Nursing Interventions for Elder Abuse

• The nursing interventions for elder abuse are based on the nursing process and evidence-based practice. The nursing interventions for elder abuse aim to prevent further harm; protect the older person’s rights; promote the older person’s safety; report the suspected or confirmed abuse; refer the older person and the caregiver to appropriate services; educate the older person and the caregiver about abuse prevention and treatment; support the older person’s physical, mental, emotional, social, and spiritual healing; and evaluate the outcomes of care.

• Some of the common nursing interventions for elder abuse are:

  • Prevention: The nurse should implement primary, secondary, and tertiary prevention strategies to reduce the risk of elder abuse. Primary prevention strategies include providing education, information, and resources to older persons, caregivers, families, and communities about aging, health care needs, legal rights, financial management, and abuse prevention. Secondary prevention strategies include screening older persons and caregivers for risk factors or signs of abuse; providing counseling, therapy, support groups, home visits, crisis intervention, and respite care to older persons and caregivers at risk of abuse; and monitoring older persons and caregivers for changes in behavior or health status. Tertiary prevention strategies include reporting suspected or confirmed abuse to the appropriate authorities; providing medical care or legal assistance or social services or shelter or protection orders or advocacy to older persons who have experienced abuse; and facilitating reunification or alternative placement for older persons who have been removed from their homes due to abuse.

  • Protection: The nurse should protect the older person’s rights according to the United Nations Principles for Older Persons. The nurse should respect the older person’s dignity or independence or participation or care or self-fulfillment. The nurse should also protect the older person from further harm by ensuring a safe and secure environment; removing or minimizing any potential sources of danger; and providing appropriate equipment or supplies or medications to prevent or treat complications or infections. The nurse should also protect the older person from re-traumatization by avoiding unnecessary or repeated examinations or procedures; using a trauma-informed approach; and providing emotional support and comfort to the older person.

  • Reporting: The nurse should report any suspected or confirmed cases of elder abuse to the appropriate authorities as mandated by the law and the professional code of ethics. The nurse should follow the reporting protocol of the institution or agency where he or she works. The nurse should document the facts and evidence of the abuse in a clear, concise, and objective manner. The nurse should also inform the older person and the caregiver about the reporting process and their rights and responsibilities. The nurse should cooperate with the investigation and provide any additional information or testimony as required.

  • Referral: The nurse should refer the older person and the caregiver to appropriate services that can provide further assessment, treatment, support, and follow-up. Some of the common services that the nurse can refer to are:

    • Medical services: such as geriatrician, surgeon, dentist, ophthalmologist, otolaryngologist, dermatologist, gynecologist, urologist, endocrinologist, neurologist, psychiatrist, psychologist, nurse practitioner, physician assistant, nurse, social worker, pharmacist.

    • Legal services: such as lawyer, judge, prosecutor, defense attorney, police officer, detective, forensic examiner, elder advocate, guardian ad litem, court-appointed special advocate (CASA).

    • Social services: such as adult protective services (APS), foster care, adoption, kinship care, group home, residential treatment center, shelter, transitional housing, independent living program.

    • Educational services: such as teacher, counselor, tutor, special education teacher, speech therapist, occupational therapist, physical therapist, school nurse, school social worker.

    • Community services: such as elder abuse prevention program, senior center, crisis hotline, helpline, support group, peer mentor, mentor, volunteer, faith-based organization.

  • Education: The nurse should educate the older person and the caregiver about abuse prevention and treatment. The nurse should provide accurate or relevant or understandable information about the causes or types or effects or signs of abuse; the reporting process and legal implications; the available services and resources; the treatment options and outcomes; the coping strategies and self-care techniques; the safety planning and protection measures; the rights and responsibilities of the older person and the caregiver; and the importance of follow-up and adherence to care.

  • Support: The nurse should support the older person’s physical or mental or emotional or social or spiritual healing. The nurse should provide holistic and culturally sensitive care that meets the individual needs or preferences or goals of the older person. The nurse should also provide therapeutic communication or active listening or empathy or validation or encouragement or praise to the older person. The nurse should also facilitate the development of a trusting or respectful or collaborative relationship with the older person. The nurse should also promote the empowerment or resilience or recovery of the older person. The nurse should also involve the family or significant others or community members in the care of the older person as appropriate.

  • Evaluation: The nurse should evaluate the outcomes of care for the older person and the caregiver. The nurse should use standardized tools or scales or questionnaires or interviews or observations to measure the progress or improvement or achievement of the expected outcomes. The expected outcomes may include:

    • The older person is free from further harm or injury.

    • The older person reports or demonstrates reduced pain or discomfort.

    • The older person’s physical wounds or infections are healed or treated.

    • The older person’s vital signs or laboratory tests or diagnostic tests are within normal limits or show improvement.

    • The older person’s functional status or nutritional status or cognitive function or mental status or mood or affect or behavior or pain level are appropriate for age or show improvement.

    • The older person reports or demonstrates reduced fear or anxiety or depression or aggression or withdrawal or confusion or dementia or delirium or hallucinations or paranoia or low self-esteem or poor social skills or difficulty trusting others or difficulty expressing emotions or difficulty coping with stress or difficulty concentrating or memory problems or sleep problems or eating problems or substance use problems or self-harm or suicidal thoughts or behaviors.

    • The older person reports or demonstrates increased happiness or confidence or self-worth or self-esteem or social skills or trust in others or expression of emotions or coping with stress or concentration or memory skills.

    • The older person reports having a positive outlook on life and a sense of meaning and purpose.

    • The older person reports having a supportive network of family members, friends, peers, mentors, professionals, and community members.

    • The older person reports having a safe and secure environment at home, work, community, or institutional care. The older person reports having a safety plan and protection measures in place.

    • The older person reports or demonstrates reduced involvement or exposure to abuse or violence or trauma or stressors.

    • The older person reports or demonstrates increased involvement or participation in positive activities or hobbies or interests or goals. 

      • - The older person reports or demonstrates increased adherence to medical care, legal assistance, social services, educational services, community services, and follow-up appointments.

      •  - The older person reports or demonstrates increased satisfaction with the quality of care and the relationship with the nurse and other professionals. 

      • - The caregiver reports or demonstrates reduced risk factors or signs of abuse; increased protective factors or signs of support; increased knowledge and skills about aging, health care needs, legal rights, financial management, and abuse prevention; increased awareness and acceptance of the older person’s needs and feelings; increased communication and cooperation with the older person and other professionals; increased adherence to medical care, legal assistance, social services, educational services, community services, and follow-up appointments; increased satisfaction with the quality of care and the relationship with the nurse and other professionals.

• The nurse should also monitor for any complications or adverse effects of the abuse or the treatment such as infection, bleeding, shock, organ failure, sepsis, death, re-injury, re-victimization, re-traumatization, non-compliance, relapse, recurrence, dissatisfaction.

• The nurse should also modify the plan of care as needed based on the evaluation of the outcomes and the feedback from the older person and the caregiver. The nurse should also collaborate with other members of the interdisciplinary team to ensure continuity and coordination of care. The nurse should also document the evaluation of the outcomes and any changes in the plan of care in a clear, concise, and objective manner.