The number of older adults increases in the world every single day. According to the National Center for Elders, in the United States alone, it is expected that by the year 2050, 90 million persons will be the elderly. With this growing population of the elderly, their care also remains crucial. The lack of proper care for elders leads to elder abuse. Elder abuse is an ethical issue in nursing. It is an ethical issue arising from the nature of how compelling a challenge it remains. It is a compelling and challenging issue because there is no clear definition of what constitutes elder abuse. However, the lack of what defines elderly abuse does not mean the act began in recent years (Yon et al., 2020). Abuse of elderly persons can be traced back to ancient times. It remained a private matter since most health activists focused on addressing child abuse and domestic violence.
Table showing the global average of elder abuse
During the early 20th century, it was addressed the WHO as a social welfare issue and an old age issue. As the years continued, the public health and criminal justice department of the WHO came together to dictate, to a large extent, how elder abuse would be identified. They further determined how it is to be analyzed and how it would be dealt with appropriately. After carrying out various analyses, the WHO was able to come up with the following identities of elder abuse. According to WHO and the Center for Disease Control, elder abuse is defined as abuse, neglect, or inappropriate treatment of persons age 60 and above by caregivers, nurses, or any persons in a position of trust to the elderly person. Some nations refer to elder abuse as elder mistreatment. Elder abuse can happen in several ways, defined by WHO. These ways of abuse include; physical abuse, emotional abuse, sexual abuse, neglect, self-neglect, financial abuse, and financial exploitation. As an ethical issue, elder abuse is a challenging issue that has to be discussed by nurses. Nurses are given the duty to identify, report, and protect vulnerable populations, including the elderly. In this paper, the discussion primarily focuses on elder abuse on the ethical side and how nurses can address it in society.
Table showing the common forms of elder abuse
The Ethical Dimension of Elder Abuse
Elder abuse is an ethical issue based on the following assessments. Each of the evaluations is divided into larger units of social, cultural, religion, and financial reasons why elder abuse is an ethical issue. Socially elder abuse becomes an ethical issue because of the stigma that surrounds it. Older people prefer to endure decades of abuse to portray a sharp image of the family. They are socially afraid to talk to others about their abuse due to fear, guilt, and shame that might occur after reporting their relatives to authorities and nurses. Another aspect proving that elder abuse is a common ethical issue is about religion. Lifelong religious devotions and deep commitment to religious structures like marital vows limit elders in abusive situations from opening up.
Additionally, reports of elder abuse have been identified where a spiritual advisor encouraged the older person to maintain their status for fear of disobeying religious doctrines. Another perspective that is proof that elder abuse is an ethical issue is financing. Low income is a perspective that contributes to the accomplishment of abuse. Finance is, therefore, the complexity of assisting elders in getting abused. Abused elders feel trapped and unable to come out because of financial dependency given to them by the abuser. The fear of elders to provide for themselves makes financial status a risk that makes elder abuse an ethical issue.
Another ethical dimension of elder abuse is the lack of awareness among the elders who are the victims. Most elders are not aware of the issues that constitute neglect, torture, or abuse. Apart from the lack of awareness on the constitution of abuse, the elders are also unaware of the laws that exist on elder abuse, which limits their judgment on what is abuse and what might not be; concerning all the dimensions mentioned above, elder abuse is considered an ethical issue that should be advised by nurses.
The Relevance of Elder Abuse to the Nursing/ Health Profession
The Nursing profession recommends that nurses protect the general population. Nurses, therefore, take a lead role in the protection of any member of the public who is at risk of a health disaster. It means that nurses protect the general take a leading role in older person care. They take a lead role in the following perspectives. Nurses take a lead role in detecting cases of elder abuse. It means nurses must always be conscious of the conditions and the possibilities of occurrence of elderly abuse. It is only through the detection of abuse that an older person can be helped. Detection is a role played by the nurses signifying the significant role that they play in elder abuse as an ethical issue.
Apart from detection, nurses play a vital role in screening. Screening is the process of assessment and objectively documenting the level of elder abuse subjected to the victim. Nurses can detect abuse from the caregiver advised by the immediate environment. Other persons might not be able to identify due to the perpetuation of existing values. However, nurses can conduct external reviews that inform their decisions on assessing a suspected case. Screening also involves applying professional methods to allow the elder abuse victim to open up about their condition. Opening up is quite a task, and if they as victims do open up, it is easier for the nurse to get the victim's help and the abuser to be held responsible. Since most elder abuse person’s fear coming out about being abused, it is the role of nurses to report suspected cases to authorities and participate in investigations that would help put the offender to justice. Other characters that connect nurses to elder abuse as an ethical issue is the societal expectation that no one can provide better care and support for victims of elder abuse than nurses. If need be, the nurse can offer referrals to victims that might require psychological or psychiatric counseling. Lastly, nurses, just like other health professionals, must prevent the occurrence of elder abuse within the community within which they operate.
Relevant Ethical Analysis
There are ethical principles regarding elder abuse. The American Psychological Association (APA) determined that disclosing information of elder abuse by any professionals, including nurses, should be in line with the APA codes. The nurses' ethical commitment underlines that reporting suspected cases of elder abuse should be in line with the principles of beneficence (The principle to do good always), non-maleficence (the principle of not harming others), and respect for the victim's human rights and dignity. Nurses should strive to maintain the confidentiality of the patient. The nurse can only share information with other professions or the victim's family.
Additionally, elder abuse involves the violation of the following nursing principles. Firstly, the principle of autonomy is violated. Elders, just like any other patient, have the right to make decisions. They have to make decisions, especially one that involves their treatment. The principle of autonomy aims to protect the vulnerable population, in which the elderly are part. If a caregiver abuses an elder, the principle of autonomy is violated. Another obvious principle is that of beneficence and non-maleficence. Elder abuse leads to harm on the victims thereby violating the principle of non-maleficence. Lack of ethical commitment to helping the elders is a violation of the principle of beneficence, which focuses on increasing the well-being of the elders. The last principle is that of justice. The patient should receive the required justice whenever they are offended. If action is not taken against the caregivers who participate in elder abuse, then the principle of justice is violated. The three ethical principles mentioned above are broken in the case of elder abuse as an ethical issue.
Apart from ethical principles, some laws prevent the occurrence of elder abuse. Each state in the United States is expected to adhere. The WHO came up with international laws that have to be followed by each member states to protect older persons from abuse. These laws include; Elder Abuse Protection law (EAP) (Phelan, & O’Donnell, 2020). The EAP law demands that information about the victim is collected. Afterward, efforts to decrease abuse are taken, and lastly, the courts and other organizations are expected to execute the law in exceptional cases involving victims. Another act is the WHO international law, which requires that each state offers protection and social services to its elderly persons (Phelan, & O’Donnell, 2020). Through protection, the law emphasizes the need to provide elders persons with emergency phone lines to report any elder abuse within 24 hours of the abuse. The law also stipulates the various certification and standards that each professional has to attain to the care of the older people. The two laws inform the kind of protection that older people should be given and what the offender is likely to be subjected to.
In terms of ethical theory, elder abuse violates the ethical theory of rights. Rights are laws established by society and considered the highest priority (Phelan, 2018). Rights are considered ethically correct justified by the large population that endorses them. Elder abuse is a violation of the rights of older people. They, like any other person, have the right to proper care and medication. Elder abuse, thereby, ethically defies the rights of elderly persons.
Another important aspect of ethical analysis of elder abuse is standards of practice. Standards of exercise are the rules or restrictions that a professional has to achieve to be considered an older adult's caregiver. To give specialty in an earlier abuse case, the standard of practice of a nurse will include; accurate assessment, objectified documents, report of a suspected case to the authority, provision of support and referential to the potential victims, and implementing strategies prevent further abuse. The analyses aforementioned provide various ethnic analyses regarding elder abuse as an ethnic issue.
Personal Professional Response
As a nurse dealing with elder abuse as an ethical issue has to be quite challenging since the task is better handled with an interdisciplinary approach. As a nurse, a personal, professional response would involve computing an inter-disciplinary team comprised of practitioners from various departments. The team headed by a registered nurse would include a counselor, a senior health practitioner or manager, a health social service provider, and a psychologist. The team's objective is to train caregivers in various ways to handle the elderly as a way of reducing the cases of elder abuse. The first step of the team would be to identify patients in imminent danger and obtain immediate treatment. Safe locations would be within nursing and clinic centers. In non-urgent situations, caregivers and elderly patients are subjected to counseling services provided by a team member. If there is a need for referential, the team might submit a patient or a caregiver to religious organizations, senior centers, or a support group. Another action plan for the caregivers would be to allow then to form a discussion group and open up to each other about the risk that they face as a group. Through the guidance of the interdisciplinary team, they can provide the best care to elderly persons limiting elder abuse.
