I. Definition

  1. Caregiver acts via intent or neglect in a way that may harm a vulnerable adult

II. Epidemiology

  1. Prevalence: 10% of older persons experience neglect or abuse by caregiver in the U.S. annually
    1. Acierno (2010) Am J Public Health 100(2): 292-7 [PubMed]

III. Types

  1. Financial or material abuse
    1. Theft of funds, resources or items
    2. Coercion of elder person to use their assets
  2. Neglect or abandonment
    1. Caregiver fails to meet elder person's needs (food, clothing, shelter, hygiene, medical care, social interaction) to maintain their well being
  3. Physical abuse
    1. Includes slapping, hitting, kicking, striking, force-feeding, restraining or otherwise inflicting pain or injury
  4. Emotional or psychological abuse
    1. Verbally abusive including humiliating or degrading statements
    2. Threats such as placing in longterm care facility or for social isolation
  5. Sexual abuse
    1. Forced sexual activity, touching or fondling a non-consenting person (includes unwanted sexual talk)

IV. Risk Factors

  1. Age over 75 years old
  2. Shared living arrangement
  3. Cognitive Impairment
  4. Behavior Problems in Dementia
  5. Social isolation
  6. Caregiver mental illness or Chemical Dependency
  7. Caregiver dependency on older person (e.g. financial)

V. Signs

  1. Atypical Bruising
    1. Bruising on lateral arms, face or back (non-bony prominence)
    2. Bruises >5 cm in diameter
  2. Atypical Burn Injury
    1. Not consistent with accidental injury
    2. Stocking or glove distribution may suggest forced immersion in hot liquid
  3. Patterned Skin Injuries
    1. Hand slap
    2. Human Bite mark
    3. Restraint marks or scars from ligature at wrists, ankles or neck
  4. Other skin findings (if not consistent with history or patient medical status)
    1. Decubitus Ulcer
    2. Traumatic Alopecia
    3. Severe diaper-rash consistent with urine burns
    4. Dirty clothing or poor hygiene
  5. Other non-skin findings suggestive of abuse or neglect
    1. Unexplained weight loss, malnutrition or dehydration
    2. Unexplained Fractures
    3. Delayed medical attention for injury or illness
    4. Medical noncompliance

VI. Differential Diagnosis

VII. Management: Approach

  1. Step 1: Assess for cognitive Impairment
    1. Example: Mini-Cog
  2. Step 2: Screen for Elder Abuse
    1. Elder Abuse Suspicion Index
      1. Relies on self-report
      2. Not an appropriate screening tool if cognitive Impairment is present
  3. Step 3: Focused examination
    1. Evaluate for signs of abuse as above
  4. Step 4: Adult Protective Services Indications
    1. Immediate danger to patient or
    2. Patient without decision making capacity
  5. Step 5: Initiate safety plan
    1. See safety plan described below
    2. Coordinate resources
    3. Initiate preventive measures to reduce risk of abuse
    4. Establish a regular follow-up plan

VIII. Management: Safety Plan

  1. Summary
    1. Individualized plan agreed upon by patient, medical provider and trusted friend or family member
  2. Components
    1. Safe places (e.g. family or friend's home, shelter, hospital)
    2. Stategies to reduce risk of harm when in contact with potential abuser
    3. Essential item list to be stored in a safe place (to bring with them in case of emergency)
    4. Emergency phone numbers (e.g. family, friends, community resources, police, medical care)
    5. Emergency logistical planning (e.g. transportation resources)
    6. Establish regular primary care follow-up

IX. Resources

  1. Administration on Aging National Center on Elder Abuse
    1. http://www.ncea.aoa.gov
  2. Baylor College of Medicine - Geriatric Education Center Pocket Guide to Elder Investment Fraud and Financial Exploitation
    1. http://www.nasaa.org/wp-content/uploads/2011/08/EIFFE-Clinicians-Pocket-Guide.pdf
  3. Eldercare Locator
    1. http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx

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