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European Journal of Applied Sciences – Vol. 12, No. 6

Publication Date: December 25, 2024

DOI:10.14738/aivp.126.17965.

Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What

Competencies are Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.

Services for Science and Education – United Kingdom

Identification of Elder Abuse at Emergency Departments: What

Competencies are Required from Staff?

Mari Salminen-Tuomaala

Seinäjoki University of Applied Sciences,

Seinäjoki, Finland

Juha Tiainen

YTHS, Oulu, Finland

Eija Paavilainen

Tampere University, Tampere & Etelä-Pohjanmaa

Wellbeing Services County, Seinäjoki, Finland

ABSTRACT

The purpose of this mixed method study was to describe emergency department

nursing staff’s ratings and experiences of their competencies in identifying elder

abuse. The target group consisted of nursing staff in emergency departments of

one university hospital and four central hospitals in Finland. The staff were

Registered Nurses, Paramedic Nurses and Practical Nurses. The study is part of a

larger research project on the identification of abuse, carried out with staff in

prehospital and emergency department care. The data was collected using an

electronic Webropol survey in autumn 2022 and spring-summer 2023. The

quantitative data was analyzed using IBM Statistics for Windows 28 and the

qualitative data using inductive content analysis. In the experience of emergency

department nursing staff, it was easier to identify physical abuse, compared to

psychological or social abuse or neglect of care in their older patients. The staff

were well aware of risk factors associated with elder abuse, but their detection

was not easy in short care contexts. According to the study results, elder abuse

identification competencies in emergency departments include detection of the

signs of abuse; assessment of the seriousness of the situation; interaction skills;

emotional intelligence and situational awareness, and ethical competencies. In

addition, the results highlight the importance of multiprofessional expertise in

ensuring the patient’s safe follow-up care and coping at home. The identification of

elder abuse is challenging in emergency departments and requires the

development of multiple competencies and knowledge, especially regarding the

detection of the signs of abuse, assessing the seriousness of the situation and

interaction skills.

Keywords: elder, abuse, nursing staff, emergency department.

BACKGROUND

Elder abuse is a global problem that has continued to increase alarmingly in recent years [1,

2]. According to the World Health Organization [3], one in six (15.7 %) over 60-year-olds

experiences abuse yearly. Earlier research has shown that abuse is even more common, since

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European Journal of Applied Sciences (EJAS) Vol. 12, Issue 6, December-2024

older people do not always report abuse due to fear or shame [4, 5]. The identification of elder

abuse and effective interventions can be seen as a matter of human dignity, which makes the

development of nursing staff competencies in this area ethically important [6-8].

Elder abuse is defined as an act or lack of appropriate action in a trusting relationship, which

jeopardizes the older (over 65-year-old) person’s health, safety or wellbeing. The abuse can

include physical or psychological violence, sexual abuse, financial abuse, neglect of care and

help or limitation of rights, or other behaviour that violates human dignity or is experienced

as insulting. Abuse can occur in the form domestic violence, in a couple relationship or in any

close relationship, or as unethical treatment in a caring relationship [2]. Increased

dependence on the help of others can increase the risk of abuse [9]. As pointed out by

Tiilikallio and Säles [10], older people may also become subjected to structural abuse in

society, which may involve age-based discrimination and lack or denial of appropriate

services.

Women in old age experience violence in their couple relationships or other close

relationships more commonly, compared to men. In Finland, there has been an increase in

reported abuse experienced by under 75-year-old women in their close relationships [11]. In

the Healthy Finland Survey, conducted in 2023 by the Finnish Institute for Health and Welfare

[12], 6 % of 65-74-year-old women and 2.1 % of the men reported having experienced

physical or psychological abuse in their close relationships during the previous 12 months. In

a study conducted in Australia it was estimated that 14.8% of community-living over 65-year- old people had experienced abuse. Psychological abuse was found to be the most common

form of abuse (11.7), followed by neglect (2.9%), financial abuse (2.1%), physical abuse

(1.8%) and sexual abuse (1%) [13]. Similarly, Yılmaz et al. [14] found psychological abuse to

be the most common form of abuse in older people. The next most common abuse subtypes

were physical abuse, neglect and financial abuse. Research has shown that elders’ physical

and psychological vulnerability and loneliness make them more susceptible to abuse [15, 16].

In addition, poor health, lack of social contacts and social support, as well low socioeconomic

status are associated with an elevated risk of abuse, especially financial, psychological and

sexual abuse. The perpetrators are usually the elders’ grown-up children, spouses or partners.

Abuse from adult children is mostly financial, physical or psychological, whereas abuse

committed by a spouse or partner is most commonly physical, psychological or sexual [13].

Abuse can lead to long-term illness and depression and increase the use of emergency

services [17-19].

According to Qu et al. [13], abused older people seek help for physical, psychological and

financial abuse more commonly, compared to sexual abuse or neglect. Help is mostly sought

from family members and friends. Nursing professionals have a central role in the

identification of elder abuse, so developing their expertise is imperative [8]. Emergency

departments are frequently visited by abused elders, but the abuse often remains undetected

[18, 20]. As declared by Åberg [21], elder abuse and violence in close relationships are

difficult to detect; they are typically hidden crimes, not reported to authorities. Is has been

estimated that only one out of twenty-four cases of abuse are reported to authorities [21, 22].

Earlier research on the identification of elder abuse in nursing has involved the perspectives

of residential and nursing homes [24-29]; home care and nursing [30-34]; prehospital

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Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are

Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.

URL: http://dx.doi.org/10.14738/aivp.126.17965

emergency services [35-37], and hospital emergency departments [38-42]. Furthermore, a

few studies have dealt with educational interventions designed for nurses on the

identification of elder abuse [43-45], including training on screening and assessment tools

[46-52].

The identification of elder abuse has been found to be hampered by the relatively short

duration of the contacts at the emergency department [39]. Secondly, emergency departments

focus on acute health problems and do not routinely seek to detect psychological or financial

problems [53]. The assessment of the situation is further complicated by ethical and family

dynamic factors [54]. As noted by Andermann [55], social risks factors underlying health

problems should also be looked at when encountering suspected abuse. Some interventions

have already been developed to identify, prevent and intervene with elder abuse. They

involve education, multiprofessional collaboration and various counselling and support

interventions [56]. It has been proposed that training arranged to help professionals detect

elder abuse should be complemented by interventions that improve the safety of the elders

and respect their autonomy and privacy [57]. When developing interventions, it is also

important to assess in which environments they could be most useful [58, 59]. Especially

creating screening tools for nursing staff at emergency department should be a priority [56,

60, 61]. Elder abuse protocols could also be developed to support nursing staff [62] and to

increase nursing students’ awareness of the scope of the problem [63]. Systematic screening

with help of checklists has proven to be effective in the detection of abuse at emergency

departments [22]. Checklists can help staff identify signs of abuse and people subjected to

abuse [64]. Earlier studies have shown that health care professionals feel that they have not

received adequate training on how to identify elder abuse [59, 65]. Increasing elder abuse

training is justifiable, as it has been shown to promote professionals’ interview skills,

assessment of the situation, organization of further care and documentation [66]. The

identification of elder abuse, the appropriate interventions and documentation call for ethical

competencies [67]. In addition, health care professionals would benefit from cultural

sensitivity [68] and training on the risk factors of abuse [55]. More information is required

about the health care professionals’ experiences of identifying elder abuse and neglect [1, 69].

Nurses working at emergency departments and caring for older clients in acute situations

have a critical role in the detection of elder abuse [22, 23].

STUDY PURPOSE AND RESEARCH PROBLEMS

The purpose of this mixed method study was to describe emergency department nursing

staff’s ratings and experiences of their competencies in identifying elder abuse. The study

aimed at producing information that can be used to promote emergency department staff’s

theoretical and practical competencies, or knowledge and skills, in the identification of elder

abuse.

The research questions were:

1. How do staff at emergency departments rate their knowledge and skills in working

with older abused clients?

2. What knowledge and skills do emergency department staff, in their own experience,

need to identify and intervene with elder abuse?