Negative Practice in Elder Care: Elderly Abuse

This paper discusses the negative practice of elderly abuse in aged care facilities, its types, impact on physical and mental health, and evidence-based solutions to reduce its occurrence. It also highlights the contributors to the issue, barriers in implementation, and approaches to improve the situation.

Negative practice
in elder care:
elderly abuse
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Introduction
• There are 730000 aged or older adults are living in the New Zealand.
• There are many concerns that the older adults experience while going through
the process of aging (Ravenswood, Douglas & Teo, 2015).
• Many of the aged populations are living with a variety of health adversities or
complications
• The residential aged care facilities provide safe and comfortable stay for the
elderly members of the society.
• The negative experience in the aged care can complicate the quality of life and
lived experiences for the elderly (Ravenswood, Douglas & Teo, 2015).
• This paper will focus on one negative experience, elderly abuse, and its impact.

Negative practice: elderly abuse
• Negative practice is any care activity which resulted in harmful
experience or impact on the recipient
• The elderly experience many negative practice outcomes which has
perilous outcomes (Superseniors.msd.govt.nz, 2018).
• The elder abuse is one such conspicuous example of a negative practice
• As per the statistics, one in ten elderly individuals in New Zealand has
gone through abuse (Superseniors.msd.govt.nz, 2018)
• The instances of negative experience can occur in home, residential care
facilities, and even in the hospitals

Elder abuse and its impact
• Elder abuse or abuse in general is any care activity that harms the elderly.
• It can be extreme; but abuse can be subtle as well.
• Both impacts the physical and metal health (Superseniors.msd.govt.nz,
2018).
• Leads to physical injuries and various psychological impacts such
depression, isolation, agitation, withdrawal and even psychosis in certain
cases (Kaplan, 2018).
• Although there are various conditions legislative and practice guidelines,
the alarming situation is only escalating.

Types of abuse
• There are various types of elder abuse
• each type has a categorical impact
• The first type is the physical abuse such as
hitting, pushing, rough handling, over-
medication, or inappropriate use of
restraints or confinement (Nzherald.co.nz,
2018).
• The second type is the psychological such as
harassment, humiliation, threats,
withholding decision making power.

Types of abuse
• The third type of elder abuse such as
inadequate food, clothing, shelter, support,
social contact, and health needs.
• The last two types of common elder abuse
are personal and institutional abuse.
• Personal abuse is inappropriate touching or
violating personal space.
• Example of institutional abuse includes
cultural or racial discrimination, inflexibility,
and violation of rights and policies.

Past experience of elder abuse
• Elder abuse is a global problem
• Most of the elder abuse cases are
unreported, the exact figure is difficult to
attain.
• 10% of the aged New Zealand population
experience some form of abuse in
community setting.
• Negligence and psychosocial abuse is the
most reported among other types of abuse.

Literature on abuse in care
setting
• One of the greatest origin of both physical and
psychological abuse is the use of restraints or
seclusion.
• the rate of elder abuse reported from care homes
carried out by care home workers is alarming
(Nzherald.co.nz, 2018).
• Instances such as taping shut the mouth of a
woman as she had been making too much noise by
a care worker has also been observed in Auckland.
• Physically restraining the elderly, especially the
elders with disability have been reported multiple
times as well (Nzherald.co.nz, 2018).

Literature on abuse in care
setting
• pushing and shoving to ensure compliance is
also notable instances of elder abuse in the
aged care homes all across NZ.
• Neglect has also been reported in the form of
overdosing, inappropriate dosing and skipping
to give medication altogether (Nzherald.co.nz,
2018).
• verbal humiliation, discrimination, and lack of
cultural safety, especially for the Maori is also
a grave concern for aged care setting of NZ.

Contributors to the issue
• Negligence, lack of compassion and noncompliance to code of
conduct is the emerging themes as contributors
• The workload, burnout and lack of proper training is the most
important factor leading to unintentional abuse
• For inflicting physical and psychological harm, the mix of
unregulated health workers with trained regulated workers has
raised concerns
• Lack of cultural safety and appropriateness training in the staff is
also a very important cause of cultural or institutional abuse

Evidence based solution
• First and foremost, training and education of the existing aged care staff
is key to addressing the negative practice of abuse
• Institutional or in-house investigation team to monitor the care quality in
aged care homes has been reported as a key intervention (Westermann et
al., 2014).
• Psychological counselling and financial support for the existing staff is a
efficient technique for reducing negative impact of burnout
• Recruitment and adequate training of culturally diverse staff from Maori
or other such traditional backgrounds can address both staff shortage and
lack of cultural safety (Miller, Beach & Thurston, 2018).

Barriers in implementation
• Lack of resources and infrastructure can be a grave issue
• Lack of compliance among the existing or new staff
• Lastly, lack of sufficient government and non government
initiative or effort can not be ignored either in facilitating
policy reform or establishing monitoring committees
(Westermann et al., 2014)

Approaches to improve
• Advocacy is the most important strategy that can be
implemented to attract attention of local governmental
and global authorities (MacKenzie, 2017)
• Advocacy by aged care staff and social welfare groups for
enhanced recruitment and training for the aged care staff
can be a considerably easy approach
• Lastly, reward based structure can improve compliance
rate among existing staff and can enhance the adherence
rate to guidelines as well (Radermacher et al., 2018).

Summary and conclusion
• Elderly abuse is a saddening issue in aged care
• Both developed and developing nation represent similar concerns
• Elder abuse in aged care settings range from physical, psychosocial,
sexual to even cultural or institutional abuse
• The workload, lack of training, burnout stress, and mix of regulated
with non-regulated are biggest contributors to the abuse
• Training, enhanced staffing and policy reforms with investigative
committees can reduce the abuse rate improve the quality of life for
elders.

References
• Brook, G. (2017). Elder abuse and neglect: past endeavours as a springboard for the future. Aotearoa New Zealand Social Work, 20(3), 44-51.
• Careerforce.org.nz (2018). Describe the use of enablers, restraints, and safe restraint practice in an aged care, health, or disability context. [Online]. Retrieved from
https://www.careerforce.org.nz/wordpress/wp-content/uploads/WB26976v2.pdf [Accessed on 30th Oct].
• Castle, N., Ferguson-Rome, J. C., & Teresi, J. A. (2015). Elder abuse in residential long-term care: an update to the 2003 National Research Council report. Journal of Applied Gerontology, 34(4), 407-443.
• Castle, N., Ferguson-Rome, J. C., & Teresi, J. A. (2015). Elder abuse in residential long-term care: an update to the 2003 National Research Council report. Journal of Applied Gerontology, 34(4), 407-443.
• Davey, J. A. (2016). Elder Abuse and Neglect. In A Restorative Approach to Family Violence (pp. 79-88). Routledge.
• Kaplan, L. (2018). We need an integrated approach to elder abuse. Australian Ageing Agenda, (May/June 2018), 23.
• MacKenzie, J. (2017). Alrc elder abuse inquiry: Recommendations for reform of aged care laws. Bulletin (Law Society of South Australia), 39(7), 36.
• Miller, E., Beach, S. R., & Thurston, R. C. (2018). Addressing Intimate Partner Violence and Abuse of Older or Vulnerable Adults in the Health Care Setting—Beyond Screening. JAMA Internal Medicine.
• Nzherald.co.nz (2018). Rest home abuse 'saddest thing in world'. [Online]. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519392 [Accessed on 30th Oct]
• Nzherald.co.nz (2018). Twenty-one cases of elder abuse in NZ last year. [Online]. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519133 [Accessed on 30th Oct]
• Nzherald.co.nz (2018). Twenty-one cases of elder abuse in NZ last year. [Online].. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519133 [Accessed on 30th Oct].
• Radermacher, H., Toh, Y. L., Western, D., Coles, J., Goeman, D., & Lowthian, J. (2018). Staff conceptualisations of elder abuse in residential aged care: A rapid review. Australasian journal on ageing.
• Ravenswood, K., Douglas, J., & Haar, J. (2017). Physical and verbal abuse, work demands, training and job satisfaction amongst aged-care employees in the home and community sector. Labour & Industry: a
journal of the social and economic relations of work, 27(4), 302-318.
• Ravenswood, K., Douglas, J., &Teo, S. (2015). The New Zealand aged care workforce survey 2014. Auckland: New Zealand Work Research Institute. Retrieved September , 14, 2015.
• Superseniors.msd.govt.nz (2018). Elder Abuse in New ZealandRetrieved from http://www.superseniors.msd.govt.nz/elder-abuse/
• Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care nursing staff: systematic literature review. International journal of nursing
studies, 51(1), 63-71.