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Old age is an authentic period of life, and integrating the unity of one’s life is one of the tasks of old age. The majority of the residents in longterm care facilities are weak and diminished due to multiple medical and psychiatric disorders and thus need help to achieve this integrating task. All health care providers should strive to keep our elderly people in caring LTC facilities. Ageism should not be a factor in allocating resources, and when attempting to evaluate the quality of life of an older individual, one must be aware of the limitations of a purely professional assessment. Abuse and neglect are prevalent in LTC populations and may cause serious setbacks to residents’ efforts to live with dignity. Ethical and medicolegal issues may also pose barriers to the residents’ ability to live their last years meaningfully. Efforts to prevent abuse, neglect, and unethical professional conduct are necessary, but far from sufficient, for residents to work toward integrating and unifying the elements in their lives. Every LTC facility needs to focus on ways to promote the need for all residents to reach their spiritual and psychological goals. Abuse and Neglect Because of their significant dependence on others for their care, LTC residents are vulnerable to abuse and/or neglect (Lindbloom et al. 2007). Elder abuse is a common problem with serious consequences for the health and wellbeing of older people (Lachs and Pillemer 2004), and it is even more common among older people at the end of their lives (Jayawardena and Liao 2006). ElC H A P T E R 10 Abuse and Neglect, Ethical Dilemmas, and Medicolegal Issues A B U S E A N D N E G L E C T A N D E T H I C A L D I L E M M A S 253 der abuse and neglect also occur frequently among people referred to geriatric psychiatry services (Vida, Monks, and Rosiers 2002). Elder mistreatment is a significant problem in LTC facilities. More than 30 percent of the nursing homes in the United States were cited for abuse violations that had the potential for significant harm to residents (House Committee on Government Reform 2001). Some of the key reasons elderly people are fearful of residing in LTC facilities are concerns involving mistreatment (Gibbs and young 2007). Elderly men and women of all socioeconomic and ethnic backgrounds are vulnerable to abuse and neglect, and most often it goes undetected. Elder abuse or mistreatment means an intentional act of commission or omission that results in harm or threatened harm to the health or welfare of an elderly person. Table 10.1 defines abuse in LTC facilities. Abuse and neglect include the intentional infliction of physical or mental injury; sexual or financial abuse; or the withholding of necessary food, clothing, monetary resources, and medical care to treat the physical and mental health needs of an older person by another person having responsibility for that older adult. Undue influence that harms the older adult should also be considered a form of abuse. Physical abuse is most recognizable, yet neglect is most common. T A B L E 1 0 . 1 Definitions of abuse in long-term care facilities Abuse The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. This also includes deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This presumes that instances of abuse of any resident, even one in a coma, cause physical harm or pain or mental anguish. Verbal abuse The use of oral, written, or gestured language that willfully includes disparaging or derogatory terms directed toward residents or their families, or within their hearing, regardless of their age, ability to comprehend, or disability. Examples of verbal abuse include, but are not limited to, threats of harm or saying things to frighten a resident, such as telling a resident that he or she will never be able to see his or her family again. Sexual abuse This includes, but is not limited to, sexual harassment, sexual coercion, and sexual assault. Physical abuse This includes hitting, slapping, pinching, pushing, and kicking. It also includes controlling the resident’s behavior through corporal punishment. Mental abuse This includes, but is not limited to, humiliation, harassment, threats of punishment, or deprivation. Involuntary seclusion The separation of a resident from other residents or from his or her room, or...

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