Nurses have a duty to report and to protect vulnerable populations including older adults. Yet it can be difficult for nurses to intervene successfully or to feel that they have made a difference in clients’ lives when older adults choose to stay in abusive situations. Abuse in the family and intimate partner abuse are often complicated because older adults are struggling with conflicting social, cultural, religious, or other pressures to continue living with their abusers (Finfgeld-Connett, D. 2014). In order to prevent harm to your clients at risk for abuse, nurses must carefully assess the ethical implications from the perspective of older adults, and then develop the best plan to intervene.
Social and Cultural
When deeply rooted cultural stigma about broken families exists, women may endure decades of abuse to portray an image of family unity rather than taking assistance to ensure their own personal safety (Finfgeld-Connett, D. 2014). As most abuse occurs in families, some older adults feel shame, guilt, or fear over reporting their relatives to the authorities (Olson & Hoglund, 2014).
Think about the dilemma of having a client with a lifelong religious devotion and a deep commitment to his/her marital vows when the relationship is abusive. There are reports of elders whose spiritual advisors have encouraged them to remain in abusive relationships rather than to leave (Finfgeld-Connett, D. 2014).
Low income contributes to the risk of abuse (Dong & Simon, 2014) and complexity of assisting elders who are abused. Some elders who have been abused feel trapped and unable to leave the relationship because of guilt over dependency of their spouse for shared income or fear for their own ability to provide for themselves (Finfgeld-Connett, D. 2014).
Nurses Role in Suspected Abuse
- “provide an accurate assessment of abuse and risk factors for abuse;
- clearly and objectively document assessment findings;
- report suspected incidents of abuse and participate in investigation as appropriate;
- provide support and referrals for clients experiencing potential or actual abuse; and
- implement strategies to prevent elder abuse.” (Olson & Hoglund, 2014)
Just remember that safety comes first. If there is a situation when a client is in eminent danger or has been injured, there should be immediate action to obtain treatment and to remove weak or disabled individual to a safe location. In non-urgent situations, nurses should take steps to help their clients to seek support from the community including counseling services, religious organizations, senior centers, or support groups to reduce their risk for being abused.
For more information, on risk factors and protective factors related to elder abuse, go to http://www.cdc.gov/violenceprevention/elderabuse/riskprotectivefactors.html
Elder Abuse: Speaking Out for Justice
Dong, X. & Simon, M.A. (2014). Vulnerability Risk Index Profile for Elder Abuse in a Community-Dwelling Population. Journal of the American Geriatric Society,
62:10–15, doi: 10.1111/jgs.12621
Finfgeld-Connett, D. (2014). Intimate partner abuse among older women: Qualitative systematic review. Clinical Nursing Research,
Olson, J.M. & Hoglund, B.A. (2014). Elder Abuse: Speaking out for justice. Journal of Christian Nursing, 31(1):14-21
Karen Innocent, DNP, RN, CRNP, ANP-BC, CMSRN
Executive Director, Lippincott Continuing Education
Wolters Kluwer, Health Learning Research & Practice