Dr. Kay Foland Introduces Section 3 Concepts Native American culture includes a strong spiritual orientation to life and living in harmony with nature.

It also includes family and tribal interdependence and support community responsibility and commitment to the welfare of others and especially respect for their elders. 

With the long history of respect for elders, it may surprise you to discover that abuse exists.

Let's listen to Madonna Blue Horse Beard as she talks about what being an elder means in the Native American culture and how changes have occurred. 

As one of the factors that Madonna mentioned, boarding schools have created changes in the way elders are treated. The Native American culture has experienced a number of changes in both the status and the role of elders and unfortunately, these changes have increased the risk factors for elder abuse and neglect. 

Let's examine the risk factors for elder abuse and neglect in the PowerPoint Presentation. 

As you can see, abuse and neglect of elders are problems more of the community as a whole, rather than simply problems of individuals. 

Additionally, abuse is often associated with unemployment and substance abuse.

There are many other characteristics in elders which 
can suggest the possibility of abuse and the nurse should be alert for them as well.

These include such factors as:

• Being a woman 

• Being isolated from other family and social contacts.

• Incontinence can also be a risk factor.

Elders can often stress the caregiver especially those elders who are physically disabled or mentally impaired or are troubled by dementia and the behaviors that can result from that dementia.

An elder who is suffering from grief over the death of a spouse is also at risk for abuse. 

Characteristics of a potentially abusive caregiver may include delaying care for an elder’s illness or injury or on the other hand bringing the elder to the emergency department for frequent or unnecessary visits. 

The caregiver may also give questionable explanations of physical findings.

Or the caregiver may continually shop around for different doctors.

They may also refuse to leave the elder alone during treatment but there can be many other factors as well.

Let's take a moment to listen to Madonna Blue Horse Beard. She is going to describe the effect that attending boarding schools had on Indians as well as the eventual loss of respect for elders this caused.

As you can see, the boarding schools had many harmful effects on Native American people. Lacking a cultural and historical background, many of those who returned from boarding schools never learned the respect for elders that had once been their tradition.

Unfortunately, this cultural change has led to a rise in elder abuse.

Now let's move on and discuss some of the reasons elder abuse among Native Americans is often hidden and not discussed or addressed by viewing the PowerPoint Presentation.

The estimated prevalence is 750 thousand to 1.2 million cases per year in the U.S. but the true rate is actually unknown, since it is commonly underreported. 

The National Center on Elder Abuse in 1998 reported that there are 400 thousand new cases of elder abuse every year. 

Types of elder abuse include:

• Physical abuse is the most recognizable, of course and it is defined as the Infliction of physical harm or injury. 

• Physical abuse also can include sexual abuse or sexual misconduct. 

• Physical abuse most commonly takes the form of hitting, slapping, or pushing, punching, pinching, burning, or striking with objects. 

For additional information and visual examples of elder abuse, surf to the National Center on Elder Abuse and read What are the Major Types of Elder Abuse.
 

Physical neglect simply means that the caregiver has failed to provide the goods or services necessary for optimal functioning of the individual or whatever is necessary to avoid harm. 

Neglect may be intentional or unintentional. 

An elder who is consistently hungry, has poor hygiene, or lacks supervision for long periods of time may be experiencing neglect.

Other examples include:

• Failure of the caregiver to check whether meals are being eaten (which could be unintentional abuse).

• Or refusal to assure that the elder is able to go shopping for essential groceries (which of course is intentional abuse). 

It can often be a willful act carried out in order to cause emotional pain or injury.

But psychological abuse may also occur by itself. 

And when it does it may be difficult to detect unless you witness obvious examples, such as threats, insults, or humiliation. 

Be aware of the signs of psychological abuse...

• A caregiver seems indifferent or angry toward an elder

• A caregiver is unwilling to cooperate with health care providers

• A caregiver seems domineering

If the elder appears withdrawn, isolated, depressed, demoralized, or fearful these might also be signs of psychological abuse.

Psychological neglect can be the failure to provide social stimulation to a dependent elder.

Examples of this include silence and ignoring the elder.

Caregivers may speak for the elder or be angry or even indifferent.

Financial or material abuse as well as neglect and violation of personal rights that ignore the elder’s decision-making capabilities are all additional forms of elder abuse. 

Although financial abuse isn’t as graphic as physical abuse, it too can be devastating. 

Financial abuse can occur when family members, caregivers, or friends take control of the elder’s resources. This can happen either through misrepresentation, coercion, or outright theft. 

Don’t forget...the elder may not even be aware of what’s happening. And, of course, elder abuse can occur in all types of settings. 

Now let's go over the most common types and characteristics of people who abuse by viewing the PowerPoint Presentation.

Caregivers can often become resentful because of the challenging and demanding situations of caring for an elder.

The caregiver can feel over-worked, fatigued, or exhausted.

They may also feel that they don’t have any time left for themselves.

Quite often they don’t know where to turn for help.

Where are the support agencies or mechanisms that can guide them out of their abusive relationships?

Well, we as health care providers, can be crucial in helping those who abuse to recognize what they are doing and find ways to alter their behavior.

Most importantly, though, we need to recognize the abuse itself and thereby help the elders who suffer from it.

We must constantly look for the signs of abuse, and provide the guidance the elder needs to be sure that the abuse comes to an end.

Statistics prove that elder abuse continues to be an escalating problem so as nurses, we have a responsibility to be strong advocates for this vulnerable population. 

Thank you for participating in Section 3 of Module 3. 

This ends Section 3 of Module 3.  To review, we have defined and elaborated on the following concepts.
 

Thank you for your time and attention.  Please be sure
to take the Post-Test for Section 3.

Proceed to Section 4.