I. Definition
- Caregiver acts via intent or neglect in a way that may harm a vulnerable adult
II. Epidemiology
- Prevalence: 10% of older persons experience neglect or abuse by caregiver in the U.S. annually
III. Types
- Financial or material abuse
- Theft of funds, resources or items
- Coercion of elder person to use their assets
- Neglect or abandonment
- Caregiver fails to meet elder person's needs (food, clothing, shelter, hygiene, medical care, social interaction) to maintain their well being
- Physical abuse
- Includes slapping, hitting, kicking, striking, force-feeding, restraining or otherwise inflicting pain or injury
- Emotional or psychological abuse
- Verbally abusive including humiliating or degrading statements
- Threats such as placing in longterm care facility or for social isolation
- Sexual abuse
- Forced sexual activity, touching or fondling a non-consenting person (includes unwanted sexual talk)
IV. Risk Factors
- Age over 75 years old
- Shared living arrangement
- Cognitive Impairment
- Behavior Problems in Dementia
- Social isolation
- Caregiver mental illness or Chemical Dependency
- Caregiver dependency on older person (e.g. financial)
V. Signs
- Atypical Bruising
- Atypical Burn Injury
- Not consistent with accidental injury
- Stocking or glove distribution may suggest forced immersion in hot liquid
- Patterned Skin Injuries
- Hand slap
- Human Bite mark
- Restraint marks or scars from ligature at wrists, ankles or neck
- Other skin findings (if not consistent with history or patient medical status)
- Decubitus Ulcer
- Traumatic Alopecia
- Severe diaper-rash consistent with urine burns
- Dirty clothing or poor hygiene
- Other non-skin findings suggestive of abuse or neglect
- Unexplained weight loss, malnutrition or dehydration
- Unexplained Fractures
- Delayed medical attention for injury or illness
- Medical noncompliance
VI. Differential Diagnosis
- See Bruise
- See Burn Injury
- See Unintentional Weight Loss
VII. Management: Approach
- Step 1: Assess for cognitive Impairment
- Example: Mini-Cog
- Step 2: Screen for Elder Abuse
- Elder Abuse Suspicion Index
- Relies on self-report
- Not an appropriate screening tool if cognitive Impairment is present
- Elder Abuse Suspicion Index
- Step 3: Focused examination
- Evaluate for signs of abuse as above
- Step 4: Adult Protective Services Indications
- Immediate danger to patient or
- Patient without decision making capacity
- Step 5: Initiate safety plan
- See safety plan described below
- Coordinate resources
- Initiate preventive measures to reduce risk of abuse
- Establish a regular follow-up plan
VIII. Management: Safety Plan
- Summary
- Individualized plan agreed upon by patient, medical provider and trusted friend or family member
- Components
- Safe places (e.g. family or friend's home, shelter, hospital)
- Stategies to reduce risk of harm when in contact with potential abuser
- Essential item list to be stored in a safe place (to bring with them in case of emergency)
- Emergency phone numbers (e.g. family, friends, community resources, police, medical care)
- Emergency logistical planning (e.g. transportation resources)
- Establish regular primary care follow-up
IX. Resources
- Administration on Aging National Center on Elder Abuse
- Baylor College of Medicine - Geriatric Education Center Pocket Guide to Elder Investment Fraud and Financial Exploitation
- Eldercare Locator
