Evidence-based guidelines: An estimated 15.7% of adults aged 60 and older are at risk to becoming a victim of elder abuse and its prevalence transcends all socioeconomic, ethnic, race and gender domains. The World Health Organization defines elder abuse as "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person." Elder abuse may be intentional or unintentional and can be classified as physical, sexual, financial, psychological, and/or neglect.
Educational project: Increased vulnerability to elder abuse exists when the older adult (OA) experiences cognitive and functional decline. Clinicians are encouraged to use validated tools for determination of cognitive and functional impairment. When these tools are unavailable, clinicians must rely on their observations, assessments, available health records and conversations with other individuals such as caregivers, family, and neighbors. The Decision Matrix for Elder Safety (DMES) classification system, created by the authors, was designed to aid in identifying OAs at increased risk for elder abuse using observations or historical narrative of functioning over time.
The DMES guides through cognitive status assessments, using the mini-mental state evaluation, a proprietary assessment tool used to screen and estimate global cognitive function and dementia, or the Mini-Cog, a free resource that has a positive association with identifying moderate to severe cognitive impairment. Tools measuring functional capabilities include Katz Index of Independence in Activities of Daily Living and Lawton Instrumental Activities of Daily Living Scale.
Enhancing quality of care: Utilizing the DMES classification system, the risk threat for elder abuse is quantified as a threat for elder maltreatment, which increases as the OA loses cognitive and functional capabilities. The authors created case studies to engage clinicians to think about the OA as a target for maltreatment based on their vulnerabilities. The scenarios help clinicians use the proposed DMES classification to estimate risk and identify vulnerabilities related to the OA’s cognition and functional needs, specifically physical, sexual, financial, psychological and/or neglect, when abuse is suspected or confirmed.
Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
DNP, CRNP, GS-C, CNE, FAANP, FAAN,
UAB School of Nursing
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