Description

• Elder abuse (EA) includes failing to meet an older adult’s needs or intentional financial, physical, or emotional actions causing risk of or actual harm. EA is often underrecognized.
• Clinicians can use the Age-Friendly Health System (AFHS) model, focusing on Matters Most, Mentation, Medications, and Mobility (4Ms). EA can be framed by societal influences (provider/caregiver education), individual factors (history of abuse), and the nature of the abuse.
• AFHS and Geriatric Emergency Department Accreditation (GEDA) frameworks can inform one’s strategy or cycles of improvement on EA.
• Extensions of such approaches can link to collaborations with first responders (police, fire department) or older adult services Department of Aging (DOA), Adult Protective Services (APS), Program of All-inclusive Care of the Elderly (PACE).

Epidemiology

Etiology and Pathophysiology

The etiology of EA involves biopsychosocial factors in combination with increased dependence on a caregiver.

Risk Factors

• Risk factors include female sex, cognitive impairment (memory, executive), disability, and age >74 years (Reis da Silva, 2024).
• Unclear advance directives
• Caregivers burnout
• Medical factors: delirium (e.g., from electrolyte imbalance), anemia, traumatic brain injury (TBI), infection, myocardial ischemia, urinary retention, constipation, end-of-life delirium, mood disorders, cognitive impairment, medication issues (polypharmacy), or movement disorders (e.g., parkinsonism).
• EA is associated with poorer outcomes and higher resource use (e.g., rehab, nursing home care).

General Prevention

• Complete annual wellness visits to discuss advanced care plan, power of attorney for health or finances, goals of care (GOC), degree of self-sufficiency, the role of the caregiver, the risk of caregiver burnout, and use an EA screening tool.
• Assess caregiver stress and burden (meet without patient). Screen for risk or presence of mood disorders (depression: PHQ-2 or PHQ-9; anxiety: General Anxiety Disorder-7 (GAD-7); loneliness: 3-item UCLA) or cognitive impairment (Folstein Mini-Mental State Examination [MMSE]), Montreal Cognitive Assessment [MoCA], Saint Louis University Mental Status [SLUMS]).
• Encourage socialization. Refer to community programs: DOA, Alzheimer’s Association, programs at a municipality.

Commonly Associated Conditions

Social isolation, increased dependence for activities of daily living/instrumental activities of daily living (ADLs/IADLs), depression, cognitive impairment, and aggressive behavior