View source for Elder abuse

==Background==
*Refers to intentional or negligent acts by a caregiver or trusted individual that cause harm or serious risk of harm to an older adult, typically aged 60 and over. 
**Includes physical, emotional, sexual, or financial abuse, as well as neglect and abandonment
**Is underreported and often occurs in private settings, including the victim's home or long-term care facilities.

==Clinical Features==

* Physical: Bruises, burns, lacerations, fractures (especially spiral), pressure ulcers
* Behavioral: Withdrawal, agitation, fearfulness, depression
* Neglect: Poor hygiene, malnutrition, dehydration, unmet medical needs
* Financial: Sudden financial difficulties, missing belongings, unpaid bills
* Sexual: Genital injuries, STIs, behavioral changes

==Differential Diagnosis==

* Accidental trauma (especially in patients with balance issues)
* Dementia-related self-neglect
* Dermatologic conditions mimicking bruising
* Medication side effects (e.g., anticoagulants causing easy bruising)
* Cultural practices or family misunderstandings
{{Psychosocial DDX}}

==Evaluation==

===Workup===

*History: Use open-ended questions, assess for inconsistencies between patient and caregiver reports
*Physical Exam: Full-body exam including skin, oral cavity, and genital area
*Labs/Imaging: CBC, BMP, coagulation studies, imaging for suspected fractures
*Social Assessment: Involvement of social worker, assess home safety and support
*Documentation: Objective, detailed descriptions of injuries, photos (if institutional policy permits)

===Diagnosis===
*Clinical diagnosis based on a combination of history, physical findings, and social context. Use screening tools like the Elder Abuse Suspicion Index (EASI) or the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).

==== Hwalek-Sengstock Elder Abuse Screening Test ====
*"Purpose: Screening device useful to service providers interested in identifying people at high risk of the need for protective services.
*Instructions: Read the questions and write in the answers. A response of “no” to items 1, 6, 12, and 14; a response of “someone else” to item 4; and a response of “yes” to all others is scored in the “abused” direction.
**1. Do you have anyone who spends time with you, taking you shopping or to the doctor?
**2. Are you helping to support someone?
**3. Are you sad or lonely often?
**4. Who makes decisions about your life—like how you should live or where you should live?
**5. Do you feel uncomfortable with anyone in your family?
**6. Can you take your own medication and get around by yourself?
**7. Do you feel that nobody wants you around?
**8. Does anyone in your family drink a lot?
**9. Does someone in your family make you stay in bed or tell you you’re sick when you know you’re not?
**10. Has anyone forced you to do things you didn’t want to do?
**11. Has anyone taken things that belong to you without your O.K.?
**12. Do you trust most of the people in your family?
**13. Does anyone tell you that you give them too much trouble?
**14. Do you have enough privacy at home?
**15. Has anyone close to you tried to hurt you or harm you recently?"<ref> Neale, A. V., Hwalek, M. A., Scott, R. O., & Stahl, C. (1991). Validation of the HwalekSengstock elder abuse screening test. Journal of Applied Gerontology, 10(4), 406-415. </ref>

==Management==

Ensure patient safety: separate from suspected abuser if possible

Treat medical issues: wound care, pain management, nutritional support

Involve interdisciplinary team: social work, case management, geriatrician

Mandatory reporting to Adult Protective Services (APS) in most jurisdictions

==Disposition==

Admit if medically unstable, unsafe home environment, or unable to self-care

Coordinate with APS, legal authorities, and case managers for safe discharge planning

Consider temporary placement in skilled nursing or rehabilitation facility if needed

==See Also==
*[[Nonaccidental trauma|Child Abuse]]
*[[Depression|Depression in Older Adults]]
*[[Delirium]]
*[[Capacity Assessment]]

==External Links==
*[https://www.mcgill.ca/familymed/files/familymed/easi%20english%20january%202013.pdf Elder Abuse Suspicion Index]
*[https://ncea.acl.gov/home National Center on Elder Abuse]
*[https://www.napsa-now.org/ Adult Protective Services (NAPSA)]

==References==
<references/>

[[Category:Trauma]]
[[Category:Misc/General]]