Elderly Abuse, Features and Treatment

Elderly Abuse Elder abuse affects 3% of the US elderly population. It continues to be under recognized and under reported. Clinical Features Elderly victims frequently live with their abuser who may be dependent on them financially, socially, or emotionally. They are often isolated from other family and friends. Abuse is strongly associated with personality problems of the caregiver who may have a history of mental illness, substance abuse, or personality disorder. Abused patients often have poor personal hygiene, inappropriate or soiled clothing, malnutrition, and worsening decubiti. They may abuse alcohol or drugs. Specific injuries suggestive of abuse include unexplained fractures or dislocations; unexplained lacerations, abrasions, and bruises; burns in unusual locations; and unexplained injuries to the head or face. Abused patients have been found to have significantly greater cognitive impairment than nonabused elderly patients. They often have a history of problematic behavior such as nocturnal shouting, incontinence, wandering, or paranoia. Diagnosis and Differential Most mistreatment of elderly patients occurs in residential settings and can be difficult to recognize. This difficulty is confounded by the fact that patients are often reluctant to disclose their abuse due to embarrassment or fear of abandonment, retaliation, or nursing home placement. The diagnosis should be considered in elderly patients with dementia, frequent falls, and dehydration or malnutrition.  The following findings are suggestive of an abusive relationship between the patient and the caretaker:  (a) the patient appears fearful of his or her companion, (b) there are conflicting accounts of the injury of illness between the patient and the caretaker,  (c) there is an absence of assistance toward the patient from the caretaker,  (d) the caretaker displays an attitude of anger or indifference toward the patient,  (e) the caretaker is overly concerned with the cost of treatment, and  (f) the caretaker denies the physician private interaction with the patient. Whenever suspected, the patient should be questioned directly about abuse. Emergency Department Care and Disposition Management of elder abuse involves treatment of medical conditions and immediate intervention. Admission is indicated when medically necessary or when the patient cannot be safely discharged back to the current living situation. A social services consultation should be obtained, and adult protective services should be notified. Forty-four states have mandatory reporting laws directed toward health care and social service workers, which require reporting of abuse despite the victim's wishes. When appropriate, caretakers should be provided with supportive services such as home health services, Meals on Wheels, transportation, and mental health services.