Elder abuse
Background
Elder abuse refers to intentional or negligent acts by a caregiver or trusted individual that cause harm or serious risk of harm to an older adult, typically aged 60 and over. It includes physical, emotional, sexual, or financial abuse, as well as neglect and abandonment. Elder abuse is underreported and often occurs in private settings, including the victim's home or long-term care facilities.
Clinical Features
- Physical: Bruises, burns, lacerations, fractures (especially spiral), pressure ulcers
- Behavioral: Withdrawal, agitation, fearfulness, depression
- Neglect: Poor hygiene, malnutrition, dehydration, unmet medical needs
- Financial: Sudden financial difficulties, missing belongings, unpaid bills
- Sexual: Genital injuries, STIs, behavioral changes
Differential Diagnosis
- Accidental trauma (especially in patients with balance issues)
- Dementia-related self-neglect
- Dermatologic conditions mimicking bruising
- Medication side effects (e.g., anticoagulants causing easy bruising)
- Cultural practices or family misunderstandings
Evaluation
Workup
History: Use open-ended questions, assess for inconsistencies between patient and caregiver reports
Physical Exam: Full-body exam including skin, oral cavity, and genital area
Labs/Imaging: CBC, BMP, coagulation studies, imaging for suspected fractures
Social Assessment: Involvement of social worker, assess home safety and support
Documentation: Objective, detailed descriptions of injuries, photos (if institutional policy permits)
Diagnosis
Clinical diagnosis based on a combination of history, physical findings, and social context. Use screening tools like the Elder Abuse Suspicion Index (EASI) or the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).
Management
Ensure patient safety: separate from suspected abuser if possible
Treat medical issues: wound care, pain management, nutritional support
Involve interdisciplinary team: social work, case management, geriatrician
Mandatory reporting to Adult Protective Services (APS) in most jurisdictions
Disposition
Admit if medically unstable, unsafe home environment, or unable to self-care
Coordinate with APS, legal authorities, and case managers for safe discharge planning
Consider temporary placement in skilled nursing or rehabilitation facility if needed
See Also
Elder Abuse Suspicion Index (EASI)
Hwalek-Sengstock Elder Abuse Screening Test
External Links
National Center on Elder Abuse
Adult Protective Services (NAPSA)