Individual Patient Care in Dementia- Essay Pay

A nurse’s role focuses on the help, care and support given to their patients whilst treating people as individuals and upholding their dignity (The NMC code, 2015). In this essay I will discuss the ways in which nurses can ensure that patients with dementia receive individualised patient care. The aim of this essay is to demonstrate how care is implemented to patients with dementia and how nurses ensure care is individualised to meet the patients’ needs and wants.

Nurses can identify the individual needs of the patient by following the nursing process.  The nursing process is a series of stages intended for nurses to demonstrate excellent care. It consists of five phases: Assessing, diagnosing, planning, implementing and evaluating.  This process is client centred. These stages mean that nurses should individualise what is needed for one patient.  A patient needs, and problems is identified through these steps. The Assessment phase is the first step in which it allows nurses to identify what the patient’s needs are. The nurse collects information from the patient by asking them questions and running physical examinations. They dissect the information that is gathered in this stage in which it is further analysed which requires in dept thinking. The Diagnosing Phase is the next phase in which the nurses make an overall diagnosis about the information that was collected in the assessment phase (Gardner, 2003). It is stated that patients tackle a medical diagnosis with what mental health professionals name an anticipatory anxiety. They are nervous and scared as to what they are told and how it may change their day to day life for them and their close ones (McClain and Buchman, 2011).  The diagnosis of dementia entails of examination, cognitive testing and assessment. Nurses informing patients that their memory and cognitive function is beginning to change can be challenging and difficult to hear hence it is crucial that nurses should uphold their dignity and inform them of the treatment that will be applied and to give them the help and support they need. (Prince and Martin, 2016). The planning phase lets the nurses create a plan of action in which ongoing treatment will be discussed. This phase allows the nurses to address patient’s needs. The implementing phase is when nurses carry out the plan of action. For dementia patients their symptoms tend to go worse. It is vital that nurses demonstrate great care in which they can them support with daily activities e.g. washing and dressing them. They should also monitor the patient and focus on the improvements made by the patients. It is vital that the nurses care, monitor and support that is given to the patients is continuous. The care that is received by the patients with dementia is much lower as to those patients without dementia hence it is fundamental that the nurses ensure that care is individualised to the patients’ needs and wants.  For the last evaluation phase, it is crucial that nurses complete an evaluation to see if the treatment that was carried out is working and if any changes happen. If the treatment isn’t working nurses can support the client, analyse and understand as to why it didn’t work (Gardner, 2003).

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Nurses should respect the patient’s beliefs and prevent making assumptions mainly grounded on their appearance or other personal quality. They must listen and consider patient concerns. It is vital that the nurse is non-judgmental and open minded towards the patient. Nurses can ensure care is individualised when it comes to fulfilling the nutrition, pain management and personal needs of the patient. If the patient cannot manage or is unable to regulate their nutrition, then the nurse should support and encourage the patient by placing food within their reach (Kaplan, 1996).

Providing care to a patient who suffers from dementia is vital as the patient does not have the ability fully understand their diagnosis. As a nurse, it is encouraged to introduce yourself to the patient to create a therapeutic relationship during treatment. Patients who have dementia are no longer able to maintain their individuality and personhood hence why it is important that nurses can try and uphold and preserve it for them. Patients value nurses recognizing their individuality. Nurses reassure patients that one is not living a horrible and unhappy life by implementing the worth and value to their life by trying to get to know the person behind the patient. Nurses can ensure that care is individualised as they could get to know the individual, their values, likes and dislikes and hobbies as this gives the patient an individuality whilst always showing compassion and respect (Collins and Hughes, 2014). This is most valued and appreciated by patients as it allows the nurses to know the characteristic and the personality of the patient.  Nurses can show recognition to the patient by acknowledging their needs and wants and providing care that is customized and adapted to it. It is important that nurses try and build an insight of the patient’s world and how to bond with them. When communicating and engaging with them they must always say their name unless the patient wishes a different way of being addressed.  Nurses can consider the patients perspective when demonstrating care that is exclusively personalised to their needs.  Giving recognition to the patient allows the relationship to build much stronger as you are giving your attention and time to them.  Nurses would give the patients the choice and responsibility to make their own decisions when it comes to their choice of food, clothes they want to wear, getting involved in activities etc. Allowing the patients to make decision like this lets them know that they are comfortable. It also gives them a sense of involvement and participation to express their qualities and personality. However, when the discussion of making clinical discussions arises and the patient is unable to make the decisions due to cognitive abilities declining, the family and doctors will be more involved. Nurses should allow the patients to create their own pace in which you shouldn’t push the patients over their limits. It would be much of a benefit to focus on the improvements made by the patients even if it’s something small. This would motivate and drive the patient building their self-esteem. When a nurse is caring for a patient who has dementia it is important that you do not patronise them. Respect for the patient is a main aspect nurses must implement in their duty of care. Nurses can ensure that the care and treatment given to the patients is with both respect and compassion (The NMC code, 2015). Socialisation and interaction is fundamental for patients as it allows the patients to maintain a social life and form relationships. Allowing the patients to experience and be around company will progress their communication skills. Nurses should recognise that all patients including people with dementia is built in relationships and that dementia patients require a healthy social environment to promote opportunities for personal and mental progress.  Dementia affects the way a patient communicates. People suffering from dementia can find difficulties responding back to question (NICE, 2012).

 When conversing with patient with dementia they may also find problems to maintain the information during a discussion. Nurses must validate and shouldn’t dismiss what is said by the patient. They must try to understand and take notice of what the patient expresses to them.  Nurses can communicate in a calm and respectful way in which they should speak directly to the patient. It can be frustrating for a patient with dementia to communicate their needs and wants hence it is vital that nurses are supposed to remain calm and patient if the patient becomes agitated (Ellis and Astell, 2017).  When a patient’s conditions begin to deteriorate, health and social care needs begin to increase causing them to require more help and personal care. When nurses are relaying information to a patient they should give the patient both oral and written information, so it can be fully understood and so it can encourage and boost their communication skills in their care and treatment. When released from hospital, people with dementia are likely to suffer a serious loss of individuality, and increased needs for help and support. So, it is important that the care is demonstrated to patients not only during hospital but when they arrive home.  Nurses can try and view the world from the viewpoint of the person with dementia, distinguishing that everyone’s experience has its own psychological validity, that people with dementia act from this outlook (Brooker, 2007).

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The ageing population is exponentially increasing resulting in challenges to nurses in coping and treating the conditions and health needs that arise with old age (Bhardwa, 2015). These barriers that I will be explaining are obstacles that prevent the pace of excellent care being demonstrated by nurses. The barriers to demonstrating care to dementia patients is that they receive poor quality in which nurses tend to focus on other patients with severe illness and diseases.  Another barrier would be ineffective advance care planning. Some people with dementia receive a delayed diagnosis which can result in them not having the mental capacity to attain decisions. A lot of patients find it difficult to vision their self-getting better due to their current state. Nurses can ensure that the care that is provided to people with dementia is quality care during the duration of their treatment. Hospice use is incredibly low for dementia patients. The people with dementia that get transferred to a hospice can result in confusion and distress at a state in which the person is unable to handle change. Also, they have completely different needs compared to cancer patience’s. It is crucial that both staff and nurses have the training required to deliver care to individuals with dementia. Age discrimination is also a barrier that elderly patients face in which the symptoms demonstrated to doctors and nurses is referred to a getting old. Nurses are failing to spot and notice the symptoms of dementia in a lot of patients which creates a poor rate of diagnosis (Collins and Hughes, 2014). The organization like the National Health Service also create barriers resulting in patients not receiving the care they need. They have limited access to resources, lack of time, heavy patient workloads and insufficient staffing. Nurses have a contribution when it comes to the barriers of providing care to patients. Some nurses have a lack of interest, lack of confidence in critical appraisal skills, lack of knowledge and them feeling overwhelmed (CAN, 2018). Dementia patients experience behavioural and personality changes. Patients that specifically have advances dementia tend to be physically aggressive, have hallucination and get agitated. These symptoms can result physical and emotional distress to both the patient and the nurse. There is also hostile treatment for dementia patients that is very familiar in which it consists of tube feeding and antibiotic treatment for infections. This treatment is known to be wrong and does not improve survival. Families of the patient shows great dissatisfaction against the aggressive treatment that is demonstrated to the patients. Nurses can implement excellent care by concentrating on improving patients comfort and increase in advance care planning (Collins and Hughes, 2014).

The points I explained in this essay show how providing and offering care to people with dementia can be complex and there can be a lot of boundaries that come along with it however when the when the needs, wants, choices and problems is focused and centred around the patient that’s when care is at its best. Nurses should always put the patient first. Nurses can value patients with dementia by promoting their self -worth and treating them as individuals.

Nurse Intervention in Cervical Screening Programmes- Custom Essays

Nurses deliver care to patients in an ever-changing environment that revolves around changes in local and governmental policies as well as technology and pharmaceutical advancement for effective practice, (Ellis, 2016). According to Nursing and Midwifery Council (NMC) Code of Conduct (2015), nurses assess patients’ needs and deliver timely, efficient and effective patient care based on the best available evidence. Evidence Based Practice is the integration of best research evidence with nursing practice and patient needs and values to facilitate effective care, it also promotes quality, safe and cost-effective treatment for patients, families, healthcare providers and health care system, (Brown, 2014; Craig and Smyth 2012). This assignment aims to explore an area in nursing, identifying gaps between theory and practice. Using research and discussing strength of the literature and overcoming related issues in the specified area.

The assignment will focus on barriers to cervical screening and nurses’ intervention to improve screening programmes. Cervical cancer screening can be detected early and treatment of precancerous cells and cervical cancer, (White et al., 2015) continues to exist. Cervical cancer starts from a pre-invasive stage known as cervical intraepithelial neoplasia (CIN) however, it can be detected through cervical screening, (Foran et al., 2015). Cervical cancer is the second most common cancer among women globally after breast cancer, (World Health Organization, 2016). According to the Department of Health (DH) (2012a) detecting cervical cancer at an early stage can prevent around 75% from developing. World Health Organization (WHO) (2015a) asserts that prevention and early detection of cervical cancer is cost –effective and a long-term strategy.  Hoppenot et al (2012) points out that screening can reduce incidence and death rates. Research shows cervical screening is associated with improved treatment for invasive cervical cancer, (Andrea et al., 2012). This highlights the importance of cervical screening programmes.

Cervical screening reduces the occurrence of cervical cancer and research shows it prevents approximately 4500 deaths annually in Britain, (Bryant, 2012). In England, there is an invitation for screening for women aged 25-64.  Women aged 25-49 should attend screening appointment every three years and women aged 50-64 every five years, (Health and Social Care Information, 2012).  However, the last fifteen years has seen a gradual increase in more women being left unscreened for  five years or above, from 16% in 1999 to 22% in 2013 (Health and Social Care Information Centre, 2013). Research shows differences in screening is among women who are younger, lower income earners, less educated or women from minority ethnic background and sexually abused women, (Waller et al., 2012; Cadman et al.,2012; Marlow et al., 2015; Albrow et al., 2014).

A comprehensive search of databases for literature review namely, Medline, Science Direct, CINAHL, National Institute for Health and Care Excellence (NICE) and Cochrane. An advance search strategy including ‘Cervical Screening, Barriers to Cervical Screening, Early Detection Cervical Cancer and Cervical Screening Adherence’. The search was refined to literature in the past five years and incorporated international literatures from United Kingdom, Australia, Sweden and Korea to give an insight of those barriers from a global perspective.

Firstly, as regards discussion of non-attendance among women from minority ethnic background. Marlow et al (2015) conducted both qualitative and quantitative study titled ‘Understanding cervical screening non-attendance among ethnic minority women in England’. The study investigated and compared differences in attendance among 720 women from minority ethnic background and White British women. For clarification purpose, ethnic minority are black, Asian and minority ethnicity (BAME). The study found that BAME women were less likely to attend cervical screening with 44-71% non-attenders compared to 12% white British women. This highlights the need for more intervention by nurses to improve practice. Reducing inequality in cancer pathway particularly among minority ethnic groups is a policy priority (Dept. of Health 2011).

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Marlow et al (2015) found that women from ethnic minority viewed that they were not sexually active so they did not have to do the test. This is an important aspect for nurses to educate in order to improve practice and to promote attendance with educational materials in various languages for better interpretation. The study also found 65% women from minority ethnic background believed they do not need to attend smear test in the absence of any symptoms compared to 6% white British women. These barriers are primarily associated with lower education and lower socio- economic status, (Fang and Baker, 2013).  It is surprising that women are still not aware of cervical cancer screening when people should have received letters and leaflets as part of the NHS programme, this highlights that women who have never attended screening had not read any information, (Kobayashi, 2016). Furthermore Benito et al. (2014) argued that nursing activities were mainly in areas namely health education and promotion, clinical, research, training, and program evaluation. Nurses’ intervention to educate thereby improving knowledge and understanding of cervical cancer and the benefits of screening is essential.

In addition, participants had deep-seated personal opinions including fear and embarrassment. Ethnic minority women were more likely to be fearful and preferred female health practitioner. To improve practice support groups in the community may be a good avenue to discuss about screening. These interventions should lay emphasis on the efficacy of cervical screening and address concerns regarding shame and embarrassment. The main strength of this study is information from a large population that makes it a relevant and reliable study to improve cervical cancer screening programme.

A qualitative study conducted by Cadman et al (2012) titled ‘Barriers to cervical screening in women who have experienced sexual abuse; an exploratory study.  Women from the age of twenty and above who visit the Website of the National Association for People Abused in Childhood (NAPAC), a United Kingdom Charity who provide support and information for people from abusive background were invited to complete a web-based survey of their opinions and experiences of cervical screening. This survey included closed questions assessing social class, screening history and past records of abuse. Participants indicated the type of abuse they had experienced either physical, sexual, emotional, neglect, spiritual or any other form of abuse. Study shows women who have a history of sexual abuse are at risk of gynaecological problems and cervical neoplasia compared to women who have not. Women who have been sexually abused are more likely to smoke, take drugs and consume alcohol. The study revealed that a number of barriers impeded their attendance and adherence to cervical screening including embarrassment, lack of trust on meeting someone for the first time, gender of smear taker, pain, tension, fear and anxiety. The findings indicated that some study participants made remarks about the intrusive nature of the test. Some participants mentioned they were not comfortable with interventions performed while on their backs.  The argument suggest that women who have history of sexual abuse may be fearful and anxious because of triggering memories of the trauma so they may avoid such responses which is true therefore this study is valid and reliable. In relation to evaluation and analysis of the study, the findings also revealed that further training should be provided to increase nurses’ knowledge and sensitivity.  NMC Code (2015) points out that health care providers respect individual choices and deliver care without delay.  In an event of a sensitive discussion, nurses are required to ask patient preference and should remain professional not expressing any sign of shock. Fujimori et al. (2014) argues that to attain effective communication, nurses should inquire patients’ preferences and expectations at the start of the screening process. To improve this skill can be taught in communications skills training which has proven to be an effective approach. Nurses could show empathy by explicitly asking women about their expectations of the screening encounter and whether they have any concerns. This may help to surface issues that the nurse and patient could tackle together to minimise anxiety and fear. For example, it could be to provide the option of a female practitioner for the cervical screening appointment, maintain dignity and sensitivity. Effective communication between nurses and patients is essential. To achieve this, however, nurses must be sensitive to their specific needs and demonstrate empathy. Having nurses who are adequately trained with special knowledge of abuse is essential. There should be interventions such as counselling and support activities as part of ways of ensuring that they attend screening. This is particularly important at cervical screening appointments for sexually abused patients to deliver safe and sensitive practice.

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The Waller et al (2012) conducted a qualitative study evaluating differences to barriers among women from different ages. The study  interviewed practitioners working in the screening programme and other related charities as well as women who never attended screening focusing on their views on how age can influence non- attendance and non-adherence in cervical screening. The study found that women were classified into two distinct groups, which were those who wanted to go for screening but did not attend which consisted younger women and others who had decided not to attend were mainly older women. Wardle (2016) argues that nurses’ intervention at improving uptake could be beneficial by considering different approaches for various age groups to improve practice.

The findings of the following analysis identified barriers that included many described in other studies namely fear of discomfort, pain, embarrassment and lack of education. There is a reliable argument that providing support with when, where and booking an appointment is effective. Additionally one of the key themes emerging from the study is that older women are more conscious about their bodies as they age. For example, one participant discussed about changes in her self-image as she grew older and how it has affected her self-esteem and how she feels reluctant to undergo invasive procedures.  Nurses could encourage action by  reassuring older women and  to remind them of the importance and benefits of cervical screening. Sabatino et al (2012) argued that effective communication improves cervical screening.

This systematic review by Albrow et al (2014) found similar findings with Waller et al (2012) further evaluated the influence of intervention in cervical screening evidence uptake amongst women less than 35 years. The findings from the study increased validity and reliability from the argument that younger women are less likely to attend cervical screening. Ninety-two records were screened and four studies investigated. One of the studies evaluated the use of invitation letters and reported no significant increase compared to standard invitation. Three studies investigated the effect of reminder letters. Study participants described how screening was yet another demand on their time and often competed with work and childcare, which are of higher priority. For others, they could not attend due to inconvenient location, fear, discomfort and embarrassment, (Waller et al., 2012). There was a widely view among 30 year old women as sickness was associated with old age and felt they had no reason to attend screening (Blomberg, 2011). Analysis of the findings  indicate an increase in the number of women attending cervical screening after receiving reminder letters compared to those that were not given, however the increase was relatively small. For this reason, cervical screening programmes need to look beyond the use of invitation and reminder letters among younger women and to develop other interventions to overcome as many barriers. Another study reported no increase amongst women aged 20-24, although in some places these women are below the age threshold. However, the same study reported an increase among 25-29 (95%) and 30-34 that also reported (95%) increase. It could be argued that there is some evidence to suggest that reminder letters had positive effects on adherence to cervical screening programmes. The results also showed that telephone reminder from a female nurse, which had 6.3% and 21.7% increase. The study also reported 2.4% increase after a physician reminder. In evaluation of how nurses can improve practice among these, age group there is a need to remove practical barriers and provide other incentive methods that includes mass media campaigns and educational intervention. There are so many users of social media especially within this age group and if used properly it will play a significant role in creating awareness and educating patients (Merolli et al., 2013). Concerning low perceived risk, this may relate to misperceptions of the purpose of the screening programmes with patients focusing on detection rather than prevention of cervical cancer.  Again, patients should be empowered through social support in the community.  In addition, nurses can educate, giving information regarding importance and benefits of cervical screening. Lastly, the review of GP incentive such as nurses providing flexibility in appointment times and out of clinic days will improve practice.

In conclusion, cervical cancer is preventable and relatively easy to diagnose. Several barriers upon women’s decision to attend cervical screening programme have been identified. Given this, there is a need for how women view cervical cancer and make screening decision. This assignment collates available evidence in order to investigate potential psychosocial influences on women from different perspectives. It is essential that patients adhere to nurses’ advice and educational interventions. In order to improve cervical cancer patient experience, there is a need that nurses receive adequate training and develop skills that can improve practice. One possible strategy is being sensitive to the screening process as a result of its intimate nature combined with effective communication. Nurses can play an important role in treating patients with dignity, respect and showing empathy. This can make a difference to all women most especially women who have experienced sexual abuse. Another contributing factor is to respect patients’ choice; an example is providing preferred gender of the sample taker. This could encourage more attendance and adherence to the cervical screening programme.

PART 2

Reflective practice is essential to nursing profession. My search for the best evidence for cervical cancer screening interventions began by doing literature search. Designing a research study is an advanced and complex skill that requires clinical experience as well as analysing and evaluating the research design. While doing my research I focused on the needs of patients and effectiveness of nursing interventions. The result of my search enabled me acquire knowledge and skills in patient care by extensive literature search using electronic databases and advanced search with combined words. Discovering how to refine my search using full text and finding up to date evidence in the last five years.  My skills have greatly improved using electronic databases. This was done in order to obtain relevant up to date search. NMC (2015) requires nurses use up to date evidence and competent to practice. Such insight in itself is relevant to nursing competency and can help to improve patient care.  I read and understood articles relevant to nursing practice, clinical expertise and understanding patient values. Reading the research articles and reflecting on each one, identifying assumptions, key concepts and methods and determined whether the conclusions were based on their findings. Appraising the steps of the research process in order to critically analyse and use it to inform practice. This developed my assessment skills and I was able to identify valid and reliable studies. Reviews and ratings of the evidence resulted in recommendations for practice. According to National Institute of Nursing Research (NINR) 2013, nursing research is defined as research that involves and develops nursing care in order to promote patient healthcare. Nurses play an important role in the National Health Service (NHS) they provide front line services, support patients and contribute to health research. Furthermore, research generates knowledge for nurses and contribute towards health care (Parahoo, 2014). I am more enlightened about the importance of analysing and evaluating research studies, which helps nurses to acquire more knowledge and be up to date with evidence thereby promoting patient care. It is evident that evidence base practice will continue to have great impact on the professional practice of nursing. Evidence based practice is important in nursing because it improves patient outcomes, care is delivered more effectively and efficiently and it minimises error, (Houser,  2016). I have acquired more knowledge, skills during the duration of this evidence based practice assignment and recognised my strengths, and areas that I needed to improve on.

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Combating Financial Abuse

Combating Financial Abuse

Introduction

Elder financial abuse is becoming a bigger threat and costly problem affecting elders and their families. As the older adult population in the U.S. continues to increase, so will the opportunities for unscrupulous criminals to take advantage of the wealth that many older adults have accumulated through their lifetime. While these crimes seem to be only committed by strangers, elder financial abuse is also committed by people who occupy traditional positions of trust, such as friends and relatives. Combating financial elder abuse begins with getting the entire family and social network involved. Talk frequently with the elder.  Have they been approached by new friends lately? Have they been offered a recent unique opportunity? Listening closely enough, one will be able to spot and stop scams before they go too far.

Importance to the study

Financial losses due to fraud and abuse can undermine the ability of older adults to continue to live in their own homes and afford their long-term health care needs. This stress can take a great toll on the elder. Many older individuals experience increased health problems that can lead to serious depression all due to the increase in financial loses. Perhaps worse is the loss of trust older adults develop in others and themselves after being the victims of financial fraud.

Financial Fraud is a Widespread Problem

In 2015 alone, older adults lost a total of $36.5 billion because of financial fraud and scams. Seniors who are socially isolated and/or in mental decline can be especially susceptible. The abuse can leave victims traumatized as well as financially harmed, or even ruined. The fear is the problem could worsen since more than 10,000 Americans turn age 65 every day.

An estimated one in five older adults has been the victim of financial fraud. Many of these victims are stripped of their assets and left with little to live on. Many of these victims rarely see their money returned even if the criminal is caught. And of course, many people don’t report the crime at all. The Federal Trade Commission says one in 24 financial elder abuse crimes ever get reported.

What are some statistics of Elder Financial Abuse?

Most analysts go with the 2010 Investor Protection Trust Elder Fraud Survey which said one in five Americans over the age of sixty-five, has been victimized by a financial fraud and a 2011 MetLife Mature Market Institute study determining that financial exploitation costs seniors at least $2.9 billion annually. At the other end of the scale, True-Link, a company that provides account-monitoring software for elders and their families, has projected that financial elder abuse costs families more than $36 billion a year, 12 times the MetLife estimate. True-Link arrived at its estimate by surveying family caregivers of older people. Defining financial elder abuse is very difficult because of the wide estimates of what is considered financial elder abuse. Many know it’s a problem but how big the problem is quite hard to say, because hard data is so scarce. The reason for this scarcity is due to the fact financial abuse often goes unreported, because the victim often feels shame and embarrassment.

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This paper will explore financial abuse and how to combat financial abuse in the elderly population.

Literature Review

Many theories have been proposed to help explain financial elder abuse. Such theories have mainly been adapted from other fields such as child abuse and intimate partner abuse.

Although the literature covers a wide variety of these theories, this review will focus on several major themes which emerge repeatedly though out the literature reviewed. These themes include: how prevalent is elder financial abuse, who is committing elder financial abuse, what effects does financial abuse have on its victims and what can be done to help prevent elder financial abuse. Although the literature presents these themes in a variety of contexts, this paper will primarily focus on their application to how devastating elder financial abuse can be to its victims.

The prevalence of financial elder abuse is on the rise. As baby boomers are now in retirement criminals are taking advantage of this ever-increasing opportunity to steal from them. Burns, Henderson, Charles, Sheppard, Zhao, Pillemer and Lachs (2017) suggests that, “Approximately one of every 18 cognitively intact older adults living in the community experiences financial fraud or scam each year.” It is felt that elder financial abuse can be considered a sort of financial exploitation. This exploitation occurs when the perpetrator misuses or takes the elder’s money for their own personal benefit. This frequently happens without the knowledge or consent of a senior, depriving them of vital financial resources.

The rising number of seniors only increases the opportunities for perpetrators to practice their art of stealing. The question that begs to be answered is who would do this to our most vulnerable generation?

Perhaps the most tragic element of elder abuse is the fact that in many cases, the perpetrator is a trusted friend or family member whom the elderly person thinks is acting in their best interest. A popular way to gain access to the elder’s finances is through using the services of a lawyer. Lawyers need to be aware of the ways in which their services may be used by family members or caregivers as a means of financial abuse. Hannah (2016) say’s “Often, a lawyer may be asked to draft documents that provide an elderly person’s family member or caregiver with an opportunity to steal the elderly person’s possessions. “A story was once told about a distraught sister, convinced that her brother was stealing from their parents. The daughter was concerned because the son was given total control over their parent’s affairs. This gave him the legal authority to make both financial decisions without being accountable to anyone else and all healthcare decisions as well.  When asked if the daughter had called Adult Protective Services, she said, “no because she didn’t want to get her brother in trouble.” Perpetrators are not limited only to the ones the senior might know, there are others.

Seniors control a major portion of the nation’s wealth. Thieves go where the money is and realize that the elderly often suffer from cognitive and physical disabilities and are vulnerable. Also, many seniors are socially isolated, lonely and have no one to consult with on financial matters thus making them susceptible to manipulation. Goergen and Beaulien (2010) explains, “Perpetrators pretend trustworthiness by posing as relatives when they call the elderly on the telephone or pose as craftsmen at victims’ doorstep, or they appeal to victims’ readiness to help by pretending to be a family member in a situation of distress and needing support.” Another sad story was told, when a man prompted an elderly woman to sell her home and wire the money to a mysterious bank account. The man, who claimed to be communicating from another country, promised to marry her. It was all a scam. Today, the woman is homeless. When asked why she did that, she said, “well that’s what you do when you’re in love.”

People committing financial fraud schemes are experts in deception, and very good at coming up with new ways to trick unsuspecting victims. They have learned to be experts in manipulation. Tacchino (2017) says in some cases, the elderly client feels responsible for what happened and they are too embarrassed to make a complaint. Suffering victimization can lead a senior to withdraw and have an increasing feeling of hopelessness. Faced with financial loss, some victims may contemplate suicide. Additionally, having money stolen in retirement can make it difficult for the elderly to afford needed medical care which can cause medical conditions to worsen.

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While it’s important to understand the signs of elder abuse, it may be more productive to take steps to prevent abuse from occurring in the first place. Oumlil and Williams (2011) Given the significance of the elderly consumer market in the development of successful and comprehensive marketing strategies, it is imperative that marketing decision-makers and policymakers better understand and respond to the varied needs of this significant consumer segment.  Family conversations can help gain insight into the senior’s affairs and mental state. Jackson (2015) explained, people who have been battling financial exploitation are pleased to observe the increased attention that financial exploitation is receiving at all levels of society. Family discussions between elders and adult children could serve as a much-needed reality check. Ideally, conversations on these matters should take place well before retirement, to ensure that elders are adequately prepared. This will give the whole family the time needed to anticipate, plan, and make smarter, more informed decisions.

In identifying weaknesses and gaps, one question would be how often are perpetrators caught and what are the penalties that they would receive.  There is very little to no news of anyone being fined or sent to prison for stealing an old person’s life savings.

In conclusion, focusing on these five major themes which have emerged though out the literature reviewed include a better understanding of the prevalence in elder financial abuse, who is committing elder financial abuse, what effects financial abuse has on its victims and what can be done to help prevent elder financial abuse. Hopefully this will show how devastating elder financial abuse can be.

Oral History

An interview with Joe F. who wished to remain anonymous is 77 years old.  He had the unfortunate experience of someone trying to trick him into sending money under the false impression of helping a family member out of a financial jam.  Joe became an unwilling expert in the popular scam which is commonly known as the grandparent scam. Goergen and Beaulien (2010) explain, that perpetrators pretend trustworthiness by posing as relatives when they call the elderly on the telephone or pose as craftsmen at victims’ doorstep, or they appeal to victims’ readiness to help by pretending to be a family member in a situation of distress and needing support. It is so simple and so devious because it uses one of most reliable assets seniors have, it’s their hearts.

Scammers will place a call to an elderly person and when the senior picks up, they will say something along the lines of: “Hi Grandpa, do you know who this is?” This is exactly how Joe said his unsuspecting scam call started out. He said when he answered the phone, the voice on the other end was hard to recognize, the excuse was given that it was a bad cell phone signal. The unsuspecting grandparent guesses the name of the grandchild the scammer most sounds like. By doing this the scammer can establish a fake identity without having to do any background research. Joe said, “Is this Jack?” The voice on the other end said, “yes, its Jack.” Once the fake grandchild identity is established the scammer will usually ask for money to solve some unexpected financial problem such as overdue rent, payment for car repairs, etc.

In Joe’s case the caller said they were in a traffic accident and needed some money to have the car towed. Often the scammer will ask money to be sent via Western Union or MoneyGram. Often money transferred this route does not require identification to collect. At this point, Joe began to be suspicious because Jack only has his learners permit and would not be driving alone.  So, Joe began to probe further by asking where Jack was. The voice on the other end was reluctant to say. Often the scam artist will beg the grandparent, “please don’t tell my parents, they would kill me.”  By this time, Joe felt like this was a scam and hung up the phone.

These scams are likely to be done hundreds of times on unsuspecting seniors just like Joe. The fact that no research is needed makes this a scam a popular one that can be perpetrated over and over at very little or no cost to the scammer.

After the call, Joe went on to say how vulnerable he felt. He said they knew my number, they knew my name and now they know my grandsons name. Then he said, “my feelings of vulnerability turned to anger.” These feelings are common with the victim. Imagine the heightened feelings of vulnerability and anger knowing they had stolen your money as well. Joe said he was glad I was doing this research on this topic and hopes this will help others be more educated about how to avoid being victims of this type of financial abuse.

Brian’s Story is about financial elder abuse that happens when the perpetrator is known to the victim. Brian’s brother, stole thousands of dollars from him when Brian moved into an assisted living center. Brian’s retirement funds began to disappear after his brother was granted power of attorney to take care of his finances. After Brian had a visit with his son, they uncovered that Brian’s brother had lied to him about the selling price of his condominium. The price was $156,000 more than what is brother had said the condo sold for. When he returned home, Brian unsuccessfully tried to address the subject with his brother. Things took a turn for the worse when he got a letter from Medicare that said that because he hadn’t paid his premiums he was suspended from the program. His brother had neglected making these payments. For Brian, taking his brother to court proved futile. Through a series of consultations, Brian said he was told that even if his brother did get convicted, he would be dead by the time he would recover any of the money. But Brian isn’t letting his financial woes keep him down.  His attitude is inspirational. Brian is not alone. So many elders will be financially abused annually, and the numbers will continue to rise, because many seniors are likely too scared or otherwise unable to seek help.

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Discussion

As many of us have parents that are elders or we might be elders ourselves, it is important to understand how prevalent elder financial abuse is. It is imperative to know who is committing elder financial abuse, to understand what effects does financial abuse have on its victims and what can be done to help prevent elder financial abuse from happening.

Some have argued that financial elder abuse is not very common because the news seldom carries stories of such cases. However, findings from Burns, Henderson, Charles, Sheppard, Zhao, Pillemer and Lachs (2017) suggests that approximately five percent of cognitively intact older adults living in the community experiences financial fraud or scam each year. As the increase of baby boomers now in retirement criminals are taking advantage of this ever-increasing opportunity to steal from them. As a home health nurse, I am finding that financial elder abuse is happening more and more due to the increased complaints reported by my patients.

So why are the elderly so vulnerable? Thieves go where the money is and realize that the elderly have it. To make getting it easier, many seniors often suffer from cognitive and physical disabilities making them more vulnerable. Goergen and Beaulien (2010) explains, perpetrators pretend trustworthiness by posing as relatives when they call the elderly on the telephone or pose as craftsmen at victims’ doorstep, or they appeal to victims’ readiness to help by pretending to be a family member in a situation of distress and needing support. This is what happened to Joe F. but he was one of the lucky ones who figured out it was a scam. Too many other seniors fall victim and lose.

It seems simple enough not to trust strangers but who can protect the senior when the abuse is coming from someone known and trusted? Lawyers need to be aware their services may be used by family members or caregivers as a means of financial abuse. Hannah (2016) often, a lawyer may be asked to draft documents that provide an elderly person’s family member or caregiver with an opportunity to steal the elderly person’s possessions. Education provided to law firms includes reviewing the tactics of a potential perpetrator and how they seek to gain access to a senior’s finances. This education is helping to reduce the incidences of elder financial abuse.

As a home health nurse, I will use this research to help educate the elderly patient population that I serve. One of a nurse’s primary ethical responsibilities is to work with the patient to provide care that maximally enables the physical, emotional and social well-being of the patient. A nurse is also responsible for protecting and advocating for patient’s safety and rights. Protecting the elderly patient from financial abuse is truly advocating for your patient.

Nurses also have a responsibility to work with the public and other professionals to foster local, community, and national efforts to improve the financial safety of the elderly population.

I have learned to be more empathetic, to help provide emotional support by listening and allowing patients to express how they feel about be a victim of financial abuse.

The older adult is often ashamed to admit that they have succumbed to financial abuse. Nurses have a unique opportunity to talk to their patient who have been victimized about their feelings and may also be able to suggest a referral to a professional who is experienced in dealing with financial abuse victims. The nurse may also be the first person to recognize symptoms of depression or suicidal intent of abused elderly victims.

The elderly population is entitled to a safe, quality life free from financial abuse. Many nurses and other professionals are working to enhance this safe quality of life for the elderly. This article has reviewed what these health care providers and other professionals have already done to promote safe financial environment and suggests activities that can further enhance the safety of our care of the Elderly form financial abuse.  Nurses are playing, and will continue to play, an ongoing role in the movement to protect the elderly from financial abuse.