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