Elder Abuse

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Basics

Description

  • The National Center of Elder Abuse divides abuse into three categories (age >60) (1):
    • Domestic: abuse from someone who has a special relationship with the elderly individual (spouse, child, friend, or in-home caregiver) that occurs in the home of the elderly or caregiver
    • Institutional: occurs in the setting of a facility that is responsible for caring for the elderly, such as a nursing home or long-term care facility
    • Self-neglect: The behavior of the elderly individual leads to harm.
  • Types of abuse in estimated order of occurrence:
    • Self-neglect (estimated 50%). The most common form of abuse (2).
    • Financial
    • Neglect
    • Emotional
    • Physical
    • Sexual
    • Taken advantage of: misinformation and unregulated online pharmaceutical, financial companies, and so forth, that specifically target the elderly leading to deleterious outcomes (3)

Epidemiology

Incidence
The incidence in the US is estimated at 10% of the population who have been victims of abuse with some estimates as high as 5 million elders affected each year. Low reporting as noted by one study (1 in 14 cases) makes the true incidence difficult to establish (4). Majority of the victims are likely to be women (5)[A]. Globally the number reported by the World Health Organization is around 15.7% (6).

Etiology and Pathophysiology

The etiology of elder abuse is a complex interplay of biopsychosocial combination of increased dependence on the caregiver by the victim in a suboptimal environment with poor behavioral coping methods, which is compounded by increased stress.

Genetics
Not contributory

Risk Factors

  • The victim:
    • Advanced age
    • Exploitable resources
    • Prior history of abuse in life
    • Dementia or other cognitive impairment (estimated that nearly 50% will experience abuse or neglect)
    • Female gender
    • Disability in caring for him/herself
    • Depression
    • Social isolation
    • Stress: health, financial, or situational
  • The abuser:
    • Mental illness
    • Financial dependency
    • Substance abuse
    • History of violence
    • Other antisocial behavior (6)
  • 60% of the time the abuser is a family member — adult children or spouses

General Prevention

  • Improve patient’s social contact and support.
  • Identify and correct potential risk factors for elder abuse:
    • Home visit to identify for potential risks of fall hazards and barriers to ambulation that could lead to fractures and functional decline that could leave the individual vulnerable to abuse
    • Evaluate for assistive devices that help the patient independently complete his/her ADLs and prevent caregiver dependence.
    • Screen for depression using validated tools like the Geriatric Depression Scale.
    • Early identification and treatment of cognitive impairment
  • Identify caregiver stress and burden; refer to community programs that aid with emotional assistance.
  • Advance life directives planning, including identifying possible caregivers, choosing a medical power of attorney (MPOA), estate and will planning, and so forth

Commonly Associated Conditions

Most common associated conditions with elder abuse are also identified as risk factors: social isolation, increased dependence for ADL/IADLs, depression, cognitive impairment, and aggressive behavior (7,8).

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Basics

Description

  • The National Center of Elder Abuse divides abuse into three categories (age >60) (1):
    • Domestic: abuse from someone who has a special relationship with the elderly individual (spouse, child, friend, or in-home caregiver) that occurs in the home of the elderly or caregiver
    • Institutional: occurs in the setting of a facility that is responsible for caring for the elderly, such as a nursing home or long-term care facility
    • Self-neglect: The behavior of the elderly individual leads to harm.
  • Types of abuse in estimated order of occurrence:
    • Self-neglect (estimated 50%). The most common form of abuse (2).
    • Financial
    • Neglect
    • Emotional
    • Physical
    • Sexual
    • Taken advantage of: misinformation and unregulated online pharmaceutical, financial companies, and so forth, that specifically target the elderly leading to deleterious outcomes (3)

Epidemiology

Incidence
The incidence in the US is estimated at 10% of the population who have been victims of abuse with some estimates as high as 5 million elders affected each year. Low reporting as noted by one study (1 in 14 cases) makes the true incidence difficult to establish (4). Majority of the victims are likely to be women (5)[A]. Globally the number reported by the World Health Organization is around 15.7% (6).

Etiology and Pathophysiology

The etiology of elder abuse is a complex interplay of biopsychosocial combination of increased dependence on the caregiver by the victim in a suboptimal environment with poor behavioral coping methods, which is compounded by increased stress.

Genetics
Not contributory

Risk Factors

  • The victim:
    • Advanced age
    • Exploitable resources
    • Prior history of abuse in life
    • Dementia or other cognitive impairment (estimated that nearly 50% will experience abuse or neglect)
    • Female gender
    • Disability in caring for him/herself
    • Depression
    • Social isolation
    • Stress: health, financial, or situational
  • The abuser:
    • Mental illness
    • Financial dependency
    • Substance abuse
    • History of violence
    • Other antisocial behavior (6)
  • 60% of the time the abuser is a family member — adult children or spouses

General Prevention

  • Improve patient’s social contact and support.
  • Identify and correct potential risk factors for elder abuse:
    • Home visit to identify for potential risks of fall hazards and barriers to ambulation that could lead to fractures and functional decline that could leave the individual vulnerable to abuse
    • Evaluate for assistive devices that help the patient independently complete his/her ADLs and prevent caregiver dependence.
    • Screen for depression using validated tools like the Geriatric Depression Scale.
    • Early identification and treatment of cognitive impairment
  • Identify caregiver stress and burden; refer to community programs that aid with emotional assistance.
  • Advance life directives planning, including identifying possible caregivers, choosing a medical power of attorney (MPOA), estate and will planning, and so forth

Commonly Associated Conditions

Most common associated conditions with elder abuse are also identified as risk factors: social isolation, increased dependence for ADL/IADLs, depression, cognitive impairment, and aggressive behavior (7,8).

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