elder abuse

Introduction

Also see domestic violence.

Classification

• types of abuse
  • physical abuse
  • sexual abuse
  • emotional abuse
  • neglect
  • exploitation
    • financial exploitation most common form of abuse
• settings of abuse
  • domestic abuse occurs in the home
  • institutional abuse
• self abuse/neglect

Etiology

risk factors

• female (patient), female caregiver less likely than male
• cognitive impairment (patient &/or caregiver)
• mental illness, depression (caregiver)
• functional impairment
• dependency of caregiver on patient or visa-versa
  • including financial dependency
• family conflict
• family history of
  • abusive behavior
  • alcoholism
  • drug abuse
  • mental illness
    • mental retardation
• financial stress
• social isolation of patient &/or caregiver
• inadequate living arrangements
• stressful events in the family

Epidemiology

• 1-4% of elderly individuals
• perpetrators commonly do not perceive their behavior as abusive or neglectful
• 90% of abusers related to victim
• > 65% of perpetrators are < 60 years of age
• 4% of elderly describe financial exploitation (GRS9)

Clinical manifestations

• presentation:
  • falls, dehydration, self neglect
  • unexplained injuries, inconsistent histories
  • unusual location of fractures
    • fractures of the back, head & face
  • 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
    • large bruises unusual
    • subjects were more likely to know the cause of a bruise if it was on the trunk
  • yellow coloration not indicative of an older bruise
  • poor knowledge or lack of concern by caregiver
  • depression, implausible explanations, reluctance to answer questions
  • multiple emergency department visits may occur before the diagnosis is made

Laboratory

• low serum albumin may be sign of elder neglect
• urine toxicology to evaluate use of chemical restraint

Complications

• independent risk factor for death.

Management

• in cases of multiple 'red flags' such as potential for elder abuse, multiple recent hospitalizations, & possible cognitive impairment, comprehensive geriatric assessment is indicated
• screening:
  • 'Are you afraid of anyone at home?'
  • 'What happens when you & your caregiver disagree?'
  • 'Has anyone touched you without permission?'
  • 'Is money stolen from you or used inappropriately?'
  • screening
    • USPSTF finds insufficient evidence to recommend routine screening
  • Hwalek-Sengstock Elder Abuse Screening instrument
  • if caregiver dominates interaction, consider speaking with the patient alone
• intervention:
  • assess readiness for change
  • assess safety
  • provide resources
  • report to authorities
    • see mandatory reporting laws for elder abuse
  • follow-up
  • strategies to engage & support perpetrators may be better than confronting & punishing them
  • resource hotline for elder abuse (800) 677-1116

More general terms

• geriatric disorder; disease of old age; geriatric syndrome
• abuse

More specific terms

• elder emotional abuse
• elder exploitation
• elder neglect
• elder physical abuse
• elder self neglect (Diogenes syndrome)
• elder sexual abuse

Patient information

elder abuse patient information