Elder abuse is a common and increasing worldwide phenomenon as populations live longer.
Many different forms of elder abuse exist, including neglect; physical, psychological, sexual, or financial abuse; and self-neglect.
The key to diagnosis is maintaining a high index of suspicion with every geriatric-patient encounter.
Certain patient and carer characteristics can help identify high risk for elder abuse.
Knowledge of local reporting procedures is advisable, as these may differ between countries and states.
Management requires a multi-disciplinary approach and includes immediate care, long-term assessment and care, education, and prevention.
There is increasing consensus on the key components that constitute elder abuse, and types of elder mistreatment. Presently, there is no globally accepted definition of elder abuse, which makes it difficult for researchers to study elder abuse, determine trends, and evaluate benefits of interventions.
According to the Centers for Disease Control and Prevention (CDC): 'Elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult.' An older adult is someone ages 60 years or older.
The World Health Organization states: 'Elder abuse is a single or repeated attack, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to the older person.' WHO: elder abuse factsheet Opens in new window
Elder abuse is often considered to be perpetrated by a caregiver or a person the elder trusts. The increasing use of technology in all spheres of life, which older adults can find harder to stay up to date with, coupled with families now being more geographically dispersed, has led to older adults being victimised by strangers through fraudulent schemes and fraudulent misrepresentations. Financial fraud is one of the fastest growing forms of elder abuse. Guardianship, meant to protect older adults unable to care for themselves has also been inappropriately used to victimise older adults with assets.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- inconsistent history
- agitated state
- social isolation
- physical injuries
- malnutrition and volume depletion
- improper medicine use
- substance abuse
- carer dominance
- pressure ulcers
- shabby appearance
- genital bleed or wound
- age >75 years
- cognitive impairment
- dependence on a carer for personal care
- depression or other mental illness in the carer
- substance abuse by the older person or the carer
- financial dependence of the carer on the older adult
1st investigations to order
- platelet function studies
- basic metabolic profile (including urea and creatinine)
- clinical photograph
Investigations to consider
- CT head
- CT abdomen
- serum levels of relevant medicines
- toxicology screen (urine and blood)
suspected elder abuse
confirmed elder abuse
Josephine P. Gomes, MD
Department of Family and Geriatric Medicine
School of Medicine
University of Louisville
JPG declares that she has no competing interests.
Dr Josephine P. Gomes would like to gratefully acknowledge Professor James O'Brien, Dr Angela R. Wetherton, and Dr Senthil R. Meenrajan, previous contributors to this topic. ARW and SRM declare that they have no competing interests.
JGOB, ARW, and SRM declared that they had no competing interests.
Kay Mitchell, MD, MS, FACP
Mayo Medical School
KM has been paid as a speaker at the American College of Physicians annual meeting. KM has also been paid for consultation for the physician excellence program.
Cari Levy, MD
Assistant Professor of Medicine
University of Colorado School of Medicine and the Denver Veterans Affairs Medical Center
CL declares that she has no competing interests.
Desmond O'Neill, MA, MD, FRCPI, AGSF, FRCP(Glasg)
Associate Professor of Medical Gerontology
Department of Medical Gerontology
School of Medicine
Trinity College Dublin
DON declares that he has no competing interests.
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