218 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS
caustic burns, or friction burns of the wrists or ankles
caused from being restrained by ropes, clothing, or
chains. Signs of physical neglect include a pervasive
smell of urine or feces, dirt, rashes, sores, lice, or in-
adequate clothing. Dehydration or malnourishment
not linked with a specific illness also strongly indi-
cates abuse.
Possible indicators of emotional or psychological
abuse include an elder who is hesitant to talk openly
to the nurse or is fearful, withdrawn, depressed, and
helpless. The elder also may exhibit anger or agita-
tion for no apparent reason. He or she may deny any
problems, even when the facts indicate otherwise.
Possible indicators of self-neglect include inability
to manage money (hoarding or squandering while fail-
ing to pay bills), inability to perform activities of daily
living (personal care, shopping, food preparation, and
cleaning), and changes in intellectual function (con-
fusion, disorientation, inappropriate responses, and
memory loss and isolation). Other indicators of self-
neglect include signs of malnutrition or dehydration,
rashes or sores on the body, an odor of urine or feces,
or failure to keep needed medical appointments. For
self-neglect to be diagnosed, the elder must be evalu-
ated as unable to manage day-to-day life and take care
of himself or herself. Self-neglect cannot be established
based solely on family members’ beliefs that the elder
cannot manage his or her finances. For example, an
older adult cannot be considered to have self-neglect
just because he or she gives away large sums of money
to a group or charity or invests in some venture of
which family members disapprove (Reyes-Ortiz, 2001).
Warnings of financial exploitation or abuse may
include numerous unpaid bills (when the client has
enough money to pay them), unusual activity in bank
accounts, checks signed by someone other than the
elder, or recent changes in a will or power of attorney
when the elder cannot make such decisions. The elder
may lack amenities that he or she can afford such as
clothing, personal products, or a television. The elder
may report losing valuable possessions and report
that he or she has no contact with friends or relatives.Josephine is an elderly woman who has moved in with
her son, daughter-in-law, and two grandchildren after the
death of her husband. She lives in a finished basement
apartment with her own bath. Friction with her daughter-
in-law begins to develop when Josephine tries to help out
around the house. She comments on the poor manners
and outlandish clothes of her teen-aged grandchildren.
She adds spices to food her daughter-in-law is cooking
on the stove. She comments on how late the children stay
out, their friends, and how hard her son works. All this is
annoying but harmless.
Josephine’s daughter-in-law gets very impatient,
telling her husband, “I’m the one who has to deal with
your mother all day long.” One day after another criticism
from Josephine, the daughter-in-law slaps her. She thenCLINICALVIGNETTE: ELDERABUSE
tells Josephine to go downstairs to her room and stay out
of sight if she wants to have a place to live. A friend of
Josephine’s calls on the phone and the daughter-in-law
lies and tells her Josephine is sleeping.
Josephine spends more time alone in her room, be-
comes more isolated and depressed, and is eating and
sleeping poorly. She is afraid she will be placed in a nurs-
ing home if she doesn’t get along with her daughter-in-
law. Her son seems too busy to notice what is happening,
and Josephine is afraid to tell him for fear he won’t be-
lieve her or will take his wife’s side. Her friends don’t
seem to call much anymore, and she has no one to talk to
about how miserable she is. She just stays to herself most
of the day.Elder abuse