Elder abuse
Background
- 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.
- Includes physical, emotional, sexual, or financial abuse, as well as neglect and abandonment
- 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
Psychosocial and Related
- Drugs of abuse
- Elder abuse
- Human trafficking
- Homelessness
- Interpersonal Violence
- Mandatory reporting
- Nonaccidental trauma
- Sexual assault
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).
Hwalek-Sengstock Elder Abuse Screening Test
- "Purpose: Screening device useful to service providers interested in identifying people at high risk of the need for protective services.
- Instructions: Read the questions and write in the answers. A response of “no” to items 1, 6, 12, and 14; a response of “someone else” to item 4; and a response of “yes” to all others is scored in the “abused” direction.
- 1. Do you have anyone who spends time with you, taking you shopping or to the doctor?
- 2. Are you helping to support someone?
- 3. Are you sad or lonely often?
- 4. Who makes decisions about your life—like how you should live or where you should live?
- 5. Do you feel uncomfortable with anyone in your family?
- 6. Can you take your own medication and get around by yourself?
- 7. Do you feel that nobody wants you around?
- 8. Does anyone in your family drink a lot?
- 9. Does someone in your family make you stay in bed or tell you you’re sick when you know you’re not?
- 10. Has anyone forced you to do things you didn’t want to do?
- 11. Has anyone taken things that belong to you without your O.K.?
- 12. Do you trust most of the people in your family?
- 13. Does anyone tell you that you give them too much trouble?
- 14. Do you have enough privacy at home?
- 15. Has anyone close to you tried to hurt you or harm you recently?"[1]
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
External Links
References
- ↑ Neale, A. V., Hwalek, M. A., Scott, R. O., & Stahl, C. (1991). Validation of the HwalekSengstock elder abuse screening test. Journal of Applied Gerontology, 10(4), 406-415.