Elder abuse
Elder abuse is physical, sexual, emotional or psychological, neglectful, abandoning, or financial harm to an older adult, most often uncovered through an injury pattern, unfilled medications, or malnutrition inconsistent with the caregiver's story. There is no validated screening instrument, so recognition rests on a history taken with the patient interviewed alone plus a targeted exam. Management sequences immediate safety, a capacity-guided response, and mandatory reporting to Adult Protective Services, which proceeds even over a capacitated patient's refusal.
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What this article covers
- Overview
Definition: physical, sexual, emotional or psychological, neglectful, abandoning, or financial or material harm to an older adult from a person in a position of trust, most often a caregiver or family member.
- Epidemiology
Prevalence: mistreatment, including abuse, neglect, and financial exploitation, is estimated to affect roughly 10% of older adults, tied to the dependence that comes with decreased functioning.
- Risk factors
Cognitive or functional impairment: dementia and an inability to give an independent history are the strongest patient-level risk factors.
- Pathophysiology
Dependency creates opportunity: declining physical, cognitive, or functional status shifts activities of daily living, mobility, medications, and finances onto a caregiver, the structural precondition for every type of abuse.
- Clinical features
Physical abuse pattern: bruising over the inner arms, inner thighs, scalp, ears, mastoid area, buttocks, nasal bridge, or temple; periorbital ecchymoses, including from being struck while wearing glasses; contact burns; and scalp hematomas.
- Differential diagnosis
Accidental fall injury: bruising over bony prominences such as the shins, forearms, or hips with a consistent, witnessed mechanism, unlike the inner-arm, ear, mastoid, buttock, or nasal-bridge…
- Diagnosis
Diagnostic basis: elder abuse is a clinical diagnosis established through a detailed history and physical examination; no validated, reliable screening instrument exists, so the diagnosis rests on…
- Management
First, address immediate safety: if the patient is in immediate danger, admit to the hospital for a safe environment while the situation is investigated, and treat any acute injury on its own merits during that admission.
- Complications
Escalating physical injury: repeated abuse can progress from bruising to fracture, contact burns, or head injury if the situation is not interrupted.
- Prognosis
Trajectory depends on interrupting the exposure: outcomes are worse the longer abuse or neglect continues undetected, since the complications above are cumulative.
- Prevention
Routine case-finding at every visit for at-risk adults: because no validated screening instrument exists, consider case-finding through a thorough history and exam at every visit for a patient with…
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