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elder abuse

Also see domestic violence. Classification: 1) types of abuse a) physical abuse b) sexual abuse c) emotional abuse d) neglect e) exploitation - financial exploitation most common form of abuse [7] 2) settings of abuse a) domestic abuse occurs in the home b) institutional abuse 3) self abuse/neglect Etiology: risk factors - female (patient), female caregiver less likely than male - cognitive impairment (patient &/or caregiver) - mental illness, depression (caregiver) [7,19] - functional impairment [7] - dependency of caregiver on patient or visa-versa - including financial dependency [7] - 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 [7] Epidemiology: 1) 1-4% of elderly individuals 2) perpetrators commonly do not perceive their behavior as abusive or neglectful 3) 90% of abusers related to victim 4) > 65% of perpetrators are < 60 years of age 5) 4% of elderly describe financial exploitation (GRS9) [7] Clinical manifestations: - presentation: a) falls, dehydration, self neglect b) unexplained injuries, inconsistent histories c) unusual location of fractures - fractures of the back, head & face d) 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 [7] - large bruises unusual - subjects were more likely to know the cause of a bruise if it was on the trunk [13] e) yellow coloration not indicative of an older bruise [13] f) poor knowledge or lack of concern by caregiver g) depression, implausible explanations, reluctance to answer questions h) 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. [7] Management: - in cases of multiple 'red flags' such as potential for elder abuse, multiple recent hospitalizations, & possible cognitive impairment, comprehensive geriatric assessment is indicated [7] - 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 [8,17] - Hwalek-Sengstock Elder Abuse Screening instrument - if caregiver dominates interaction, consider speaking with the patient alone [7] - 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 [7] - resource hotline for elder abuse (800) 677-1116 [9]

Related

mandatory reporting laws for elder abuse

Specific

elder emotional abuse elder exploitation elder neglect elder physical abuse elder self neglect (Diogenes syndrome) elder sexual abuse

General

geriatric disorder; disease of old age; geriatric syndrome abuse

References

  1. Contributions from Linda Kuribayashi MD, Dept of Medicine, UCSF Fresno
  2. Kleinschmidt KC Elder abuse: a review. Ann Emerg Med 30(4):463-472, 1997 PMID: 9326861
  3. Lachs MS & Pillemer K Abuse and neglect of elderly persons. N Engl J Med. 1995 Feb 16;332(7):437-43. PMID: 7632211
  4. Rosenblatt DE et al Reporting mistreatment of older adults: the role of physicians. J Am Geriatrics Soc 44:65-70, 1996 PMID: 8537593
  5. Paris BE et al Elder abuse and neglect: how to recognize warning signs and intervene. Geriatrics 50(4):47-51, 1995 PMID: 7721114
  6. Conwell Y Elder abuse-a risk factor for suicide? Psych Clin N Am 20(3):667-683, 1997 PMID: 8720513
  7. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  8. Journal Watch 24(8):66, 2004 US Preventive Services Task Force, Screening for family and intimate partner violence: recommendation statement. Ann Intern Med, 2004. 140:382-6 PMID: 14996680 http://www.ahrq.gov/clinic/3rduspstf/famviolence.famviolrs.htm Nelson HD et al, Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the US Preventive Services Task Force, Ann Intern Med, 140:387, 2004 PMID: 14996681 http://www.ahrq.gov/clinic/3rduspstf/famviolence.famviolrev.htm - Lachs MS, Screening for family violence: what's an evidence-based doctor to do? Ann Intern Med. 2004 Mar 2;140(5):399-400 PMID: 14996683
  9. Acierno R, Hernandez MA, Amstadter AB et al Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. Am J Public Health. 2010 Feb;100(2):292-7 PMID: 20019303
  10. Dong XQ, Simon M, Evans D. Cross-sectional study of the characteristics of reported elder self-neglect in a community-dwelling population: findings from a population-based cohort. Gerontology. 2010;56(3):325-34 PMID: 19786733
  11. Dong XQ, Simon MA, Beck TT et al Elder abuse and mortality: the role of psychological and social wellbeing. Gerontology. 2011;57(6):549-58 PMID: 21124009
  12. Dyer CB, Marcus M, Burnett J. Introduction: the consortium for research in elder self-neglect. J Am Geriatr Soc. 2008 Nov;56 Suppl 2:S239-40 PMID: 19016965
  13. 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
  14. Widera E, Steenpass V, Marson D, Sudore R. Finances in the older patient with cognitive impairment. JAMA. 2011 Feb 16;305(7):698-706. Review. PMID: 21325186
  15. Lachs MS, Pillemer KA Elder Abuse N Engl J Med 2015; 373:1947-1956. November 12, 2015 PMID: 26559573 http://www.nejm.org/doi/full/10.1056/NEJMra1404688
  16. Acierno R, Hernandez MA, Amstadter AB et al Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. Am J Public Health. 2010 Feb;100(2):292-7. PMID: 20019303 Free PMC Article
  17. Moyer VA; U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: recommendation statement. Ann Intern Med. 2013;158:478-486 PMID: 23338828 - Draft Recommendation Statement U.S. Preventive Services Task Force Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening1 - Draft Evidence Review U.S. Preventive Services Task Force Draft Evidence Review for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening1 - US Preventive Services Task Force Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018;320(16):1678-1687. PMID: 30357305 https://jamanetwork.com/journals/jama/fullarticle/2708121 - Feltner C, Wallace, Berkman N Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320(16):1688-1701 PMID: 30357304 https://jamanetwork.com/journals/jama/fullarticle/2708120 - Rhodes KV, Dichter ME, Smith KL. Challenges and Opportunities for Studying Routine Screening for Abuse. JAMA. 2018;320(16):1645-1647 PMID: 30357278 https://jamanetwork.com/journals/jama/fullarticle/2708091 - Miller E, Beach SR, Thurston RC. Addressing Intimate Partner Violence and Abuse of Older or Vulnerable Adults in the Health Care Setting - Beyond Screening. JAMA Intern Med. Published online October 23, 2018 PMID: 30357255 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2707820
  18. Dong XQ Elder Abuse: Systematic Review and Implications for Practice. J Am Geriatr Soc 2015:63(6):1214-1238 PMID: 26096395
  19. Pillemer K, Burnes D, Riffin C, Lachs MS Elder abuse: global situation, risk factors, and prevention strategies. Gerontologist 2016. 56(Suppl 2): S194-S205 PMID: 26994260 PMCID: PMC5291158 Free PMC article
  20. Evans CS, Hunold KM, Rosen T, et al. Diagnosis of elder abuse in U.S. emergency departments. J Am Geriatr Soc. 2017;65(1):91-97 PMID: 27753066 PMCID: PMC5258672 Free PMC article https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.14480
  21. Lachs MS, Pillemer KA. Elder abuse. N Engl J Med. 2015;373(20):1947-1956 PMID: 26559573 Free article https://www.nejm.org/doi/10.1056/NEJMra1404688
  22. Gironda MW, Nguyen AL, Mosqueda LM. Is This Broken Bone Because of Abuse? Characteristics and Comorbid Diagnoses in Older Adults with Fractures. J Am Geriatr Soc. 2016 Aug;64(8):1651-5. PMID: 27418043 PMCID: PMC5926181 Free PMC article.
  23. Gibbs LM. Understanding the medical markers of elder abuse and neglect: physical examination findings. Clin Geriatr Med. 2014 Nov;30(4):687-712. PMID: 25439636 Review.
  24. American College of Obstetricians and Gynecologists
  25. National institute on Aging Elder Abuse https://www.nia.nih.gov/health/elder-abuse