ABUSE and how to recognise it in the elderly
Abuse usually conjours up images of a person being hit. Whilst that is an issue, of course, I think it might be interesting to look at this and other kinds that are not often thought about.
1 Physical abuse: Any bruises, flinching when touched in a certain area, fear when a certain care staff enters a room should all be taken very seriously. Sudden, unexplained pain, should be investigated. Being lifted by hand, pulled up by the shoulders, any physical moving and handling which does not conform to the Moving and Handling Regulations.
2 Mental/emotional abuse: This can be sneering, making jokes about the person, threatening with emotional consequences for not complying (eg, your family won't be coming, the staff think you are a nuisance, you are not liked). I would add here, no emotional recognition of the person, absence of care in this way.
3 Verbal: Some of above, but talking over the person, ignoring the person, talking down to the person, shouting, swearing, aggression, threatening.
4 Medical: Doctors writing a person up for anti psychotics or other sedatives, just to control the person's behaviour or noisiness. Sedation in the elderly is extremely dangerous and should only be used in very low doses for correctly diagnosed psychosis. This should also be reviewed at the very latest, every month.
Sedation is a leading cause of falls, stopping eating and drinking because of sleepiness, loss of functions that were there before, etc. Also they can have very dangerous effects on the heart and blood pressure and heart attacks are proven to increase a great deal due to anti psychotics. They are banned except in exceptional circumstances, in most Good homes.
Nurses hiding meds in food, crushing it into drinks, forcing it into the mouth. Someone refusing meds should be handled with intelligence and if it continues, getting the doctor involved. Many can be changed to liquids. Getting a doctor to check the med chart and take them off anything they don't need.
5 Institutional: The mealtimes!! The kitchen dictates the daily activities and it shouldn't. Due to breakfast, lunch and tea at set times, people are shoe horned into a daily routine which does not reflect their needs. A good home should have a very flexible meal times to accomodate the needs of different people.
Also putting people to bed early is terrible. Can you go from 6pm till 10am without a drink? That is 16 hours of the day! The person gets up disorientated, sleepy from dehydration, very poor kidney function which also therefore causes more confusion. Also, do you go 16 hours out of 24 without anything to eat? The reasons given are that they don't have enough staff - it is how you use your staff, not the amount.
Getting people dressed, put on the toilet, showered in a conveyor belt system. Often associated with staff talking over them, walking into the room whilst the person is naked, ignoring them, forced to have a shower which terrifies a person. Can you go to the toilet when told to? Being left on a toilet for ages, and then a pad put on, even if you don't need one. When the person asks for the toilet, being told - "you have a pad, go in that".
Food shovelled into the person with no recognition if the person likes it, wants it at that time, and they are hurried to eat it. Stirring pureed food altogether into a mush on the plate, not keeping different foods separate and constant explaining of what the food is.
Asking a person living with dementia what they want to eat the day before - I'll leave you to work that one out.....
Sitting people in rows so they cannot see or hear anyone else and can only look forward. The TV blaring out non stop.
Neglect Leaving a person in bed and the only contact they have with a human being is nurses coming in to do clinical things to them. Not speaking to the person. Not cleaning or dressing them properly. Not giving enough fluids or food, especially when the person is drowsy and not motivated. Not washing enough etc
Not listening to someone shouting out for help. Someone living with dementia may do this for other reasons, but this should be checked as often as possible to check that there isn't a reason which is obvious. Anyone shouting for help should be given more time whenever possible.
Pressure sores, especially if left untreated and the question to always ask is not what they are doing to heal it, but what are they doing to prevent it happening again. Believe it or not, most nurses don't think about that.
Not giving any stimulation. Not giving loving touch, kindness or smiles.
Not moving someone from one place to another, taking them out in sunshine, locking them into a chair with a table in front of them and not allowing reasonable risks to be taken by the person eg trying to walk to a toilet.
Not noticing depression Depression is very common in the elderly, especially people with dementia. Tearfulness, withdrawn, sleeping a lot, self harming in lots of ways, angry outbursts, shouting, wanting to die. If anyone else said they wanted to die, would we ignore it?
Sexual abuse This may shock you, and its not common, but there are people who do this. The elderly person with dementia often can't explain but are left in shock and terror. These people react the same as anyone else who has been assaulted this way. Sometimes the person with dementia may shout out in fear when handled a certain way, or show fear when a certain person enters the room (they can remember eg smell, handling, tone of voice, to recognise the person). They may show sudden terror at having their clothes removed. Other people with dementia can be the cause here too.
Financial abuse This can go from staff stealing money or objects to relatives stealing everything in their house. Taking money out of bank accounts, and claiming benefits for the person which they never spend on that person.
Cultural/racist abuse Racism is obviously wrong in any place. But ignoring cultural differences eg dress codes, washing codes, food types, is also abuse. Also in here you can get assumptions made based on stereotypes. I nursed in a home which had many Jamaican people. We gave this food to all the Jamaicans until a relative came in and said that one man hated it and wanted only English food! I also nursed a lady who was a seikh. She couldn't eat unless seated on the floor and food shared with the nurses. Took us a while to work that out!
If you hear that there aren't enough staff, that is wrong. It isn't the amount of staff, its changing how those staff act and behave and how the institution is run. Imagination and good training is vital.
You may think of other things, but I hope this gives you pause for thought when you visit your loved one.
Last edited by calypso; 10-10-13 at 20:18.
“You have power over your mind - not outside events. Realize this, and you will find strength.”