Elder abuse: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
| Line 17: | Line 19: | ||
* Medication side effects (e.g., anticoagulants causing easy bruising) | * Medication side effects (e.g., anticoagulants causing easy bruising) | ||
* Cultural practices or family misunderstandings | * Cultural practices or family misunderstandings | ||
{{Psychosocial DDX}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 22: | Line 25: | ||
===Workup=== | ===Workup=== | ||
History: Use open-ended questions, assess for inconsistencies between patient and caregiver reports | *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 | |||
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 | |||
Labs/Imaging: CBC, BMP, coagulation studies, imaging for suspected fractures | *Documentation: Objective, detailed descriptions of injuries, photos (if institutional policy permits) | ||
Social Assessment: Involvement of social worker, assess home safety and support | |||
Documentation: Objective, detailed descriptions of injuries, photos (if institutional policy permits) | |||
===Diagnosis=== | ===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). | *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 ==== | ==== Hwalek-Sengstock Elder Abuse Screening Test ==== | ||
"Purpose: Screening device useful to service providers interested in identifying people at high | *"Purpose: Screening device useful to service providers interested in identifying people at high risk of the need for protective services. | ||
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. | ||
Instructions: Read the questions and write in the answers. A response of “no” to items 1, 6, 12, | **1. Do you have anyone who spends time with you, taking you shopping or to the doctor? | ||
and 14; a response of “someone else” to item 4; and a response of “yes” to all others is scored in | **2. Are you helping to support someone? | ||
the “abused” direction. | **3. Are you sad or lonely often? | ||
**4. Who makes decisions about your life—like how you should live or where you should live? | |||
1. Do you have anyone who spends time with you, taking you shopping or to the doctor? | **5. Do you feel uncomfortable with anyone in your family? | ||
**6. Can you take your own medication and get around by yourself? | |||
2. Are you helping to support someone? | **7. Do you feel that nobody wants you around? | ||
**8. Does anyone in your family drink a lot? | |||
3. Are you sad or lonely often? | **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? | |||
4. Who makes decisions about your life—like how you should live or where you should live? | **11. Has anyone taken things that belong to you without your O.K.? | ||
**12. Do you trust most of the people in your family? | |||
5. Do you feel uncomfortable with anyone in your family? | **13. Does anyone tell you that you give them too much trouble? | ||
**14. Do you have enough privacy at home? | |||
6. Can you take your own medication and get around by yourself? | **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> | ||
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== | ==Management== | ||
*Ensure patient safety: separate from suspected abuser if possible | |||
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 | |||
Treat medical issues: wound care, pain management, nutritional support | *Mandatory reporting to Adult Protective Services (APS) in most jurisdictions | ||
Involve interdisciplinary team: social work, case management, geriatrician | |||
Mandatory reporting to Adult Protective Services (APS) in most jurisdictions | |||
==Disposition== | ==Disposition== | ||
*Admit if medically unstable, unsafe home environment, or unable to self-care | |||
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 | |||
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== | ==See Also== | ||
*[[Nonaccidental trauma|Child Abuse]] | |||
[[Nonaccidental trauma|Child Abuse]] | *[[Depression|Depression in Older Adults]] | ||
*[[Delirium]] | |||
[[Depression|Depression in Older Adults]] | *[[Capacity Assessment]] | ||
[[Delirium]] | |||
[[Capacity Assessment]] | |||
==External Links== | ==External Links== | ||
*[https://www.mcgill.ca/familymed/files/familymed/easi%20english%20january%202013.pdf Elder Abuse Suspicion Index] | |||
[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)] | |||
[https://ncea.acl.gov/home National Center on Elder Abuse] | |||
[https://www.napsa-now.org/ Adult Protective Services (NAPSA)] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Trauma]] | |||
[[Category:Misc/General]] | |||
Latest revision as of 17:18, 3 November 2025
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 and Related
- Drugs of abuse
- Elder abuse
- Human trafficking
- Homelessness
- Interpersonal Violence
- Mandatory reporting
- Nonaccidental trauma
- Sexual assault
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?"[1]
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
External Links
References
- ↑ 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.