While elders visit primary care providers (PCPs), many of whom are advanced practice nurses (APNs), approximately five times per year, only a small percentage of PCPs routinely screen these patients for abuse and neglect, and fewer still make reports to Adult Protective Service agencies. Of the estimated two million elders abused or neglected in the US annually, most cases are perpetrated by family members. The increasing longevity and growing dependency of elderly women, who are more likely to be alone, impoverished, and suffer from multiple chronic conditions, place the elderly woman at significant risk for abuse and neglect. While many elderly are too ashamed or fearful to discuss their life situations with their providers, APNs have the opportunity to develop rapport and trust in the patient-provider relationship. APNs are often involved with assisting their elderly patients in transitioning between independent living and growing dependence on family members for support and care.
Resilience, the successful adaptation and functioning in high risk situations, has been described as a personality characteristic and as a dynamic process by which individuals respond to their environments. Resilience, a strength that some elderly women possess, may be developed in women with low resilience. Wagnild and Young’s (1993) Likert-type scale is recommended to measure resilience as part of abuse screening.
There are several benefits of screening elderly women to identify those at high risk for abuse and to determine their resilience. Advanced practice nurses in primary care may be able to predict which women are at risk for abuse and to intervene either to facilitate and augment their resilience or to monitor or modify their environment such that abuse will not occur. These nurses may meet with family members or refer patients who need social service or other resources to cope with their caregiving arrangements.
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