Pennsylvania Nurse 2019 74.3 | Page 8

significant as a role of the nurse to strategically iden- tify a potentially abused elderly individual and to be proactive in a myriad of applicable interventions in the prevention of elder abuse. Definition of Elder Abuse Elder abuse includes physical, emotional, sexual, and/or financial abuse, exploitation, neglect, and abandonment (Eliopoulos, 2018; National Council on Aging, n.d.). According to Eliopoulos (2018), elder abuse is defined as “the infliction of physical or emotional harm, neglect, financial exploitation, sexual mistreatment, or abandonment of an older adult” (p. 500). It is further defined to include abuse to any individual over age 60 as an intentional act, or failure to act, in which the victim experiences a safety breech, a health risk, or an action that results in actual harm (National Institute of Health, 2016). The World Health Organization (2016) also added that elder abuse may be “a single or repeated act that causes harm or distress to an older person” (para. 1). Targeted Population One in ten individuals over age 60 experiences some type of abuse (Centers for Disease Control and Pre- vention, 2015). This statistic is believed to be inac- curate and, in fact, much higher. This may be due to the individual’s inability to report the abuse or fear of reporting the perpetrator. The elderly individual may be unable to report abuse due to inaccessibility (lack of phone service), geographical isolation, cogni- tive issues such as memory impairment or dementia, physical incapacity such as aphasia or frailty, depen- dency on the perpetrator due to physical limitations such as effects from a stroke, general fear of retalia- tion or that the abuser(s) may get in trouble from the complaint, and other factors. The profile for the older adult at greatest risk for abuse is a disabled woman, age 75+, living with a relative, and physically, socially, or financially depen- dent on others (Eliopoulos, 2018; Robnett, Brossoie, & Chop, 2020). The majority of elder abuse occurs to females. Other victims live alone or may be separated from their family due to distance. Another separa- tion factor may be related to family dysfunction such as a feud or disclaimer of certain family members Issue 74, 3 2019 Pennsylvania Nurse 6 which thereby eliminates family from visiting on a regular basis to determine the elder’s welfare. Elder Abuse: Types, Definitions, and Manifestations There are several types of elder abuse that may be imposed upon the older population. Abuse may occur in varying degrees and may include more than one type. Reported studies found that “up to 89% of abused elders are victims of multiple forms of abuse which is referred to as polyvictimization” (Ramsey- Klawsnik, 2017, p. 299). Manifestations may not be directly evident, or the victim is vague in the descrip- tion of how the symptoms occurred. Seven types of elderly abuse are most common: (1) physical; (2) emotional; (3) sexual; (4) financial; (5) neglect; (6) abandonment; and (7) healthcare fraud. Standardization of elder abuse definitions allows comparisons of the problem across locations (Centers for Disease Control and Prevention, 2019). Knowl- edge of definitions and awareness of manifestations can help identify abuse to further reveal the signifi- cance of the issue, thereby promoting nurse advo- cacy for prevention and intervention efforts. Physical Abuse Physical abuse is intentional physical force that re- sults in acute or chronic illness, bodily injury, physi- cal pain, functional impairment, distress, or death (Centers for Disease Control and Prevention, 2019). It may consist of the following direct or indirect observations: bruises, burns, lacerations, hemato- mas, loss of hair, scabs, edema, skin discoloration from healing bruises, pinching, choking, kicking, bite marks, weight loss, disheveled appearance, poor hygiene, perineal bruising or orifice discharge, urine and/or feces odor, spitting, hitting, pushing, broken eye glasses, and fractures or dislocations on imaging films. Emotional Abuse Emotional abuse is verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress (Centers for Disease Control and Preven- tion, 2019). It may consist of the following direct or indirect observations: shaking, rocking behavior, poor eye contact, confusion, disorientation, introverted behavior, anxiety, agitation, violent episodes, disen-