Nurses on the Frontlines of Addressing Elder Abuse

Cecilia’s son told her that the government had stopped sending her Social Security checks. Concerned, Cecilia talked to another family member, who had noticed the son making big-ticket purchases.

It didn’t take long to figure out that the son, who Cecilia relied on for help, was taking her checks. Cecilia decided not to report the theft, but worked with other family members and her bank to secure her funds.

It helped that one of Cecilia’s family members is a nurse, who tells the story to encourage families and professionals to guard against elder abuse.

Elder abuse includes verbal or physical abuse, neglect, financial exploitation and sexual assault. These injustices can seriously undermine older people’s health, safety, security and social supports—even increasing their risk of death. Elder abuse may be more common than you think.

One of every ten older adults will experience some form of elder abuse. Three-quarters of perpetrators are family members. What we know is likely the tip of the iceberg. It’s estimated that only one out of 23 incidents is reported.

Why are older adults targeted? Amy Scarr, MSSW, APSW, Senior Social Worker at Dane County Adult Protective Services, says social isolation is a significant risk factor.

“In old age and old-old age, people are beginning to lose relationships to death. They can become lonely, isolated and dependent. Cognitive decline can make them more susceptible to abuse,” says Scarr. “On the financial side, a regular income, accumulated assets, and perhaps a lack of familiarity with financial management or technology make them a vulnerable target.”

Nurses are uniquely positioned to recognize signs of elder abuse. Of all the healthcare professions, nurses are most likely to interact with older adults, whether in clinics, homes, hospitals or long-term care facilities.

“Because nurses have eyes on older adults across the care continuum, we have more opportunities to see if abuse is occurring, and can activate adult protective services more quickly,” says Barb King, PhD, RN, APRN-BC, FAAN, Associate Professor at the University of Wisconsin–Madison School of Nursing and Director of the School’s Center for Aging Research and Education (CARE).

Nurses are trained to care for the whole person, considering their physical and social environments. Geriatric nurses often involve family caregivers to address the burden on them. Family caregivers may lack information or support, or have their own health or financial issues. Caregiver stress can be a factor in elder abuse.

“Preparing the caregiver is key,” says King. “Nurses are in an ideal position to prepare the caregiver and identify what resources are needed, be that in-home care or respite services. We teach nursing students to think of the patient and the caregiver as a pair. They rely on each other. When demands on one increase, how do you help them to re-balance?”

Nurses are also trained to notice changes. Changes in how family caregivers treat older relatives or changes in older people’s health can be warning signs of elder abuse.

“In rural communities especially, nurses know patients over the course of their lives, and are best positioned to know their health baseline,” explains Sarah Endicott, DNP, RN, GNP-BC, School of Nursing Clinical Assistant Professor.

“Nurses can determine if a change in condition has occurred. You can’t make the assumption that the symptoms you are seeing in an older adult are normal because of their old age,” says Endicott. “Nurses are good at picking up on that change and looking for other possible reasons, such as abuse.”

In Cecilia’s case, family members including a nurse and banking professionals recognized and stopped the financial exploitation. Endicott and King agree that providing information and support to older adults and their family caregivers lowers the risk of elder abuse.

“If we invest in building a safety net around older people, we decrease the risk of elder abuse before it starts,” says King.

–Peggy Rynearson