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
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
Diagnostic tests
1st tests to order
- CBC
- platelet function studies
- basic metabolic profile (including BUN and creatinine)
- clinical photograph
- x-rays
Tests to consider
- CT head
- CT abdomen
- serum levels of relevant medications
- toxicology screen (urine and blood)
Treatment algorithm
suspected older adult abuse
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.
References
Key articles
Centers for Disease Control and Prevention. About abuse of older persons. Nov 2024 [internet publication].Full text
American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women. Elder abuse and women's health: ACOG Committee Opinion No 824. Obstet Gynecol. 2021 Mar 1;137(3):e89-93.Full text Abstract
Hirst SP, Penney T, McNeill S, et al. Best-practice guideline on the prevention of abuse and neglect of older adults. Can J Aging. 2016 Jun;35(2):242-60.Full text Abstract
National Institute for Health and Care Excellence. Safeguarding adults in care homes. Feb 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dementia
- Falls in older adults
- Medication nonadherence
More DifferentialsGuidelines
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