Elder Abuse

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Basics

Description

  • The National Center of Elder Abuse divides abuse into three categories (age >60) (1)[A]:
    • 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)[C]
    • 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)[C]

Epidemiology

Incidence
Estimate is that as many as 1:10 have been victims of abuse, placing a conservative number at 50,000 cases per year. Majority of whom are believed to be women (4)[A].

Prevalence

A recent national survey measuring prevalence of abuse in individuals of at least 60 years and older found that 11.9% of the surveyed population suffered some form of abuse:

  • 5.2% encountered financial mistreatment by family members.
  • 5.1% suffered potential neglect.
  • 4.6% encountered emotional mistreatment, mostly by humiliation or verbal abuse.
  • 1.6% encountered physical mistreatment, mostly through battery.
  • 0.6% sexually mistreated, mostly through forced intercourse.

Etiology and Pathophysiology

The etiology of elder abuse is a complex 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
    • 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 (5)[C]

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 ADLs/IADLs, depression, cognitive impairment, and aggressive behavior (5)[C],(6)[B].

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