elder physical abuse

Introduction

Use of physical force resulting in bodily injury, pain or physical impairment.

Including, but not restricted to:

• hitting
• beating
• pushing
• shoving
• shaking
• slapping
• kicking
• pinching
• burning
• inappropritate use of restraints
• inappropriate punishment

Etiology

• resident to resident abuse is the most prevalent form of elder physical abuse in nursing homes
  • dementia units house residents with particularly aggressive behavioral disorders

History

(questions)

• Are you afraid of anyone at home?
• Have you been struck, slapped or kicked?
• Have you been tied down or locked in a room?
• Have you been force-fed?

Clinical manifestations

• Warning signs:
  • injury inconsistent explanation or uncared for
  • pain from touching
  • cuts
  • burns
  • bruises*
  • welts
  • frequent use of hospitals
  • 'doctor shopping'
• unusual location of fractures
  • fractures of the back, head & face
  • upper extremity fractures should raise suspicion
• unusual location of bruises
  • ~ 90% of accidental bruises on extremities (arms, legs)
  • bruises on the head, face, ears, neck, genitalia, posterior torso, buttocks or sole of feet unusual
  • bruises
  • large bruises unusual
  • subjects are more likely to know the cause of a bruise if it was on the trunk
• injuries of the upper trunk should raise suspicion
• Uncertainties
  • higher burden of chronic illness & prevalence of frailty leads to greater uncertainty whether injury is a result of physical abuse
  • pathologic fractures in bedbound patients with severe osteoporosis may provoke accusations of physical abuse from family memebers

* color of bruises not reliably related to duration of injury

* many bruises in the elderly occur spontaneously, often without the patient being aware

Diagnostic criteria

• not yet identified

More general terms

• elder abuse