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Neglect and abuse of older adults

Last reviewed: 6 Jan 2025
Last updated: 02 Jan 2025

Summary

Definition

History and exam

Other diagnostic factors

  • self-report
  • inconsistent history
  • agitated state
  • social isolation
  • physical injuries
  • malnutrition and volume depletion
  • improper medication use
  • substance misuse
  • caregiver dominance
  • pressure ulcers
  • overall neglected or unkempt appearance
  • genital bleed or wound
Full details

Risk factors

  • age >75 years
  • cognitive impairment
  • dependence on a caregiver for personal care
  • depression or other mental illness in the caregiver
  • substance misuse by the older person or the caregiver
  • financial dependence of the caregiver on the older adult
  • social isolation or loneliness
Full details

Diagnostic tests

1st tests to order

  • CBC
  • platelet function studies
  • basic metabolic profile (including BUN and creatinine)
  • clinical photograph
  • x-rays
Full details

Tests to consider

  • CT head
  • CT abdomen
  • serum levels of relevant medications
  • toxicology screen (urine and blood)
Full details

Treatment algorithm

INITIAL

suspected older adult abuse

ACUTE

confirmed older adult abuse

Contributors

Authors

Josephine P. Gomes, MD

Associate Professor

Department of Family and Geriatric Medicine

School of Medicine

University of Louisville

Louisville

KY

Disclosures

JPG declares that she has no competing interests.

Acknowledgements

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.

Disclosures

JGOB, ARW, and SRM declared that they had no competing interests.

Peer reviewers

Kay Mitchell, MD, MS, FACP

Assistant Professor

Mayo Medical School

Jacksonville

FL

Disclosures

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

Denver

CO

Disclosures

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

Dublin

Ireland

Disclosures

DON declares that he has no competing interests.

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