Elder mistreatment
Background
Elder mistreatment (including neglect, abuse) has been reported in about 5 percent of the older adult population in the United States. Prior studies suggest that only one in 23 elder abuse cases are reported1. Perpetrators are typically family members, caregivers, and trusted others (such as neighbors, financial advisors). Almost 50% of older adults living with dementia experience elder mistreatment, and older women and socially isolated older adults are more likely to be victims of abuse2.
Types of Elder Abuse
There are many types of elder abuse as outlined in the table below. For additional information on elder abuse, consider reading the following American Family Physician article on “Detecting Elder Abuse and Neglect: Assessment and Intervention”
The tables included in this section are from that article.
| Table 1. Types of Elder Abuse | ||
|---|---|---|
| Types of abuse | Characteristics | Examples |
| Financial or material | Illegal or improper use of funds or resources, exploitation | Theft of debit or credit cards, coercion to deprive the older person of assets (e.g., forcible transfer of property or accounts) |
| Neglect or abandonment | Intentional or unintentional refusal or failure of designated caregiver to meet needs required for an older person’s well-being | Failure to provide adequate food, clothing, shelter, medical care, hygiene, or social stimulation/interaction |
| Physical | Infliction of pain or injury | Slapping, hitting, kicking, force-feeding, restraint, striking with objects |
| Psychological or emotional | Infliction of mental anguish | Verbal aggression or threat, threats of institutionalization, social isolation, humiliating or degrading statements |
| Sexual | Non-consensual genital contact, unwanted sexual talk | Suggestive talk, forced sexual activity, touching, fondling a non-consenting competent or incompetent person |
| Adapted with permission from Perel-Levin S. Discussing Screening for Elder Abuse at Primary Health Care Level. Geneva, Switzerland: World Health Organization; 2008:6. | ||
Signs and Symptoms of Elder Abuse or Neglect
Certain signs or symptoms may raise one’s suspicion of possible elder abuse or neglect. It is important to recognize that many diseases and conditions can mimic abuse or neglect in older individuals. Consequently, a thorough history, review of the medical records and physical exam is important. The Elder Abuse Suspicion Index (EASI) is a screening tool that can be used to screen cognitively intact older adults. When there is concern for abuse or neglect, interviewing patients and their caregivers separately can be helpful. It is important to not jump to conclusions that neglect or abuse is occurring, however, we don’t want to miss opportunities to intervene if it is.
| Table 3. Signs and Symptoms of Possible Elder Abuse or Neglect | |
|---|---|
| Bruising in unusual locations (not over bony Prominences; on lateral arms, face, or back; larger than 5 cm)Burns in patterns inconsistent with unintentional injury or with the explanation provided (e.g., stocking or glove pattern, suggesting forced immersion)
Decubitus ulcers, unless the result of unavoidable decline Dehydration, fecal impaction Evidence of sexual abuse Intraoral soft tissue injuries Malnutrition, medically unexplained weight loss Missing medications |
Patterned injuries such as hand slap or bite marks; ligature marks or scars around wrists, ankles, or neck suggesting inappropriate restraint.
Poor control of medical problems despite a reasonable medical plan and access to medication Subconjunctival or vitreous ophthalmic hemorrhage Traumatic alopecia or scalp swelling Unexplained fractures Unusual delay in seeking medical attention for injuries Urine burns (similar to severe diaper rash), dirty clothing, or other signs of inattention to hygiene |
| Information from reference 28 through 30. | |
Financial Abuse
Financial abuse is a common form of abuse that is not visible. Signs of financial abuse in older adults may include:
- Having a new ‘best friend’ or partner, particularly someone who causes isolation from family and friends
- Change in spending patterns
- Not paying bills or bills bouncing when they are typically paid on time
- An unexpected change in power of attorney or will
- Missing medical appointments when they typically seek medical care
Mandatory Reporting
As with children, physicians and medical students are mandated to report suspected abuse of any vulnerable adult. A vulnerable adult is defined as any person 60 years or older with functional, physical, or mental inability to care for self; or an adult age 18 years or older who:
- Has a developmental disability; or
- Has a guardian; or
- Lives in a nursing facility, boarding home, adult family home, or soldier’s home, residential habilitation center, or any facility licensed or required to be licensed by the Department of Social and Health Services (DSHS); or
- Receives in-home services through a licensed health care agency, hospice, or an individual provider; or
- Self-directs his/her own care (someone who chooses to direct another person, such as a caregiver, to perform care related tasks)
If you are concerned about the safety of a vulnerable adult in the hospital or clinic, talk with your attending physician. Contacting the team social worker is often the next step – they are skilled in assisting with mandatory reporting through Adult Protective Services (APS). While federal laws exist regarding elder abuse or neglect, it is important to recognize that laws regarding elder abuse or neglect can vary state by state.
References
- Burnes D, Hancock DW, Eckenrode J, Lachs MS, Pillemer K. Estimated Incidence and Factors Associated With Risk of Elder Mistreatment in New York State. JAMA Netw Open. 2021;4(8):e2117758. doi:10.1001/jamanetworkopen.2021.17758
- Cooper C, Selwood A, Livingston, G. The prevalence of elder abuse and neglect: a systematic review. Age and Ageing. 2008;(151-160). https://doi.org/10.1093/ageing/afm194