Elder abuse (EA) is a public health concern (autonomy, wellbeing). Defined as: (i) intentional actions that cause harm or create a serious risk of harm to a vulnerable elder (financial, physical, emotional, impaired capacity for self-care or self-protection risk) by a caregiver or other person who stands in a trust relationship, or (ii) failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm (National Academy of Sciences, 2003). In 2009, the estimated cost was approximately $2.9 billion, a 12% increase from the preceding year (National Committee for the Prevention of Elder Abuse).
The global incidence of EA is around 16% (World Health Organization [WHO]). In the United States, it is estimated that 10% of the population are victims of EA and as many as 5 million elders are affected each year.
EA in both the community and in institutions has increased during the COVID-19 pandemic (WHO). The estimated annual prevalence per 1,000 people of key forms of violence is: 22 for physical and sexual abuse, 17 for intimate partner violence, fatal suicide 0.17, nonfatal self-harm 0.27, and 9.7 to 32.6 for violence by older adults with dementia against others (1).
Etiology and Pathophysiology
The etiology of EA involves biopsychosocial factors in combination with increased dependence on the caregiver by the victim in a suboptimal environment with poor behavioral coping methods, further compounded by increased stress.
The victim: advanced age; female gender; low socioeconomic status; exploitable resources; social isolation; lack of purpose; PTSD in veterans; poor self-perceived health; loss of sense of control; health care insecurity; prior history of abuse in life; functional dependence; cognitive impairment; mental illness or substance use; polyvictimization (victim’s perception of EA, protecting the offender, perpetrator influence on the victim). The abuser: early child abuse; history of violence; mental illness or substance use; high stress or poor coping; poor physical or cognitive health; inadequate training or supervision; poor prior relationship between the caregiver and the victim; financial dependency on the victim.
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. 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: Department of Aging, Adult Protective Services (APS), Alzheimer’s Association.
Commonly Associated Conditions
Conditions commonly associated with EA can be risk factors. They include social isolation, increased dependence for activities of daily living/instrumental activities of daily living (ADLs/IADLs), depression, cognitive impairment, and aggressive behavior.
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