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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:
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.
- 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
- Social isolation
- Stress: health, financial, or situational
- The abuser:
- 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].