Elder Abuse

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Introduction 3 Classification 4 Etiology 5 Epidemiology 6 Clinical-manifestations 7 Laboratory 8 Complications 9 Management 10 More General Terms 11 Additional Terms 12 References

More Specific Terms

• elder emotional abuse
• elder exploitation
• elder neglect
• elder physical abuse
• elder self neglect
• elder sexual abuse

Introduction

• Also see domestic violence.

Classification

• types of abuse

• physical abuse
• sexual abuse
• emotional abuse
• neglect or exploitation

• settings of abuse

• domestic abuse occurs in the home
• institutional abuse

• self abuse/ neglect

Etiology

• risk factors

• cognitive impairment (patient &/or caregiver)
• dependency of caregiver on patient or visa-versa
• family conflict
• family history of

• abusive behavior
• alcoholism
• drug abuse
• mental illness

• mental retardation

• financial stress
• social isolation of patient &/or caregiver
• inadequate living arrangements
• stressful events in the family [9]

Epidemiology

• 1-4% of elderly individuals
• perpetrators commonly do not perceive their behavior as abusive or neglectful
• 90% of abusers related to victim
• > 65% of perpetrators are < 60 years of age

Clinical-manifestations

• presentation:
• falls, dehydration, self neglect
• unexplained injuries, inconsistent histories
• unusual location of bruises

• ~ 90% of accidental bruises on extremities
• bruises on ears, neck, genitalia, buttocks or soles of feet unusual [7]

• poor knowledge or lack of concern by caregiver
• depression, implausible explanations, reluctance to answer questions
• multiple emergency department visits may occur before the diagnosis is made

Laboratory

• urine toxicology to evaluate use of chemical restraint

Complications

• independent risk factor for death. [7]

Management

• screening:
• 'Are you afraid of anyone at home?'
• 'What happens when you & your caregiver disagree?'
• 'Has anyone touched you without permission?'
• 'Is money stolen from you or used inappropriately?'
• screening

• USPSTF finds insufficient evidence to recommend routine screening [8]

• intervention:
• assess readiness for change
• assess safety
• provide resources
• report to authorities

• see mandatory reporting laws for elder abuse

• follow-up
• strategies to engage & support perpetrators may be better than confronting & punishing them [7]
• resource hotline for elder abuse (800) 677-1116 [9]

More General Terms

• geriatrics
• abuse

Additional Terms

• mandatory reporting laws for elder abuse

References

1. Contributions from Linda Kuribayashi MD, Dept of Medicine, UCSF Fresno
2. Kleinschmidt KC Elder abuse: a review. Ann Emerg Med 30(4):463-472, 1997 PMID: [1]
3. Lachs MS & Pillemer K Abuse and neglect of elderly persons. N Engl J Med. 1995 Feb 16;332(7):437-43. PMID: [2]
4. Rosenblatt DE et al Reporting mistreatment of older adults: the role of physicians. J Am Geriatrics Soc 44:65-70, 1996 PMID: [3]
5. Paris BE et al Elder abuse and neglect: how to recognize warning signs and intervene. Geriatrics 50(4):47-51, 1995 PMID: [4]
6. Conwell Y Elder abuse-a risk factor for suicide? Psych Clin N Am 20(3):667-683, 1997 PMID: [5]
7. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
8. Journal Watch 24(8):66, 2004 US Preventive Services Task Force, Ann Intern Med, 140:382, 2004 [6] Nelson HD et al, Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the US Preventive Services Task Force, Ann Intern Med, 140:387, 2004 <PubMed> PMID: [7] <Internet> [8] Lachs MS, Ann Intern Med, 140:387, 2004 PMID: [9]
9. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
10. url>http://www.eldercare.gov/</url>
11. Elder Abuse: NIH Institute and Center Resources [10]
12. National Guideline Clearinghouse Elder abuse prevention. University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core ngc-guideline: [11]

elder abuse