Geriatric Abuse (Elder Abuse)
Geriatric abuse is the willful infliction of physical pain or injury; emotional pain, injury, humiliation, or intimidation; exploitation or misappropriation of money or property; or neglect by the designated caregiver of nutritional hygiene or medical needs (Box 1-1).
Battered elder syndrome
PREVALENCE (IN U.S.):
• 3.2% in a large study in Boston.
• Estimated up to 10% of individuals >65 yr of age.
• Only 15% of elder abuse comes to the attention of authorities.
• Most (>60%) abuse is committed by one spouse against another.
• Approximately 25% of abuse is committed by an adult child of the victim who is living in the same home and is usually financially dependent on the victim.
• Women thought to be at greater risk
PREDOMINANT AGE: Risk increases as level of disability, not age, increases
PEAK INCIDENCE: >80 yr old
PHYSICAL FINDINGS & CLINICAL PRESENTATION
• Physical abuse with multiple injuries at various stages with implausible or inconsistent descriptions of their origins; injuries are usually to head, neck, chest, breast, abdomen
• Extreme fear, hypervigilance, or withdrawal
• Torn or blood-stained underwear or new onset of a sexually transmitted disease signaling sexual abuse
• Toxicologic evidence of unprescribed medications
• Relatives with mental illness or substance abuse
• Excessive dependence on the elderly individual for financial, housing, and other necessities
• A history of violence, particularly within the family
Risk increases as the elder’s level of disability increases. Consequently, poor hygiene, poor nutrition, confusion, psychosis in the setting of dementia, and poor
compliance with prescribed treatments may all occur without ongoing abuse.
• Interview patient separately from the suspected abuser.
• Build trust; patients may be reticent.
• Ask direct questions.
• Be aware that physical findings are usually unexplained injuries or burns.
• Toxicology screens or therapeutic drug monitoring
• If sexual abuse suspected, screening for sexually transmitted diseases
• Reporting abuse to Adult Protective Services is mandatory in most states. This also provides the physician access to specialized personnel who can aid in
evaluation and disposition.
• Separate patient and abuser.
• If the burden of care underlies the abuse, refer to respite services.
ACUTE GENERAL Rx
As indicated for injury or pain relief
If the patient’s level of disability does not allow for independent living, institutionalization may be required.