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elder physical abuse

Use of physical force resulting in bodily injury, pain or physical impairment. Including, but not restricted to: 1) hitting 2) beating 3) pushing 4) shoving 5) shaking 6) slapping 7) kicking 8) pinching 9) burning 10) inappropritate use of restraints 11) inappropriate punishment Etiology: - resident to resident abuse is the most prevalent form of elder physical abuse in nursing homes [1,3] - dementia units house residents with particularly aggressive behavioral disorders History: (questions) 1) Are you afraid of anyone at home? 2) Have you been struck, slapped or kicked? 3) Have you been tied down or locked in a room? 4) Have you been force-fed? Clinical manifestations: 1) Warning signs: a) injury inconsistent explanation or uncared for b) pain from touching c) cuts d) burns e) bruises* f) welts g) frequent use of hospitals h) 'doctor shopping' 2) unusual location of fractures - fractures of the back, head & face - upper extremity fractures should raise suspicion [4] 3) unusual location of bruises a) ~ 90% of accidental bruises on extremities (arms, legs) b) bruises on the head, face, ears, neck, genitalia, posterior torso, buttocks or sole of feet unusual [1] c) bruises d) large bruises unusual e) subjects are more likely to know the cause of a bruise if it was on the trunk [5] 4) injuries of the upper trunk should raise suspicion [4] 5) Uncertainties a) higher burden of chronic illness & prevalence of frailty leads to greater uncertainty whether injury is a result of physical abuse [1] b) pathologic fractures in bedbound patients with severe osteoporosis may provoke accusations of physical abuse from family memebers * color of bruises not reliably related to duration of injury * many bruises in the elderly occur spontaneously, often without the patient being aware [2] Diagnostic criteria: - not yet identified [1]

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elder abuse

References

  1. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Wiglesworth A, Austin R, Corona M, Bruising as a marker of physical elder abuse. J Am Geriatr Soc. 2009 Jul;57(7):1191-6. PMID: 19558476
  3. Pillemer K, Chen EK, Van Haitsma KS et al Resident-to-resident aggression in nursing homes: results from a qualitative event reconstruction study. Gerontologist. 2012 Feb;52(1):24-33. PMID: 22048811 Free PMC Article
  4. Khurana B, Bayne HN, Prakash J, Loder RT. Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings. J Am Geriatr Soc. 2024 Apr;72(4):1011-1022. PMID: 38376211 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18801
  5. Mosqueda L, Dong X. Elder abuse and self-neglect: JAMA. 2011 Aug 3;306(5):532-40. PMID: 21813431 - Mosqueda L, Burnight K, Liao S. The life cycle of bruises in older adults. J Am Geriatr Soc. 2005 Aug;53(8):1339-43. PMID: 16078959