Purpose and scope
The purposes of this best practice guideline (BPG) are to expand the awareness of abuse and neglect of older adults and to provide evidence-based recommendations for preventing and addressing abuse and neglect in all health-care settings across the continuum of care in Canada.
The scope of this guideline includes harms caused by the main forms of abuse and neglect. These are:
- physical abuse,
- emotional/psychological abuse,
- sexual abuse,
- financial abuse/exploitation, and
- neglect.
This guideline also includes education and policy/organization/system recommendations that address resident-to-resident aggressive behaviour. Harms inflicted by one resident (often an older adult with cognitive impairment who is living in a long-term care facility) upon another resident are distinctly different from the other forms of harm covered in this document.
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Registered Nurses’ Association of Ontario. (2014). Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, ON: Registered Nurses’ Association of Ontario.
Recommendations
Recommendation 1.1: Establish and maintain a therapeutic relationship with older adults, and families as appropriate, when discussing issues of abuse and neglect.
Recommendation 1.2: Ensure privacy and confidentiality when discussing issues of abuse and neglect unless legal obligations require disclosure of information.
Recommendation 1.3: Be alert for risk factors and signs of abuse and neglect during assessments and encounters with the older adult.
Recommendation 1.4: Carry out a detailed assessment in collaboration with the older adult, interprofessional team, and family, as appropriate, when abuse or neglect is alleged or suspected.
Recommendation 1.5: Identify the rights, priorities, needs and preferences of the older adult with regard to lifestyle and care decisions before determining interventions and supports.
Recommendation 2.1: Collect information and resources needed to respond appropriately to alleged or suspected abuse and neglect in ways that are compatible with the law, organizational policies and procedures, and professional practice standards.
Recommendation 2.2: Collaborate with the older adult, family and interprofessional team, as appropriate, to develop an individualized plan of care to prevent or address harm.
Recommendation 3.1: Respond to alleged or suspected abuse and neglect according to legal requirements and organizational policies or procedures.
Recommendation 3.2: Implement an individualized plan of care that incorporates multiple strategies to prevent or address harm, including
- education and support for older adults and family members,
- interventions and supports for those who abuse or neglect,
- providing resources/referrals, and
- development of a safety plan.
Recommendation 4.1: Collaborate with the older adult, family and interprofessional team, as appropriate, to evaluate and revise the plan of care, recognizing that some instances of abuse and neglect will not resolve easily.
Recommendation 5.1: All employees across all health-care organizations that serve older adults participate in mandatory education that raises awareness about
- ageism;
- the rights of older adults;
- the types, prevalence and signs of abuse and neglect of older adults;
- factors that may contribute to abuse and neglect; and
- individual roles and responsibilities with regard to responding or reporting abuse or neglect.
Recommendation 5.2: Nurses, other health-care providers, and supervisors who work in healthcare organizations that provide care and services to older adults participate in mandatory and continuing education opportunities that include
- understanding issues of abuse and neglect;
- assessing and responding to abuse and neglect;
- roles, responsibilities and laws;
- positive approaches to working with older adults;
- effective strategies for challenging/responsive behaviours; and
- fostering a safe and healthy work environment and personal well-being.
Recommendation 5.3: Educational institutions incorporate the RNAO Best Practice Guideline, Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches into curriculum for nurses and, as appropriate, for other health-care providers.
Recommendation 5.4: To help nurses and other health-care providers build competence in preventing, identifying, and responding to abuse and neglect of older adults, education programs are designed to
- address attitudes, knowledge and skills;
- include multimodal and interactive/participatory strategies; and
- promote an interprofessional approach.
Recommendation 6.1: Organizations/institutions establish and support collaborative teams to assist with preventing and addressing abuse and neglect of older adults.
Recommendation 6.2: Organizations/institutions establish policies, procedures and supports that enable nurses and other health-care providers to recognize, respond to, and where appropriate, report abuse and neglect of older adults.
Recommendation 6.3: Institutions* adopt a combination of approaches to prevent abuse and neglect of older adults, including
- screening potential employees, hiring the most qualified employees, and providing proper supervision and monitoring in the workplace;
- securing appropriate staffing;
- providing mandatory training to all employees;
- supporting the needs of individuals with cognitive impairment, including those with responsive behaviours;
- upholding resident rights;
- establishing and maintaining person-centred care and a healthy work environment; and
- educating older adults and families on abuse and neglect and their rights, and establishing routes for complaints and quality improvement.
*Note: may apply to other health-care settings.
Recommendation 6.4: Organizations/institutions with prevention and health promotion mandates (such as community and public health organizations) lead or participate in initiatives to prevent abuse and neglect of older adults.
Recommendation 6.5: Organizations/institutions identify and eliminate barriers that older adults and families may experience when accessing information and services related to abuse and neglect.
Recommendation 6.6: Provincial and territorial nursing regulatory bodies provide accurate information on jurisdictional laws and obligations relevant to abuse and neglect of older adults across the continuum of care.
Recommendation 6.7: Governments dedicate resources to effectively prevent and address abuse and neglect of older adults.
Recommendation 6.8: Nurses, other health-care providers, and key stakeholders (e.g., professional associations, health service organizations, advocacy groups) advocate for policy/ organization/system level changes, including the availability of necessary resources, to effectively prevent and address abuse and neglect of older adults.
