Improved health care for older Americans will be one of the great challenges of the next several decades. By the year 2030, approximately 21% of the population will be 65 and older (Wilson and Trost, 1987).

Elder abuse is a behavior that is only beginning to gain the attention needed to apply remedies and recourse on an institutional basis. It is estimated that one in twenty people will experience elder abuse (Carluccio, 1991). Definitions of elder abuse must consider a variety of verbal and physical behaviors.

The following paper will consider verbal abuse. While seemingly more difficult to diagnose, verbal abuse is more prevalent. The lack of physical symptoms and a less than adequate understanding on the part of those who are victims of abusive behavior are of concern to the paper. Of importance to the investigation is a critical approach to understanding the recourse available to the nurse practitioner who recognizes potential and diagnosed elder abuse. The examination will limit itself to those suggestions for cases found in nursing homes.

A dramatic reversal of behavior can be witnessed after a therapeutic course has been attended to by those in proximity to the victim, as well as the perpetrator of the abuse. Theories are many, and the following examination will primarily concern itself with change theories and the expected realizations and goals resulting within the context of institutional care involving nurse practitioners. Definitions of a variety of abuses can be determined and a variety of therapeutic and change oriented approaches can be taken. The resulting examination makes prescription for the intervention of the nurse practitioner and the potential, subsequent consequences.

Introduction

Among people who seek the services of care facilities such as nursing homes are reported to have found that many circumstances in which elders are involved indicate abuse. In a study Bond, et al (1995) found that neglect was the most commonly reported category of elder abuse, followed by financial and psychological abuse. Physical abuse was the least frequently reported category. Another study conducted in 1988 as reported by Mahmiash (1995), financial abuse was the most commonly reported category, followed by chronic verbal aggression, physical abuse, and neglect.

Within the health care industry, it is a newly determined goal of many professionals to foster the changes within systems with a therapeutic and healing approach. Change theories can be employed for a structural application. Nurse practitioners have a vast potential to function within the diagnosing, treating and facilitating short term and long term plans for change in residential and support systems of elders.

The nurse practitioner faces the mounting problem of elder abuse as the population steadily ages. Valuable efforts to implement conscientious methods are crucial to the healthy functioning of care takers and nurse practitioners can maintain a professional attitude determined to facilitate the needs of the profession as well as the patient.

Of significant concern are the areas where abuse may have previously gone unnoticed or accepted. Verbal abuse results in the realization of emotional or psychological harm. Definitions, from a legal source are- emotional abuse includes ridiculing or demeaning, making a derogatory remark or cursing directly at a person who is a resident of a long term care facility. Threatening to inflict physical or emotional harm on a patient is also a crime, as long as the behavior is performed knowingly. The use of words to cause a response is a crucial criteria in determining abusive language. The recipients themselves may often allow abusive language, unable to recognize the long-term effects. To be abusive, speech must meet four criteria: as accountable speaker, unwarranted assumptions about relationships, unwarranted violations of rights. And a recipients who is harmed (Nandal and Wood, 1997).

Discussion

Theories of addressing recourse for the nurse practitioner includes a Nurse practitioners as a specialist who can have a significant role in the addressing of elder patient needs. A recent trend has been a movement away from a pathology to problem focused approach to identifying strengths and resources. While change is understood to be the goal, this valuation of change can be a guiding focus for any professional who has encountered systematic abuse and the resulting, underlying facilitate change. Neutrality is the guideline that holds the most promise for shifting the nurse from a former stance of expert, advice-giver to that facilitator in creating the context for change.

Residential Care for Elders

Currently only 5% of the population lives in residential are facilities (Smith & Maurer, 1995). Nursing homes provide an invaluable service to elders who are in need of around the clock care. Services often made available in nursing homes are continuous nursing care, rehabilitation, social activities, supervision, and room and board in state licensed facilities. Within the clinical staff of nursing homes an increase has been seen in the number of available nurse practitioners to residents.

Definition of Verbal Abuse

Verbal abuse is a demeaning and emotionally coercive dynamic present in many relationships of society. Residential care facilities for elders are no different than any other institution within society. Despite proximity to the proper mandated authorities, verbal abuse experienced by elder residents is rarely reported by the victim (Smith & Maurer, 1995). While often a result of isolation, the elder as a resident should be able to safely report the experience suffered by staff or family members. A key limitation of the information that is currently available is that it is not grounded in older person's understanding of elder abuse (Stones, 1995).