The 2 most crucial types of elderly abuse to me, that I see is self neglect and neglect by a trusted other. “Although self-neglect is not specifically identified as a form of abuse in all state laws, it is the type most frequently encountered and addressed by adult protective services agencies. It also is commonly addressed by nurses in home care settings and is recognized by geriatric health care practitioners as a complex clinical issue. An ethical issue that is central in many—if not most—cases of self-neglect is determination of the person’s capacity to refuse services that may be unwanted, as discussed  in”  (Miller).

Self-neglect develops gradually and is often associated with lack of resources, such as food, money, and housing; other times adequate resources are available, but the older adult may refuse services. Self-neglect occurs within the context of interactions among several risk factors in the older adult and his or her social and physical environments. Typically, older adults who become self-neglecting experience a combination of the following risks: (1) physical disability or medical conditions, (2) cognitive impairments or mental illness, and (3) inadequate social supports. Also, prior traumatic personal experiences, such as physical or sexual abuse or exposure to violence, are associated with increased prevalence of self-neglect in older adults who have no cognitive impairment” (Lien, Rosen, Bloeman, et al., 2016) (Miller).

How I could advocate and protect them from self-neglect according to the text:

  • “Facilitation of referrals for comprehensive and interdisciplinary assessment
  • Interventions to address functional limitations (e.g., making suggestions about assistive devices, facilitating referrals for rehabilitation therapists)
  • Interventions to improve management of chronic conditions (e.g., medication management strategies, education about self-care)
  • Assessment and interventions related to risks for falls and other safety concerns
  • Facilitation of appropriate and acceptable support services (e.g., home-delivered meals, personal care assistance)” (Miller).

The second one I see often is neglect by a trusted other, why it is crucial: “Neglect by trusted others can be intentional, unintentional, or both, depending on factors such as motivation, knowledge, and skill level of the responsible person. Also, neglect may evolve gradually as the health and functional levels of the caregiver or the dependent older adult change. For example, caregivers may initially be well intentioned and provide good care, but become overwhelmed or lack the skills as the needs of the care recipient increase. Other times, caregivers may experience functional or cognitive impairments and not only become incapable of providing care to others but also be in a position of needing care for themselves” ( Miller).

How I could advocate and protect them from neglect from a trusted other:

  • “These situations often involve a combination of acute and chronic risk factors that can be addressed by health care professionals.
  • Nurses are in key positions to identify risks for actual or potential domestic elder abuse.
  • Nurses have key roles in working with family caregivers who are actual or potential perpetrators of elder abuse.
  • Nursing interventions such as caregiver education or referrals to appropriate resources may be effective in preventing or resolving some situations of domestic elder abuse” (Miller).

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