Elder abuse is not a new phenomenon. There is evidence of its existence centuries ago. More recent is recognition of elder abuse as a health and social problem. In the United States this first surfaced in the 1950s, but it was not until the 1980s that elder abuse “came of age” as a major concern of older Americans. However, elder abuse is not confined to a single locale. Rather, it is a global problem, found in both developed and developing countries (Antezberger, 2009). The purpose of this essay is to example the types of elder abuse, how to identify elder abuse, risk factors associated with elder abuse, reporting elder abuse and ethics associated with elder abuse in a healthcare role, specifically as a certified nurse assistant (CNA).
Forms of Elder Abuse
Unfortunately elder abuse can take many forms. The first form and obvious is physical abuse. Physical abuse is the use of force that causes unnecessary pain or injury, even if the reason is to help, can be regarded as abusive behavior. Physical abuse can include deliberate or inadvertent hitting, beating, pushing, kicking, pinching, burning, biting, overmedicating, under medicating, or force-feeding; improper use of physical or chemical restraints; and exposure to severe weather. Emotional or psychological abuse is a form of abuse or behaviors that causes an older adult to have fear, mental anguish or emotional pain or distress. This kind of abuse includes name-calling, intimidation, insults and threats which could lead to manipulation. Neglect is a form of abuse that has a wide range. Neglect can range from withholding appropriate attention from the individual to intentionally failing to meet the older adults’ physical, social, or emotional needs. It can include failure to provide food, water, clothing, medication, or assistance with activities of daily living or personal hygiene. In addition, failure to manage older adults’ money responsibly and withholding necessary health care can be considered neglect. Sexual abuse is any nonconsensual intimate contact physically as well as any suggestive poses, photography and pornography forced upon the elder. Sexual abuse is not often reported as a kind of elder abuse due to embarrassment and low self esteem. Finally there is financial abuse and exploitation. Financial exploitation includes fraud, taking money under false pretenses, forgery, forced property transfers, purchasing expensive items without permission, or denying older adults access to their own funds or home. It includes the improper use of legal guardianship arrangements, powers of attorney, or conservatorships, as well as a variety of scams by salespeople, health-related services, mortgage companies, or friends (Muehlbauer & Crane, 2006).
Signs and Symptoms of Abuse
Warning signs of abuse may not be readily apparent to the CNA providing routine care on a newly admitted patient. Signs and symptoms of physical abuse, neglect or mistreatment include bruising, pressure marks, broken bones, abrasions and burns. Emotional abuse signs and symptoms include unexplained withdrawal from normal activities, new onset of depression or any changes in alertness; such as, lethargy, sleepiness or not responding to the caretaker. Other signs of emotional abuse include frequent arguments between the elder and caregiver, controlling spouse, threatening language and belittling comments. Sexual abuse signs include bruising around breasts or genitalia or unusual signs of anxiety related to perineal care. Financial exploitation can be identified by sudden changes in financial status, such as not being able to obtain prescription medicines anymore or suddenly disheveled and unkempt (Sorenson, 2012).
Risk factors associated with Elder Abuse
Many nonprofessional caregivers, such as spouses, adult children, other relatives and friends, find taking care of an elder to be satisfying and enriching. But the responsibilities and demands of elder care giving, which escalate as the elder’s condition deteriorates, can also be extremely stressful. The stress of elder care can lead to mental and physical health problems that make caregivers burned out, impatient, and unable to keep from lashing out against elders in their care.
Among caregivers significant risk factors for elder abuse include an inability to cope with stress, depression, which is common among caregivers, lack of support from other potential caregivers in the family, substance abuse of any kind especially alcohol, and the perception that taking care of the elder is burdensome and without any type of reward. Neglect, physical abuse, emotional, sexual and financial abuse can all occur because the intensity of the elder person's illness or dementia increases. Risk factors associated with elder abuse include several factors concerning the elder themselves outside of the caregivers. Perhaps the elder was an abusive parent or spouse, or have a history of domestic violence in the home. The elder themselves may have a tendency toward verbal or physical aggression, calling the caregivers names or belittling them. In this instance the caregiver may wish to use abuse as a form of revenge for the history of their abuse (Anetzberger, 2009).
Reporting Abuse
CNA observations are important for identifying abuse and neglect. If you suspect abuse and neglect from observing or suspecting signs and symptoms associated with elder abuse you need to report it to your supervisor, or other trusted person, including a registered nurse for help in reporting. Do not assume that someone else will report it. It is the obligation of any professional caregiver, including CNA is to report any suspected abuse.
The national elder abuse incidence study found that only 21% of the cases were reported to and later substantiated by adult protective services. Adult protective services is the lead agency for receiving and investigating reports of domestic, and sometimes institutional, elder abuse nationwide (Anetzberger, 2009). Suspected or known abuse that occurs anywhere other than in a long-term care facility should always be reported to the local adult protective services agency or local law enforcement ("Abuse and neglect: What should you do", 2014).
National standards for care in nursing homes are based on the Nursing Home Reform Act of 1987. The law is part of the Consolidated Omnibus Budget Reconciliation Act of 1987 (Sorenson, 2012). In long-term care facilities suspected or known abuse should be reported to the Ombudsman. Ombudsmen are trained individuals who advocate for the protection and rights of all residents in long-term care facilities. These facilities include skilled nursing facilities, residential care facilities for the elderly, community care facilities and intermediate care facilities. The primary responsibility of the Ombudsman program is to investigate and resolve complaints made by, or on behalf of, individual residents ("Abuse and neglect: What should you do", 2014).
The Elder Abuse and Neglect Act provides that people who in good faith report suspected abuse or cooperate with an investigation are immune from criminal or civil liability or professional disciplinary action. It further provides that the identity of the reporter shall not be disclosed except with the written permission of the reporter or by order of a court. Anonymous reports are also accepted (Sorenson, 2012).
Consequences for not reporting suspected or known abuse is criminal to the same extent as being the abuser yourself. If found guilty of not reporting known or suspected elder abuse or abusing an elder yourself you could be jailed, imprisoned or imposed with fines and judgments. Fines and judgments can be in the hundreds of thousands of dollars, and long prison terms can be handed out by the courts. Fines and judgments can be in excess of one million dollars against caregivers and facilities involved in elder abuse ("Abuse and neglect: What should you do", 2014).
Code of Ethics
A code of ethics is a fundamental document for any profession. It provides a social contract with the society served, as well as ethical and legal guidance to all members of the profession. The code of ethics for CNA's provides guidance for legal and ethical responsibilities to patients and, and in the broader sense, to society. It is the duty of a CNA to work toward easing the pain and improving the health of the patient. You should provide equal care to all the patients, irrespective of their religion, race, gender, age or medical condition. Along with medical needs, a nursing professional is also responsible to address the emotional, physical, spiritual and social requirements of the patients. The nurse assistants should always try to render the services to the best of their ability. Patient’s safety and welfare must be the first concern which directly ties into the role of reporting elder abuse.
Conclusion
Elder abuse is neither a new phenomenon nor entirely a recently recognized health and social problem. Elders' have a right to be free from abuse and neglect, and as a CNA it is our responsibility as professional caregivers to ensure the rights and welfare of elders' are protected at all times. It is important as a CNA to take time and visit with our patients, ask questions and be ever vigilant to the signs and symptoms of abuse. Certified nursing assistants play an important part in the healthcare team of providing care and in times can spend more time with the patients to find indications of abuse. As a professional it is our duty to report abuse and protect our patients from further harm or exploitation.

References:
Abuse and neglect: What should you do. (2014, January). Nurse Aide/VIP, 25(1), 3-9.
Anetzberger, G. (2009). Chapter 25: elder abuse. In B. Bonder, V. Dal Bello-Haas, M. Wagner, B. Bonder, V. Dal Bello-Haas, M. Wagner (Eds.) , Functional Performance in Older Adults (3rd Edition) (pp. 609-632). Philadelphia, Pennsylvania: F.A. Davis Company
Muehlbauer, M., & Crane, P. (2006). Elder abuse and neglect. Journal of Psychosocial Nursing, 44(11), 43-48.
Sorenson, H. (2012). Elder abuse identification; A public health issue. AARC times, 12-16.