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Elder Abuse

Elder Abuse is a topic covered in the 5-Minute Clinical Consult.

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  • 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]


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].


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.

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

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Stephens, Mark B., et al., editors. "Elder Abuse." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117247/all/Elder_Abuse.
Elder Abuse. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117247/all/Elder_Abuse. Accessed April 21, 2019.
Elder Abuse. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117247/all/Elder_Abuse
Elder Abuse [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117247/all/Elder_Abuse.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Elder Abuse ID - 117247 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117247/all/Elder_Abuse PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -