1. Fulmer, Terry PhD, RN, FAAN


Training and resources to detect, prevent elder abuse.


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It seems self-evident that older adults should be free from concern related to their quality of life, safety, and well-being, but evidence suggests that one in 10 seniors over the age of 60 is abused or mistreated each year.

Figure. Terry Fulmer... - Click to enlarge in new window Terry Fulmer

The Elder Justice Act was signed into law by President Obama on March 23, 2010, as part of the Affordable Care Act. The law provides federal resources to "prevent, detect, treat, understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation." While the law has not yet been adequately funded, it would create a national adult protective services database and other crucial infrastructure to support a more comprehensive national approach to elder abuse.


Elder mistreatment is a broad term used to describe harms suffered by victims of abuse, neglect, exploitation, and abandonment. It can take many forms and be difficult to recognize. Reliable statistics on elder abuse prevalence are hard to come by, but research suggests that the majority of victims of elder abuse are older women who live in the community and the majority of abusers are family members, that elder abuse often goes unreported by nurses and other health care professionals, and that older adults with dementia are at particular risk.


Elder mistreatment is the antithesis of elder justice. The 3.1 million individuals in the nursing workforce can make a difference in the lives of older adults by asking them screening questions related to their safety and to any evidence of violence in the home. While each state has specific language that explains how elder mistreatment should be addressed, most also have mandatory reporting requirements for nurses. Just as many states require mandatory child abuse training before nursing licensure and relicensure, elder abuse training for nurses should also be mandatory.


Injustices against older adults include financial fraud and verbal and physical violence. It's hard to forget the story of the elderly gentleman who was left at a dog track in Idaho wearing a shirt labeled "Proud to be an American" or, more recently, the story of nursing-home workers in Massachusetts filming their abuse of residents and posting it on social media. The stories of Mickey Rooney, Brooke Astor, and other celebrities have drawn attention to the problem, but there are millions of individuals who suffer mistreatment and have no fame to shine a light on their plight.


In my own nursing practice, I've been especially concerned for older adults with cognitive impairment who are at risk for neglect. Of all of the types of elder mistreatment, neglect is the most prevalent, and often the most dangerous. Older people may or may not survive a physical attack, but they will certainly die of a profoundly infected pressure ulcer, of the failure to be appropriately hydrated, or if basic needs are not met. It's essential that nurses understand how to recognize and respond to elder abuse.


* The Department of Justice has collated resources for practitioners on law enforcement, mandatory reporting, long-term care facilities, and financial exploitation:


* A Nursing Response to Elder Mistreatment curriculum was developed by the International Association of Forensic Nurses:


* The Administration for Community Living's Prevention of Elder Abuse, Neglect, and Exploitation program,, provides federal leadership in strengthening elder justice strategic planning and programming.


* American Academy of Nursing expert panels on aging; psychiatric, mental health, and substance abuse; and violence have named elder justice a priority area.


* An online Nurses Improving Care for Healthsystem Elders course, which I helped develop, provides guidance on this urgent issue:



The Elder Justice Act empowers nurses and holds us accountable for ensuring that there is appropriate screening and intervention in elder mistreatment cases. This bodes well for all of us.