The Issue Of Elder Abuse And Neglect Social Work Essay

The Issue Of Elder Abuse And Neglect Social Work Essay Elder abuse and neglect is a critical health care issue that must be brought to the attention of health care providers and older adults family members. Adults older than 65 who live at home or in long-term care facilities may be at risk for abuse. Nurses should be aware of the causes, screening questions, symptoms of abuse, and resources in the community. Armed with information and a better understanding about the issue, nurses can minimize the devastating effects of abuse on older adults and their families. Every man, woman, and child deserves to be treated with respect and caring. Individuals of all ages deserve to be protected from harm by caregivers (American Psychological Association, 2006). Significant policy developments during the past 20 years have focused on eliminating abuse. However, a deficit in health care providers knowledge and clinical skill application remains. The purpose of this article is to define and describe the kinds of abuse, their potential clinical presentations, and theoretical explanations for abuse to enhance nurses knowledge and understanding of their role in its assessment and management in older adults. BACKGROUND Abuse is defined as the infliction of injury, unreasonable confinement, intimidation, or punishment, with resulting physical harm, pain, or mental anguish (Table 1). It can also be the willful deprivation by a caregiver of goods or services that are necessary to maintain physical or mental health (American Psychological Association, 2006). Elder abuse and neglect has plagued society for centuries but only recently has the issue come to the attention of health care providers, law enforcement agencies, and protective services. Fewer research studies exist about the maltreatment of older adults than about other forms of family violence, including child abuse, rape, and intimate partner violence. The earliest reports of elder abuse and neglect in the United Kingdom in the 1970s dramatized case reports of the phenomenon, termed Granny battering. The health care community and the public were shocked and appalled. A decade later, studies confirmed that the problem was common in the United S tates as well. In the late 1970s, the U.S. Senate Special Committee on Aging issued a series of reports on abuse and neglect occurring in nursing homes. In 1981, the U.S. House of Representatives Select Committee on Aging conducted hearings in which victimized older adults gave firsthand testimony of their experiences with abuse. In 1986, the Institute of Medicine published recommendations for preventing the maltreatment of older adults in institutions, and several years later, the Elder Abuse Task Force was created by the Secretary of the U.S. Department of Health and Human Services. The task force developed an action plan for the identification and prevention of maltreatment of older adults in their own homes, health care facilities, and communities. The action plan included data collection, research, technical assistance, training, and public education. The National Center on Elder Abuse was established as part of the Administration on Agings Elder Care Campaign. Adult Protective Services progra ms now exist in every state to serve vulnerable adults, particularly older adults, who may be at risk for abuse and neglect. Many law enforcement agencies and Offices of the District Attorney have investigative staff specifically trained to address abuse of older adults and other vulnerable populations, in collaboration with health care and protective service professionals. Such actions have led to increased public and health care provider awareness about elder abuse and neglect. Researchers have also sought to grasp the full scope and causes of maltreatment among older adults. Laws that require health care providers to report suspected cases have been instituted in nearly every state. The Joint Commission on Accreditation of Healthcare Organizations (2006) standards for emergency departments and ambulatory care centers call for improved identification and management of elder abuse, in addition to intimate partner violence and child abuse. As the U.S. population ages, demands placed on health care systems to care for older adults are increasing. More than 36 million people who live in the United States are older than age 65, and 600,000 older adults will require assisted living (U.S. Department of Health and Human Services, Administration on Aging, 2006). Currently, there are approximately 17,000 nursing homes in the United States, with 1.6 million residents (U.S. Department of Health and Human Services, Administration on Aging, 2004). Unfortunately, older adults are becoming victims of intentional abuse and neglect within their own homes, as well as in assisted living and long-term care facilities. Each year in the United States, 1 to 2 million adults older than age 65 are injured, exploited, or mistreated by their caregivers (National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect, 2003). One community-based, cross-sectional survey reported that 32 of every 1,000 older adults reported that they had experienced some form of maltreatment at least once since reaching age 65 (Pillemer Finkelhor, 1988). Underreporting is typical with all kinds of abuse, and it is estimated that only 1 in 14 elder maltreatment cases are reported. Health care providers can expect to see a steady increase in the number of cases of elder maltreatment as the older adult population rapidly increases. THEORIES OF ELDER ABUSE Elder abuse is a complex problem with multiple risks and causes. Dysfunctional family lives, cultural issues, and caregiver inadequacies have been implicated as contributing factors. Awareness of such factors may help nurses understand and anticipate situations where maltreatment may be preventable. Several theories attempt to explain the existence and increasing occurrence of elder abuse. The transgenerational, or social learning, theory asserts that violence is a learned behavior. Individuals who have witnessed or been victims of family violence are more likely to try to resolve challenging and difficult life situations with violent tactics they learned in their formative growth. Although 90% of perpetrators of elder abuse are reported to be family members, this cannot account for all cases (Fulmer, Guadagno, Bitondo, Dyer, Connolly, 2004). Situational theory supports the idea that the greater the burden on caregivers, the more likely caregivers are to abuse. Exchange theory addresses the dependence of older adults on their caregivers as a risk of abuse, along with inadequate methods of problem solving as an established pattern of family behavior. Political economic theory addresses the changing roles of older adults. Their loss of independence and income may cause them to look to others for care and support (Fulmer et al., 2004). Psychopathology of the caregiver theory studies caregivers with severe emotional or mental health problems or addictions that put the older adults for whom they care at risk of being abused. For example, a caregiver with a mental health problem who cares for a frail older adult with cognitive impairment is a dangerous combination and may lead to resistant behavior and maltreatment. Although theoretical frameworks cannot explain all cases of elder maltreatment, they can provide a foundation for nurses to begin to understand the combination of factors responsible for the occurrence of elder abuse and initiate a holistic plan of care. NURSING ASSESSMENT INTERVENTIONS Nurses are in an ideal position to play a significant role in the detection, management, and prevention of elder maltreatment and may be the only individuals outside of the family who have regular contact with an older adult. Nurses are uniquely qualified to perform physical and psychological assessments, order confirmatory diagnostic tests (e.g., blood tests, x-rays), and collaborate with physicians and protective services. They may authorize services, such as home health care, or recommend hospital admission as they initiate further investigation by the appropriate local agencies. Opportunities for abuse detection and intervention occur daily in health care settings. In institutional settings, nurses may monitor patient health and perform health history interviews and physical, psychological, sexual, and financial abuse assessments that may be crucial to elicit reports, expose or prevent abuse, and intervene for patients safety (Wieland, 2000). Nurses and other health care providers are part of an interprofessional team collaborating to ensure appropriate, sensitive, and safe outcomes for older adult patients. Institutional maltreatment occurs in long-term care facilities, board-and-care homes, and other assisted-living facilities. Institutional medical directors, private practitioners, nurses, and all health care workers in daily contact with older adults have a responsibility to identify, treat, and prevent abuse. Abuse may be perpetrated by a staff member, another patient, an intruder or a visitor, or a family caregiver. Abuse may include failure to implement a plan of care or provide treatment, unauthorized use of physical or chemical restraints, and use of medication or isolation for punishment or staff convenience. Nurses must be aware of patient diagnoses, medical orders for care, and medications and their side effects to recognize what is suspicious and needs further evaluation or warrants a report to supervisors. However, most elder maltreatment does not occur in institutions but in the home at the hands of a caregiver, often a family member. Unless nurses are educated about abuse and how to observe suspicious injuries, elder abuse may be difficult to detect. Definitions of the kinds of abuse and their signs and symptoms should be included in the training and education of family members and health care workers who care for older adults. Older adults experiencing abuse may be unable to communicate clearly, their bruises may be attributed to the aging process, or they may be fearful and hesitant to report abuse (Wieland, 2000). Indications of physical abuse should signal health care providers to evaluate for other kinds of abuse, such as sexual abuse. In addition to inadequate information, training, and the caregivers experience of caring for older adults, older adults are at risk for maltreatment due to other vulnerabilities. Older adult residents in institutions are typically dependent and chronically ill and may have cognitive, visual, and auditory impairments. They are usually more frail than are younger patients and may not have regular visitors who monitor their mental status, physical condition, or health care. In older adults, each vulnerability increases their mortality risk (Fulmer et al., 2004). Co-existing conditions and medical diagnoses may lead to worse outcomes for older adults who are abused. They may have a decreased ability to heal after injury and may experience greater trauma from physical injuries than do younger people. Their bones are more brittle and tissue more easily bruised, abraded, and lacerated with minimal trauma. Injured older adults differ from the younger population in terms of cause of injury, physical and psychological responses to abuse and injury, and outcomes. Dementia is common in 50% of residents of long-term care facilities (National Center for Health Statistics, 1985), and cognitive impairments often cause older adults to behave in a more resistant manner toward caregivers. Impaired cognition, along with insufficient resources, staff shortages, high staff turnover, and inadequate supervision and training, may increase the risk of elder maltreatment. In addition, societal ignorance about required standards for quality care and victimized older adults acceptance of abusive or neglectful behavior can lead to exacerbation of elder abuse in institutions. Routine questions related to elder abuse and neglect can be incorporated into daily nursing practice. Diminished cognitive capacity does not necessarily negate older adults ability to describe maltreatment. It is always reasonable for nurses to ask about abuse or neglect. A brief mental status examination can be helpful in evaluating patients cognitive status. Assessment for elder abuse should include caregiver, as well as victim, evaluation. Nurses should conduct interviews and examinations with the patient first, in a private setting separate from the caregiver. Clinical settings should have a protocol for the detection and assessment of elder maltreatment. Protocols should consist of a narrative, checklist, or standardized forms that enable rapid screening for elder abuse and provide guidelines for sound documentation that may help disclose patterns of abuse over time and will withstand scrutiny in court. Basic demographic questions should be included and should allow the interviewer to determine the family composition and socioeconomic status. Interviews should proceed from general questions that assess the patients sense of well-being to those focusing on specific kinds of abuse. Common signs and symptoms of maltreatment should be evaluated (Table 2). Elder abuse screening instruments are summarized by Fulmer et al. (2004). Questions recommended by Wieland (2000) for general abuse screening and assessment include: * Do you feel safe where you are living? * Who is responsible for your care? * Do you often disagree with your caregiver(s)? If so, what happens? * Does anyone scold or shout at you, slap or hit you, or leave you alone and make you wait for care or food? After general screening questions, more specific questions about kinds of abuse may follow: * Has anyone ever touched you without your consent? * Has anyone ever made you do things you did not want to do? * Has anyone ever taken something that was yours without asking? * Have you ever signed any documents that you did not understand? Health care providers do not have to prove that elder maltreatment has occurred. They need to screen and document suspicious verbal and physical findings, which may be as simple as stating that the patient seems to have health or personal problems and needs assistance. Sound documentation may include drawings of injuries on body diagrams or photographs to support written reports. Suspicious claims for abuse and neglect may be difficult to quantify. Diagnosis of elder maltreatment depends on education about abuse and application of that knowledge by the multidisciplinary team of health care providers, law enforcement agencies, advocates, and patients. Protocols for elder abuse screening, assessment of risk factors, and documentation should be posted in all health care facilities. ABUSE AND THE LAW National standards for care in nursing homes are based on the Nursing Home Reform Act of 1987. The law is part of the Consolidated Omnibus Budget Reconciliation Act of 1987, often referred to as OBRA 87. The intent of the law is to promote high-quality care and prevent substandard care. The law also seeks to ensure that the rights of nursing home residents are respected. These include: * The right of protection against Medicaid discrimination. * The right to participate in health care decisions and to give or withhold informed consent for particular interventions. * The right to safeguards to reduce inappropriate use of physical and chemical restraints. * The right for provisions to ensure proper transfers or discharges. * The right to full access to a personal physician, long-term care ombudsman, and other advocates. * The right to be free from verbal, sexual, physical, or mental abuse, corporal punishment, and involuntary seclusion. * The right to be free from physical restraints or psychoactive drugs administered for the purpose of discipline or convenience. Nearly all states have mandatory reporting laws that require health care professionals and paraprofessionals to report suspected elder abuse and neglect to a designated authority. Some state laws specify that after authorities have been alerted to suspected elder abuse or neglect, an agent of the state must make an onsite investigation in an attempt to corroborate the report. Uniform reporting systems are established, and cases are assigned and investigated by protective services in a timely fashion. Cases are assigned and investigated by protective services in a timely fashion. Nurses may play an important role in preventing and identifying elder abuse, as well as in the subsequent investigation. CONCLUSION Elder abuse is a significant problem in the United States and often goes unreported and unrecognized. Elder abuse may be physical, emotional, psychological, sexual, or financial. Immediate care, overnight housing, and care in a safe location, in addition to long-term care and home-delivered food, may be necessary. Elder abuse may be a minor issue that can be easily resolved or it can result in severe and life-threatening debilitation. The more knowledge health care providers have, the more likely they are to institute strategies for abuse prevention and management. No matter how minor or severe the abuse, nurses have a duty to assess elderly patients according to recommended protocols and report suspected abuse to designated authorities. The multidisciplinary team then works together to help resolve the issue. The application of knowledge about elder abuse includes screening, assessment, and sound documentation in an attempt to enhance the quality of life and maximize the functional ability of older adults. [Sidebar]

Presidents of the Philippines

Inocencio, Salve Regina S. W;F 11:00-12:30 BSCA 2-2March 6, 2013 Presidents of the Philippine Republic President| Birthday| Native Land| Term of Office| AKA/ Alias| Distinction| Greatest Achievement/ Legacy| Downfall| Cause of Death| Remarks| 1. Emilio Aguinaldo| March 22, 1869| Kawit, Cavite| January 20,  1899–April 1,1901| Heneral Miong| * He was the youngest (at age 28) to have become the country's preside * The longest-lived former president (having survived to age 94)| * Gained the freedom of the Philippines from the Spaniards. The Philippines’ first President| * The invasion of the Americans| (February 6, 1964 )Coronary thrombosis| * He is still a good president of the Philippines even though there are lots of controversies about him. He did his best to protect his people from the invaders. | 2. Manuel L. Quezon| August 19, 1878| Baler, Aurora| November 15, 1935-August 1, 1944| Nonong| * He is the president of the  Commonwealth of the Philippines| * Father of the  National Language * He appears on the Philippine twenty peso bill| | (August 1, 1944)Tuberculosis | * He did a great job to improve the economy. 3. Jose P. Laurel| March 9, 1891| Tanauan, Batangas| December 4, 1942  Ã¢â‚¬â€œ October 14, 1943| JPL| * The puppet president of the Philippines. He was controlled by the Japanese in heading the country| * He was selected, by the National Assembly, under vigorous Japanese influence, to serve as President. | * He violated his Oath of Office and headed an illegal government of the Philippines. | (November 6, 1959)Unspecified| * I cannot say that Laurel is a good leader in the country because there are many wrong doings that he did. He was also been accused as a traitor. 4. Sergio Osmena| September 9, 1878| Cebu City, Cebu| August 1, 1944-May 28, 1946| SO| * The first  Visayan   to become President of the Philippines. | * Founder of  Nacionalista Party * Together with Manuel Roxas, Pres. Sergio Osmena went on a mission to the US to ask for the Philippines' independence. The mission was called OSROX. The Philippines was granted its independence. | | (19 October 1961)Unspecified| * Despite of the war, Osmena was still brave to fight for the Philippines. He didn’t leave his countrymen in the fight. He also did rehabilitations in order to reserve the Philippines from war. | 5. Manuel Roxas| January 1, 1892| Capiz, Capiz| May 28, 1946-April 15, 1948| Manoling| * The first president of the independent  Third Republic of the Philippines| * Ratification of the Bell Trade Act * The Inclusion of the Parity amendment in the constitution * The signing of the 1947 Military Bases Agreement * The enactment of Hare – Hawes cutting Law in 1932 Tydings Mcduffie Act which led to the granting of the Philippine independence on July 04, 1946| | (April 15, 1948)Heart attack| * His term only last 1 year 10 months and 18 days.But even though he only served short, he managed to contribute in rescuing the country fro m its dire economic straits. He has he trait of agood leader. | 6. Elpidio R.Quirino| November 16, 1890| Vigan, Ilocos Sur| April 17, 1948-December 30, 1953| Pidiong| | * Hydroelectric project in Lanao * The establishment of PACSA * He signed the Magna Carta of Labor and Minimum Wage Law * Amnesty for the Huks| The Quirino administration was generally challenged by the  Hukbalahaps, who ransacked towns and barrios| (February 29, 1956)Hart Failure| * He was marked notable with reconstruction and economic gain But, his administration tainted by widespread corruption. | 7.Ramon Magsaysay| August 31, 1907| Iba, Zambales| December 30, 1953-March 17, 1957| Monching| * He was the first Philippine President born during the 20th century. | * His administration was considered one of the cleanest and most corruption-free; his presidency was cited as the Philippines' Golden Years * He led the foundation of the  Southeast Asia Treaty Organization  also known as the Manila Pact of 1954 * He is the first Philippine president to wear a barong tagalog in his inauguration| | (March 17, 1957)Plane crash| * He brought back the trust of the Filipinos to the government and militaries by proving integrity I his term.He is a good man to all. | 8. Carlos P. Garcia| November 4, 1896| Talibon, Bohol| March 18, 1957-December 30, 1961| CPG| | * He  exercised the  Filipino First Policy * He acted on the Bohlen–Serrano Agreement * Initiated the â€Å"The Austerity Program†| | (June 14, 1971)Heart attack | * He believes that the government should no longer would tolerate the dominance of foreign interests in the national economy. Because of this the country learned to stand on its own. | 9.Diosdado Macapagal| September 28, 1910| Lubao, Pampanga| December 30, 1961-December 30, 1965| Dado| | * He introduced the country's first  land reform  law * He   placed the peso on the free currency exchange market * He shifted the country's observance of Independence Day fro m July 4 to June 12. | | (April 21, 1997)Heart failure,  pneumonia  and  renal  complications| * He focused on suppressing graft and corruption in the country. He also pursue the agricultural land reform code of 1963. And this favored the farmers.This does mean he is for the masses. | 10. Ferdinand E. Marcos| September 11, 1917|   Sarrat,  Ilocos Norte| December 30, 1965-February 25, 1986| Macoy| * The dictator who proclaimed martial law | * He proclaimed martial law and reigned 20 years as the President of the Philippines * Laws written by Marcos are still in force and in effect. | Corruption, political mismanagement, assassination of Benigno â€Å"Ninoy† Aquino Jr. | (September 28, 1989)Kidney failure| * Marcos’ term is worst.His administration was marred by massive corruption, political repression, and human rights violations. He is a selfish and greedy leader. | 11. Maria Corazon C. Aquino| January 25, 1933| Paniqui, Tarlac| February 25, 1986- June 30, 1992| Cory| * She uses a yellow ribbon as a symbol of democracy. | * The first female president of the Philippines and in Asia * She was named Woman of the Year by the Time Magazine in 1986 * Mother of Philippine Democracy| * Coup attempts , natural disaster like the erruption of the Mt.Pinatubo, the earthquake in Luzon, the typhoon Uring and it is also n her term where MV Dona Paz sank| (August 1, 2009)Colon Cancer| * Despite the fact that she doesn’t have any learning about politics, she still runs for the democracy. She is a fearless and selfless woman. | 12. Fidel V. Ramos| March 18, 1928| Lingayen, Pangasinan| June 30, 1992-June 30, 1998| Eddie| | * He declared his support for reinstating the death penalty * It is in his term the Philippines experienced rapid economic growth and expansion * He signed into law  Republic Act 7636-  Anti-Subversion Law. * 1997 Asian Financial Crisis| (March 18, 1928- Present)| *   As a result of his hands-on approach to the economy, t he Philippines were dubbed by various internationally as  Asia's Next Economic Tiger. He is a hard- working man and appropriate to be a leader. | 13. Joseph E. Estrada| April 19, 1937| Tondo, Manila| June 30, 1998  Ã¢â‚¬â€œ January 20, 2001| Erap| * He is an actor before becoming the President of the Philippines| * He declared an â€Å"all-out-war† against the  Moro Islamic Liberation Front| * Jueteng case * Jose Pidal issue| (April 19, 1937- Present)| * Estrada is a brave man.A fighter against those people who are enemy of the country. But, he is not also that idealistic leader. Still there are controversies about corruption and gambling. | 14. Gloria M. Arroyo|   April 5, 1947|   Lubao, Pampanga| January 20, 2001  Ã¢â‚¬â€œ June 30, 2010| Ate Glo| | * She focuses on infrastructures like the Clark,rehabilitation of NLEX and SLEX, MRT/ LRT extension and the PNR * Tourist industry boost in her term| * Electoral sabotage * Corruption| (April 5, 1947- Present)| * She is not the model of a person with integrity.Her family especially her husband took money from the government’s income. Yes she have many deeds to improve infrastructures but she is no good as a president. | 15. Benigno Aquino III| February 8, 1960| Manila| June 30, 2010- present| Noynoy| * Came from the family who contributed to gain the democracy of the people from Marcos. | * He signed  Executive Order No. 9, eorganizing the Presidential Commission on the  Visiting Forces Agreement * He  signed  Proclamation No. 3, declaring November 23, 2010, as a national day of remembrance for the victims in the  Maguindanao massacre. * Implemented Executive Order # 7 which suspends the privileges of executives of 122 Government Owned and Controlled Corporations (GOCCs). | | (February 8, 1960- Present)| * Aquino is walking in the shoes of his parents. He is cleaning the government from corruption and improving the economy. But, despite of this many are still not satisfied with his performance|

Causes & Symptoms of Stress

For many people, stress is so commonplace that it has become a way of life. Modern life is full of hassles, deadlines, frustrations, and demands. Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best. But when you’re constantly running in emergency mode, your mind and body pay the price. The events that provoke stress are called stressors, and they cover a whole range of situations everything from outright physical danger to making a class presentation or taking a semester's worth of your toughest subject. But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life. The body does not distinguish between physical and psychological threats. When you’re stressed over a busy schedule, an argument with a friend, a traffic jam, or a mountain of bills, your body reacts just as strongly as if you were facing a life-or-death situation. If you have a lot of responsibilities and worries, your emergency stress response may be on most of the time. The more your body’s stress system is activated, the easier it is to trip and the harder it is to shut off. Long term exposure to stress can lead to serious health problems. Chronic stress disrupts nearly every system in your body. It can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility, and speed up the aging process. Long-term stress can even rewire the brain, leaving you more vulnerable to anxiety and depression. However, anything that puts high demands on you or forces you to adjust can be stressful. This includes positive events such as getting married, buying a house, going to college, or receiving a promotion. What causes stress depends, at least in part, on your perception of it. Something that's stressful to you may not faze someone else; they may even enjoy it. You may feel like the stress in your life is out of your control, but you can always control the way you respond. Managing stress is all about taking charge: taking charge of your thoughts, your emotions, your schedule, your environment, and the way you deal with problems. Stress management involves changing the stressful situation when you can, changing your reaction when ou can’t, taking care of yourself, and making time for rest and relaxation. You can’t completely eliminate stress from your life, but you can control how much it affects you. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the opposite of the stress response. When practiced regularly, these activities lead to a reduction in your everyday stress levels and a boost in your feelings of joy and serenity. They also increase your ability to stay calm and collected under pressure.

The Revolutionary Revolution And The Mexican Revolution

During a decade of political and social chaos in Mexico, an uprising was conjuring against President Porfirio Diaz and the dictator style of his reign. As stated in Mexicans in Revolution, 1910-1946: An Introduction, â€Å"The roots of the Revolution reached back to the successful programs of the government of Porfirio Dà ­az and his regime, called the Porfiriato, that governed the republic from 1876 to 1911.†1 Francisco Madero, a representative for the common people and a candidate in the presidential election in 1910, promoted a resistance that opposed the reelection of Diaz. Eventually, the struggle to overthrow Diaz resulted in the Mexican Revolution. Madero’s forces, as well as the federal army, were compiled from middle and lower class men as well as las soldaderas, women soldiers. Las soldaderas represented the brave women that fought next to their brethren on the front line of battle, but also aided the cause behind the scenes by serving as nurses, washers, an d cooks. 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