Abuse in the Elderly and Impaired

1. Abuse in the Elderly and Impaired Tintinalli’s Chapter 300

2. Introduction • 3 percent of the elderly population experiences abuse or neglect • the year 2020, about 20 percent of the U.S. population will be 65 years or older • Detection of elder abuse and neglect is contingent on physicians' awareness of the problem

3. Types of Abuse • Physical: Injury or harm intending to cause suffering, pain, or impairment • Sexual: Nonconsensual sexual involvement of any kind • Emotional: Inflicting anguish, pain, or distress, verbally or nonverbally • Financial: Illegal or improper use of funds, property, or assets • Neglect: Refusal or failure of caregiver to fulfill obligations or duties • Abandonment: Desertion by custodian or caregiver who has assumed responsibility for care • Self Neglect: Failure of the older person to provide for own mental and medical care

4. Social and Environmental Risk Factors • elderly victims are socially isolated from family and friends • abuser is often dependent on the victim for housing and financial, social, and emotional support • Functional disability and worsening cognitive impairment of the aging individual

5. Focus History On • detecting the presence of caretaker mental illness, mental retardation, dementia, or drug or alcohol abuse • family history of violence • caretaker dependence on the elder patient for housing, finances, or emotional support • patient isolation • whether the patient and suspected abuser are living together • recent occurrence of stressful life events for the caretaker • Physician Shopping • Ask the patient, “Are you happy at home?”

6. Findings That May Suggest Abuse • 1. The patient appears fearful of his or her companion. • 2. There are conflicting accounts of the injury or illness between the patient and caretaker. • 3. There is an absence of assistance from the caretaker. • 4. The caretaker displays an attitude of indifference or anger toward the patient. • 5. The caretaker is overly concerned with the costs of treatment needed by the patient. • 6. The caretaker denies the patient the chance to interact privately with the physician.

7. Physical Exam • focus on detecting signs and symptoms of poor personal hygiene, inappropriate or soiled clothing, dehydration, malnutrition, and worsening decubiti • Look for unexplained signs of trauma (Secondary Trauma Survey)

8. Treatment • Two fold Treatment • Treat acute injuries • Intervention on underlying abuse • Multidisciplinary approach • Aim at improving caretaker exhaustion • All 50 states have passed legislation aimed at protecting elderly victims of domestic abuse and neglect • nationwide reporting hotline called Eldercare Locator 1-800-677-1116 • Adult Protective Services needs to be involved • since 1975, the Older American Act has required each state to have a long-term care ombudsman program to investigate nursing home care complaints

9. Disposition • Patients who do not medically require admission may need to be admitted for protective placement • A formal safety assessment can be requested from professionals, such as a hospital-based social worker or an on-call community-based elder abuse counselor • drug and alcohol abuse among the elderly must be recognized by ED staff and addressed through appropriate referrals • Caregivers should be provided with intervention options, such as arranging for home care, respite, or counseling

10. The End