectacles, hearing aid Sudden and unexplained decline in health situation Bed sores Exaggerated/lack or unsuitable use of medicine Contractures, Decubiti Diarrhea or Constipation Urine burns Repetitive hospital admissions due to probable failure of health care surveillance Depression Subjective complaint of neglect Disclosure of neglect 2- Tracking in tools Question et endroit où on retrouve cette maltraitance/négligence information dans l’OEMC bonifié Interventions/ interprétations Indices de Maltraitance physique Blessures ou lésions : contusions, lacérations, marques de coups, fractures, hémorragies internes, cicatrices, brulures, Plainte subjective Auto-déclaration de violence physique ÉTAT DE SANTÉ : 1.Histoire de santé personnelle et familiale et diagnostics actuels : Lésions traumatiques et certaines autres conséquences de causes externes Diagnostic avec facteur de risque : Hospitalisation(s) dans la dernière année 2. SANTÉ PHYSIQUE Histoire de chute Fonctions sensorielles : Condition de la peau PERCEPTION DE L’USAGER : Croyez-vous… Blessures ou trauma incompatibles avec les faits rapportés Blessure non expliquées ou dont les explications sont insuffisantes ou nonconvaincantes Toujours prendre au sérieux la plainte subjective d’une personne La personne est-elle en danger? Si oui, appliquer les mesures de protection. 3- Comparison Signes cliniques de maltraitance OÉMC-Bonifié Maltraitance physique Blessures ou lésions : contusions, lacérations, marques de coups, fractures, hémorragies internes, cicatrices, brulures, Plainte subjective Auto-déclaration de violence physique Légende : item précis ■ appréciation générale RAI GÉVA-A ■ ■ ■ Results (1) • EA is not easy to objective (except physical abuse… maybe) • Lowest EA screened by Comprehensive assessment tools are: • Financial or material exploitation, • psychological abuse • sexual violence • Self-neglect is a major point of interest for practitioners but difficult to comprehend and to know what to do now. More research are necessary in this way. Results (2) • GEVA-A is the less efficient for EA detection (not conceptualized for elders and more centered on access criteria than clinical ones) • RAI is interesting because the integrated protocols and guides • OÉMC includes many items. OÉMC-bonifié will upgrade the content and the friendly-using because electronic form and integrated care pathways (ICPs). Results (3) • It’s not easy to isolate EA • EA is related with many others geronto-geriatrics problems • Every author include EA assessment in a larger assessment (ex.: Fulmer includes General, Social and Usual Lifestyle Assessments sections in the tool) • Stakeholders have to link and interpret information (clinical judgement) before conclude to EA Conclusion What’s the best way: • add specific detection tools? • upgrade using tolls? In two cases, be aware to have to much hope in the artefact. Clinical support doesn't limited to tool’s presence. Clinical pathways or protocols are essentials to support practices to provide services with equity and efficience. References • Anetzberger, G. J. (2001). Elder Abuse Identification and Referral: The Importance • • • • • • of Screening Tools and Referral Protocols.Journal of Elder Abuse & Neglect 13(2), p. 3-22. Cohen, M., Levin, S. H., Gagin, R., & Friedman, G. (2006). Development of a Screening Tool for Identifying Elderly People at Risk of Abuse by Their Caregivers. J Aging Health 18(5), 660-685. Dubuc, N., Bonin, L., Tourigny, A., Mathieu, L., Couturier, Y., Tousignant, M., Corbin, C., Delli-Colli, N., & Raiche, M. (2013). Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people. Int J Integr Care, (Apr–Jun), 1-13. Fulmer, T., Street, S., et Carr, K. (1984). Abuse of the Elderly: Screening and detection.Journal of Clinical Nursing 10(3), p. 131-140. Fulmer, T., (s.d.). Elder Mistreatment. Training Manual and Protocol. On line. http://hartfordign.org/uploads/File/Fulmer_EM_full.pdf Laforest, J., Maurice, P., Beaulieu, M. & Belzile, L. (2013). Synthèse de connaissances sur la recherche de cas de maltraitance envers des personnes aînées par des professionnels de la santé et des services sociaux en première ligne. Institut national de santé publique du Québec (INSPQ). Québec (Canada). On line. http://www.inspq.qc.ca/publications/notice.asp?E=p&NumPublication=1687 Ministère de la Famille et des Aînés (2010). Plan d'action gouvernemental pour contrer la maltraitance envers les personnes aînées 2010-2015. Québec : Gouvernement du Québec.