Elderly abuse is a common phenomenon in most societies, given that as people get old, they increasingly rely on others to meet their needs. Age continuously reduces physical strength with time, which in turn reduces one’s ability to meet various daily needs. Therefore, older people have to rely on others such as family members, neighbours, and caregivers. With an increasing level of dependency on others, the elder person becomes vulnerable to various forms of elder abuse (Rigon et al., 2022). Elderly abuse is not only physical but also emotional, sexual, financial, and gross-neglect of their well-being.
In the United States, elderly abuse is among the most common challenging issues and involves issues such as justice, ethics, health, and human rights. It is estimated that between 700,000 and 1.2 million elderly people in the country suffer mistreatments at the hands of others each year (Rigon et al., 2022). Out of these figures, only about 400,000 cases are identified every year (Rigon et al., 2022). Nurses and other health professionals have a duty to play in the detection, managing, prevention, and addressing elderly abuse. Specifically, most elderly people prefer informing nurses and other healthcare workers attending to them about abuse, especially if family members are the perpetrators.
Nevertheless, some abused elderly people do wish to have the information revealed to other parties or authorities, as they also want to protect the family members involved in abuse. On the contrary, nurses and other healthcare providers are required to ensure protection of their patients (Rigon et al., 2022). Therefore, an ethical dilemma arises because the nurses need to protect the privacy rights of the patient while also ensuring that they are protected from further abuse.
History of the Dilemma
From a historical perspective, elderly abuse has been a problem in various societies across the world for centuries. Nevertheless, it is only in the last few decades that elder abuse and mistreatment has become a social and ethical issue. In the US, the passage of Medicare, Medicaid, and the Older Americans Act in the 1960s became the initial indication of recognition of elder abuse as a social policy and health issue (Rigon et al., 2022). Indeed, these legislations and policies provide evidence of a shift toward increased awareness human welfare issues that affect the elderly.
In the same decade, the passage of the Social Security Act made is mandatory for funding to the states for the establishment of strategies to protect the older people with physical and mental challenges who were exploited, neglected, or unable to meet their personal needs (Rigon et al., 2022). In 1977, Social Security Act’s Title XX authorized the support of protective care and services to adults aged 18 and above to all income levels who were suffering neglect, abuse, or exploitation. Furthermore, this legislation stimulated the establishment of the Adult Protective Services through social service block grants (Rigon et al., 2022). In 2003, the Elder Justice Act was introduced to the Senate and eventually became the Elder Justice Act of 2003. This law brought together advocates who were committed to reform the social policy to protect the old people.
The Elder Justice Act was passed in 2010 and become a major victory for the vulnerable people in the country. The Patient Protection and Affordability Act was passed at the same time, which made it possible for care providers to combine problem identification and recognition (Ghaffari, Alipour & Fotokian, 2020). The Elder Justice Act authorizes the expenditure of federal funds required to implement the law as well as provide benefits to the abused elders countrywide.
How Elderly People Are Abused
Definitions of elderly abuse vary widely based on differences in jurisdictions. Nevertheless, it is generally agreed that the definition by the World Health Organization best describes the various forms of elderly abuse. According to WHO (), elder abuse is a single or repeated act, or lack of the right action, that occurs within any type of relationship where trust is expected and results in harm or distress to the older individual. This definition has been widely accepted, including by the American Medical Association, various US states, and some Canadian Provinces (Ghaffari, Alipour & Fotokian, 2020).
Elder abuse is further categorized into physical abuse, emotional or psychological abuse, financial or material abuse, and sexual abuse and neglect. In some jurisdictions, self-neglect is also recognized as a form of elder abuse but not in others. The Who definition does not include self-neglect since it states that there is some relationship involved, which implies that there is a perpetrator who violates the trust between him or her and the elderly person (Ghaffari, Alipour & Fotokian, 2020). In essence, the WHO definition of elder abuse concerns the relationship rather than the actual act.
Physical abuse refers to actions or behaviours that cause or might result in pain, body harm, psychological distress, or impairment. These actions and behaviours include shoving and pushing, hitting, poking, and slapping, biting, pinching, and pulling the hair, spitting at the victim or confining and restraining them inappropriately.
Emotional and physiological abuse refers to severe or persistent verbal and non-verbal actions and behaviours that can cause psychological or emotional harm. These actions also lessen a victim’s sense of dignity, identity, and self-worth. Emotional or psychological abuse is one of the most common forms of abuse that are unreported in most cases but distressing to the victims. Among others, this form of abuse includes actions or words that belittle the older person and tend to be hurtful and make them feel unworthy (AMA, 2017). Failure to consider the wishes of the older person is also considered an act of emotional abuse. In addition, failure to respect their belongings and pets, inappropriate control activities such as denying them access to friends and children, and treating them like children are also considered actions of emotional and psychological abuse.
Also, threatening an older person with such things as abandoning them, denying them utilities, or putting them in an elderly home causes emotional and psychological distress (AMA, 2017). Furthermore, withholding affection, name-calling, verbal aggression, isolation, humiliation, and intimation, and removing decision-making power while the older adult is still competent are forms of emotional and psychological abuse.
Financial and material abuses are actions or lack of action with respect to the assets, material possessions, funds, property, or legal documents, that are coerced or unauthorized or misuse of legal authority. Similarly, any improper conduct that is done with or without the older adult’s informed consent and which results in a monetary or personal loss for the victim or personal and monetary gains for the perpetrator is a form of financial abuse (AMA, 2017). Furthermore, using fraud, force, or trickery to misuse the funds and property of older adults is a form of financial abuse.
On its part, sexual abuse involves direct or indirect involvement in sexual activities with the older adult without his or her consent (AMA, 2017; Ghaffari, Alipour & Fotokian, 2020). This includes coercing them through trickery, force, threats, or other methods into undesired or unwanted sexual activities.
From an ethical perspective, nurses and other care providers have a duty to play in detecting, recognizing, reporting, and addressing cases of elderly abuse. Screening and assessment for mistreatment or abuse are necessary steps for determining whether an elderly person is facing abuse, exploitation, or neglect by someone or is unable to provide self-care. According to the American Medical Association (AMA, 2017), clinicians need to screen for elder mistreatment and abuse in any clinical setting. In addition, the Medicare program requires nurses to screen and monitor the old people for the signs and symptoms of abuse and mistreatment. Evidently, nurses and other healthcare providers are uniquely positioned to identify and distinguish signs and symptoms of abuse and mistreatment from those of aging. Therefore, they have a duty to diagnose these problems in their routines with elderly patients.
There exist comprehensive ethical principles about abuse of the elderly people. On one side, nurses and other healthcare providers have a duty to identify, recognize, report, and prevent elderly abuse. They need to ensure that abuse is not only prevented, but also mitigated. On the other hand, they need to protect the rights of the victims such as privacy of information and decision-making. When disclosing information about elderly abuse, care providers should use the American Psychological Association (APA) codes. APA Code 4/02 is related to privacy limitations and should apply when a nurse is seeking to reveal evidence of abuse identified in an elderly patient (Ghaffari, Alipour & Fotokian, 2020). On its part, APA Code 4/05 relates to the disclosure of information regarding the actual abuse of the elderly people.
If the elderly victims of abuse suffer from cognitive disorders, it is necessary that the care providers maintain the confidentiality of such information but also contact legal authorities. As APA Code 4/02 states, the healthcare providers are allowed to disclose to the authorities any information in suspected abuse cases even without the need for the patients’ consent (Ghaffari, Alipour & Fotokian, 2020). In the same manner, Code 4/05 allows the care providers to share information about abuse with the victim’s families or with other experts to protect them from harm.
The ethical principles that can be violated in elderly abuse include respect (autonomy and dignity) and non-maleficence. Autonomy is violated when the right for independence decision-making without limitations is denied (Ghaffari, Alipour & Fotokian, 2020). Noteworthy, autonomy includes the right for decision-making and respect for the independence (. Patients have the right to participate in making decisions regarding their situations and medical care. Nevertheless, when elderly patients are abused but do not want the perpetrators to be held responsible, such rights can be violated for the purpose of protecting them even without their consent.
Nurses can violate the rights of patients when they have evidence of elderly abuse. In essence, the key issue is to provide safety of the elderly people. Nevertheless, nurses experience dilemma, as they have to make decisions on whether to disclose information regarding elderly abuse or protect the rights of the victims such as privacy, respect, and autonomy. In most cases, such nurses might be unable to make proper decisions because they need to consult others in the clinical setting, which also amounts to violating confidentiality rights of their patients. Fortunately, there are laws and codes that help such nurses by allowing them to forego the rights of the patients for the sake of protecting their welfare. Noteworthy, APA codes 4/02 and 4/05 have made it easy for nurses and healthcare providers to determine whether to disc lose information about abuse to other experts and authorities.
Ghaffari, F., Alipour, A., & Fotokian, Z. (2020). The effects of education on nurses’ ability to recognize elder abuse induced by family members. Nursing and Midwifery Studies, 9(1), 1-8. Web.
Pozgar, George D. (2014). Legal and ethical issues for health professionals. (4th Edition). Burlington, MA: Jones and Bartlett Learning
Rigon, S., Dascal-Weichhendler, H., Rothschild-Meir, S., & Gomez Bravo, R. (2022). Elder Abuse and Neglect. In The Role of Family Physicians in Older People Care (pp. 289-321). Springer, Cham.