elder abuse, a reportable offense of physical, sexual, psychological, or material abuse, as well as violation of the rights of safety, security, and adequate health care of older adults. Contributing factors may include economic considerations, interpersonal conflicts, health, and dependency. Often the abused person denies that abusive acts occur and feels helpless and resigned to abuse. Health care workers are required to report suspected abuse, and perpetrators may be subject to criminal charges. Also called abuse of the elderly. ▪ OBSERVATIONS: Manifestations are dependent on the form of abuse. Physical abuse signs include cuts; lacerations; bruises; welts; black eyes; broken bones and sprains; dislocations; injury incompatible with history; broken eyeglasses; torn clothing; physical signs of punishment or restraint; laboratory findings of medication overdose or underuse of prescription drugs; elder report of being hit, slapped, kicked, or maltreated; and caregiver’s refusal to allow visitors to see elder alone. Sexual abuse signs include bruises around the breasts or genitalia; unexplained venereal disease or genital infections; unexplained vaginal or rectal bleeding; torn, stained, or bloody underclothing; and elder report of being assaulted or raped. Emotional abuse signs include emotional upset or agitation; hesitation to speak; extreme withdrawal; unusual behavior usually attributed to dementia; implausible stories; and reports of being verbally or emotionally abused. Neglect signs include dirty appearance; presence of feces and/or urine; environmental safety hazards; dehydration; malnutrition; untreated bed sores; poor personal hygiene; untreated health care problems; and elder report of mistreatment. Abandonment signs include desertion of an elder at a public institution or location such as a hospital, clinic, or shopping center, and elder self-report of abandonment. Signs of exploitation include unusual, sudden, or inappropriate activity in bank accounts; signatures on checks that do not resemble the older person’s signature; unusual concern by caregiver that an excessive amount of money is being spent on care of the older person; numerous unpaid bills; overdue rent; abrupt changes in a will or other financial documents; unexplained disappearance of funds or valuable possessions; and unexplained or sudden transfer of assets to a family member or someone outside the family. Signs of self-neglect include dehydration; malnutrition; untreated or improperly attended medical conditions; poor personal hygiene; hazardous or unsafe living conditions; inappropriate or inadequate clothing; and overall lack of self-care. Diagnosis is typically made by social service, health care, and legal experts after history, investigation, and physical examination. Laboratory tests and drug screening may be done to determine the extent of malnutrition, dehydration, and medication drug levels. Severe injury, disfigurement, and death are all complications of chronic or severe physical abuse. ▪ INTERVENTIONS: Obvious signs of abuse are reported to the local authorities for immediate investigation and elder protection. If the elder is perceived to be in immediate danger, elder protection should be sought through the local Adult Protective Services or the county Department of Social Services. If signs are vague or inconsistent, observations are documented and reported to appropriate local authorities for investigation. ▪ PATIENT CARE CONSIDERATIONS: Health care professionals serve as a frontline resource for the detection, intervention, and prevention of elder abuse. This includes the identification of high-risk dependent elder relationships, such as those where an elder is dependent on caretakers; elders with functional impairments; previous history of abuse or neglect; evidence of substance abuse or polypharmacy; signs of depression; and lack of or limited financial and/or support resources. Members of the health care team need to do a thorough assessment for signs of coercive caretaker arrangements or lack of caretaker skills, identification of family crises that could trigger abuse or neglect, and identification of signs of abuse or neglect. All evidence should be carefully documented and reported to appropriate sources. The health care professional is also instrumental in assisting elder and family to seek respite care services, counseling, and support groups. Social agency referrals are needed for financial and functional assistance (e.g., housekeeping, cooking, and shopping). Skill-building workshops for family members, coordinated care of elderly needs, public education about the problem, and coordination among state agencies and service providers are all mechanisms for prevention. Education includes caregiver instruction about alternative forms of venting frustrations and information about available community resources.
