OLDER ABUSE

OLDER ABUSE

OLDER:

• A human being is more than age of 60 years.

DESCRIPTION:

 

• Abuse of an older adult involves physical, emotional, or sexual abuse; neglect; and economic exploitation.
• Older adults at most risk include individuals who are dependent because of illness, immobility, or altered mental status.
• Factors that contribute to abuse and neglect include long-standing family violence, caregiver stress, and the older adult's increasing dependence on others.
• Victims may attempt to dismiss injuries as accidental, and abusers may prevent victims from receiving proper medical care to avoid discovery.
• Victims often are isolated socially by their abusers.
• Domestic mistreatment takes place in the home of the older adult and is usually carried out by a family membrane or significant others; this can include physical maltreatment, neglect, or abandonment.
• Institutional mistreatment takes place when an older adult experiences abuse when hospitalized or living somewhere other than home (e.g., long term care facility).
• Self-neglect is the choice by a mentally competent individual to avoid medical care or other services that could improve optimal function, to not care for one-self, and engage in actions that negatively effect his or her personal safety; unless declared legally incompetent, an individual has the right to refuse care.

ASSESSMENT:

PHYSICAL ABUSE:

• Sprains, dislocation, or fractures
• Abrasions, bruises, or lacerations
• Pressure sores
• Puncture wounds
• Burns
• Skin tears

SEXUAL ABUSE:

• Torn or stained underclothing
• Discomfort or bleeding in the genital areas
• Difficulty in walking or sitting
• Unexplained genital infections or disease

EMOTIONAL ABUSE

• Confusion
• Fearful and agitated
• Changes in appetite and weight
• Withdrawn and loss of interest in self and social activities

NEGLECT

• Disheveled appearance
• Dressed inadequately or inappropriately
• Dehydration and malnutrition
• Lacking physical needs, such as glasses, hearing aids, and dentures

SIGNS OF MEDICATION OVERDOSE

ECONOMICS EXPLOITATION:

• Inability to pay bills and fearful when discussing finances
• Confused, inaccurate, or no knowledge of finances

INTERVENTIONS:

• Assess for physical injuries and treat physical injuries.
• Report case of suspected abuse to appropriate authorities (follow state and agency guidelines).
• Separate the older adult from the abusive environment, if possible, and contact adult protective services for assistance in placement while the abuse is being investigated.
• Explore alternative living arrangements that are least restrictive and disruptive to the victim.
• The older adult who has been abused may need assistance for financial or legal matters.
• Provide referrals to emergency community resources.
• When working with caregivers, assess the need for respite care or counselling if needed to deal with caregiver stress.

ACTIONS TO TAKE WHEN AN OLDER CLIENT IS PHYSICALLY ABUSED: 

1. Assess and treat the wounds.
2. Ensure the victim is removed from the threatening environment.
3. Adhere to mandatory abuse reporting laws.
4. Notify the caseworker of the situation.
5. Document the occurrence, findings, actions taken, and the victim's response.

• When a victim is abused, the priority is to assess and treat any physical injuries.
• We need to stay with the victim and provides comfort and support.
• After physical injuries are treated, we ensures that client is safe and is removed from the threatening environment.
• Eider abuse needs to be reported.
• We should also contact the caseworker of the situation so that the incident is reported and follow-up can occur.
• If there is no caseworker, contacts social services or the appropriate service to initiate this process.

WHAT IS HYPERTENSION (HIGH BLOOD PRESSURE)?

WHAT IS HYPERTENSION (HIGH BLOOD PRESSURE)?

DESCRIPTION:

• A high blood pressure is termed as Hypertension.
• Abnormally high blood pressure.
• A state of great emotional tension.
• For an adult (ages 18 and above), a normal BP is a  systolic BP below 120 mm Hg and a diastolic pressure below 80 mm Hg.
• An individual classified with pre hypertension has a systolic BP between 120-139 mm Hg or a diastolic pressure between 80 and 89 mm Hg.
• Stage 1 hypertension can be classified as a systolic BP between 140 and 159 mm Hg or a diastolic pressure between 90 and 99 mm Hg.
• Stage 2 hypertension can be classified as a systolic BP equal to or greater than 160 mm Hg or a diastolic pressure equal to or greater than 100 mm Hg.
• Hypertension is a major risk factor for coronary, cerebral, renal, and peripheral vascular disease.
• Hypertension is initially asymptomatic.
• The goals of treatment include reduction of the BP and preventing or lessening the extent of organ damage.
• Non pharmacological approaches, such as life styles, may be prescribed initially; if the BP cannot be decreased after a reasonable time period (1 to 3 months), the client may require pharmacological treatment.

PRIMARY OR ESSENTIAL HYPERTENSION:

RISK FACTORS:

• Aging
• Family history
• African American race
• Obesity
• Smoking
• Stress
• Excessive alcohol
• Hyper lipidemia
• Increased intake of salt and caffeine

SECONDARY HYPERTENSION:

• Secondary hypertension occurs as a result of other disorder or conditions.
• Treatment depends on the cause and the organs involved.
• Precipitating disorders or conditions.

1. cardiovascular disorders
2. renal disorders
3. endocrine system disorders
4. pregnancy
5. medications (e.g., estrogen, glucocorticoids, mineralocorticoids)

ASSESSMENT:

• May be asymptomatic (Idiopathic)
• Headache
• Visual Disturbances
• Dizziness
• Chest pain
• Tinnitus
• Flushed face
• Epistaxis

DIABETES MELLITUS

DIABETES MELLITUS

DESCRIPTION:

• Diabetes mellitus is a chronic disorder of impaired carbohydrate, protein, and lipid metabolism caused by a deficiency of insulin.
• An absolute or relative deficiency of insulin results in hyperglycemia.
• Type 1 diabetes mellitus is a nearly absolute deficiency of insulin (primary beta cell destruction); if insulin is not given, fats are metabolized for energy, resulting in ketonemia (acidosis).
• Type 2 diabetes mellitus is a relative lack of insulin or resistance to the action of insulin; usually, insulin is sufficient to stabilize fat and protein metabolism but not carbohydrate metabolism.
• obesity is a major risk for diabetes mellitus.
• diabetes mellitus can lead to chronic health problems and early death as a result of complications that occur in the large and small blood vessels in tissues and organs.
• Male erectile dysfunction can also occur as a result of this disease.

ASSESSMENT:

• Polyuria
• Polydipsia
• Polyphagia
• Hyperglycemia
• Weight loss
• Blurred vision
• Slow wound healing
• Vaginal infections
• Weakness and paresthesias
• Sign of inadequate circulation to the feet
• Sign of accelerated atherosclerosis (renal, cerebral, cardiac, peripheral)

DIET:

• The diabetic client's diet should take into account weight, medication, activity level, and other health problems.
• Day-to-Day consistency in timing and amount of food intake helps to control the blood glucose level.
• As prescribed by the doctor, the client may be advised to follow the recommendations of the American Diabetic Association diet or U.S. dietary guidelines issued by the U.S. departments of Agriculture and Health and Human services.
• Carbohydrate counting may be a simpler approach for some clients; it focuses on the total grams of carbohydrates eaten per meal. The client may be more compliant with carbohydrate counting, resulting in better glycemic control; it is usually necessary for clients undergoing intense insulin therapy.
• Incorporate the diet into individual client needs, lifestyle, and cultural and socioeconomic patterns.

EXERCISE:

• Exercise lowers the blood glucose level, encourages weight loss, reduces cardiovascular risks, improves circulation and muscle tone, decreases total cholesterol and triglyceride levels, and decreases insulin resistance and glucose intolerance.
• Instruct the client in dietary adjustments are individualized.
• If the client requires extra food during exercise to prevent hypoglycemia, it need not be deducted from the regular meal plan.
• If the blood glucose level is higher than 250 mg/dL (14.2 mmol/L) and urinary ketones (type 1 diabetes mellitus) are present, the client is instructed not to exercise until the blood glucose level is closer to normal and urinary ketones are absent.
• The client should try to exercise at the same time each and should exercise when glucose from the meal is peaking, not when insulin or glucose lowering medications are peaking.
• Insulin should not be injected into an area of the body that will be exercised following injection, as exercise speeds absorption.
• Instruct the client with diabetes mellitus to monitor the blood glucose level before, during and after exercising.

INSULIN:

• Insulin is used to treat type 1 diabetes mellitus and may be used to treat type 2 diabetes mellitus when diet, weight control therapy, and oral hypoglycemic agents have failed to maintain satisfactory blood glucose levels.
• Illness, infection, and stress increase the blood glucose level and the need for insulin; insulin should not be withheld during times of illness, infection, or stress because hyperglycemia and diabetic ketoacidosis can result.
• The peak action time of insulin is important to explain to the client because of the possibility of hypoglycemic reactions occuring during this time.
• Regular insulin (U-100 strength) can be administered via IV injection (IV push). Regular insulin (U-100) and the short duration insulin. (lispro, aspart, and glulisine) can be administered via IV infusion.
• Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels.
• Oral anti diabetic agents act in a number of ways; stimulate the pancreas to produce more insulin, increase the sensitivity of peripheral receptors to insulin, decrease hepatic glucose output, delay intestinal absorption of glucose, enhance the activity of incretins, and promote glucose loss through the kidney.