Introduction: What Is Known About Elder Abuse
Elder abuse occurs at an alarming rate: around one million incidences a year and perhaps more due to under-reporting and inconsistencies in defining what constitutes elder abuse (Falk, Baigis, Kopac, et al., 2012). Roberto (2016) estimates as many as one in every ten American elders experience some kind of abuse. Unfortunately, “there is no uniform term or agreed-upon definition used among state governments, researchers, health care and service providers, and advocates,” (Roberto, 2016, p. 302). Cultural and religious diversity further impedes the evolution of a comprehensive and universally applicable definition of elder abuse, in spite of the fact that some forms of abuse and certain instances can be considered unequivocal (Saghafi, Bahramnezhad, Poormollamirza, et al., 2019).

Some types of abuse may go undetected, such as financial abuse or identity theft, which could go unnoticed for years. Healthcare workers often feel powerless to intervene in instances of financial abuse perpetrated by family members because of the fact that the family members are also primary caregivers, and there may also be little if any legal resources to investigate the problem (Falk, Baigis & Kopac, 2012). Other than the fact that it is “highly prevalent,” perpetrated by healthcare workers, caregivers, and other elders in assisted living/nursing home communities, not much is known about elder abuse because there are no established means of reporting it or assessing for risk factors (Lachs, Teresi, Ramirez, et al., 2016, p. 229). Elder abuse consists of various forms and degrees of physical, sexual, psychological, and financial abuse. It is also important to include self-neglect and general neglect as forms of elder abuse. Furthermore, both men and women can be victims and perpetrators but research shows that men are by far more likely to be the perpetrators of the sexual abuse of elders (Malmedal, Iversen & Kilvik, 2015).

Ethical Dimensions

Why Is Elder Abuse An Ethical Issue?

On the surface, elder abuse appears to be a cut-and-dry ethical issue. However, the different phenomena comprising elder abuse are far more complex than it would seem. Not all cases of elder abuse involve physical or sexual assault, or overt instances of verbal abuse and aggression. Financial abuse and psychological abuse vary in their severity; moreover, cultural differences may impact perceptions of abuse. Competency creates ethical dilemmas, particularly when it comes to the decision-making capacity of elders due to cognitive decline and the legal role that family members play in healthcare decisions (Forum on Global Violence Prevention; Board on Global Health, 2014).

Healthcare workers and caregivers are also not always the perpetrators of elder abuse. The fact that other residents of senior care facilities can be perpetrators in verbal, emotional, physical, and sexual abuse makes it even more challenging to respond to and identify elder abuse (Lachs, Teresi, Ramirez, et al., 2016). Nurses have a responsibility to protect their patients from abuse, but may encounter conflicts when they suspect family members, other residents, or other healthcare workers are perpetrating some form of elder abuse. Misreading cues, misunderstanding cultural communication or elder care styles, and being overly intrusive into the affairs of residents could also become major challenges to preventing or mitigating elder abuse in healthcare institutions.

Sexual abuse is a surprisingly common form of elder abuse. In a review of literature by Malmedal, Iversen & Kilvik (2015), findings “show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women,” (p. 7). However, even sexual abuse is not always easy to define, and matters related to mental competency will be mediating factors.

Relevance to Nursing and Health Professionals

Elder abuse is of extreme importance to all healthcare professionals, including those whose work does not otherwise focus on the geriatric population. An aging population and the growing numbers of seniors in healthcare institutions ensures that almost all health professionals will...…difficult decisions about when to intervene in situations where verbal or psychological abuse is considered normative in other cultures, perhaps by speaking directly with the patients themselves.

From a professional point of view, nurses need to continually review the professional literature and stay abreast of changes to eldercare legislation, policy, and protocol. Concerns should be raised immediately to administrators, who may need to be reminded of their responsibilities and obligations under federal or state laws. Nurses also need to become more sensitive to what constitutes elder abuse, as many of their actions could be misconstrued as abusive when really they are trying to help patients avoid self-injurious behavior or self-neglect. For example, elders who are prone to wandering aimlessly could get lost. Some patients are quick to lose their tempers at nurses, and it should also be noted that many healthcare providers experience abuse at the hands of their patients. There may also be cases in which patients will abuse the system or manipulate healthcare providers by feigning abuse. Nurses need to learn the means by which to physically guide irascible patients and address challenging scenarios and situations.

Conclusion and Reflection

All healthcare workers need to become more aware of and concerned about elder abuse. Elder abuse is commonplace, but it frequently goes ignored or undetected. Some nurses or healthcare providers might worry that their concern about elder abuse constitutes an infringement on the rights of the patient or caregivers, while others may fear losing their jobs by whistleblowing on a colleague. To reduce the severity and prevalence of elder abuse, all nurses can arm themselves with information about the laws that protect them and their patients. Likewise, nurses can empower patients with information about how to recognize abuse, helping patients understand and exercise their legal rights if necessary. Creating a supportive and safe environment in eldercare facilities, training personnel and caregivers, and being more mindful of the various types of abuse including financial abuse, will all be key components in reducing instances of elder…