Elder Mistreatment (Elder Abuse)

Introduction

Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.

  • Elder Mistreatment or abuse is acts that cause harm to vulnerable elderly persons
  • It occurs deliberately or through neglect
  • It is meted out by caregivers or persons held in trust
  • It may occur in home or institutional settings
  • It may affect older persons across all social classes
  • It may affect males as well as females
  • Diagnosis may be missed if not carefully sought

Risk factors

For suffering abuse

  • Advanced age
  • Disability (physical or mental)
  • Lack of financial skills
  • Recent bereavement or other personal loss
  • Conditions that increase dependence

For committing abuse

  • Elder dependence
  • Family caregiving
  • Lone caregiver and stress.
  • Mental illness
  • Physical abuse in the past
  • Substance abuse

Types

  • Financial or material neglect:
  • Exploitation, theft of financial
    documents, forcible transfer of property, etc.
  • Neglect or abandonment neglect:
    Caregiver fails to meet the older person’s needs e.g. clothing, hygiene, healthcare, shelter, social stimulation, etc.
  • Physical neglect:
    • Injury inflicted through striking, force feeding, use of restraints, etc.
  • Psychological neglect:
    • Mental anguish inflicted through insulting statements, threats, social isolation, etc.
  • Self-neglect neglect:
    • Acts by older adult that threaten their own wellbeing or safety
  • Sexual neglect:
    • Forced sexual activity, touching or fondling without consent

Clinical features

  • Bruising in unusual locations
  • Burns in patterns suggesting intentional injury
  • Delay in seeking medical care
  • Decubiti
  • Dehydration
  • Inattention to personal hygiene.
  • Injury patterns suggesting use of restraints
  • Malnutrition
  • Traumatic alopecia
  • Unexplained fractures
  • Unexplained weight loss

Differential diagnoses

  • Allergic reactions
  • Adverse reactions to medications
  • Contact dermatitis
  • Mental illness
  • Senile purpura
  • Systemic diseases presenting with
    features of neglect e.g. diabetes mellitus, malabsorption, urinary tract infection, etc.

Complications

  • Physical harm
  • Psychological harm e.g. living in fear, depression, anxiety, etc.
  • Morbidity worsening
  • Mortality

Investigations

  • As indicated by history and clinical
    features

Treatment objectives

  • Improve safety
  • Improve health status
  • Improve overall wellbeing

Non-drug treatment

Individualized, multi-disciplinary approaches:

  • Assess decision making capacity
  • Social work referral
  • Comprehensive geriatric assessment
  • Other referrals as indicated.

Drug treatment

  • As indicated by the clinical scenario e.g. analgesia for pain

Prevention

  • Recognize warning signs (in the older adult, caregiver, home or institution) and intervene