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- The National Center of Elder Abuse divides abuse in 3 categories (older than age 60):
- Domestic: Abuse from someone who has a special relationship with the elderly individual (spouse, child, friend, or in home caregiver) that occurs in the home of the elderly or caregiver
- Institutional: Occurs in the setting of a facility that is responsible for caring for the elderly such as a nursing home or long-term care facility
- Self-neglect: The behavior of the elderly individual leads to harm
- Types of abuse:
Current estimates of ederly abuse are between 400,000 and 500,000 per year; however, these may be under reported because only APS cases were reported (3).
A recent national survey measuring prevalence of abuse in individuals of at least 60 years and older found that 11.9% of the surveyed population suffered some form of abuse:
- 5.2% encountered financial mistreatment by family members
- 5.1% suffered potential neglect
- 4.6% encountered emotional mistreatment, mostly by humiliation or verbal abuse
- 1.6% encountered physical mistreatment, mostly through battery
- 0.6% were sexually mistreated, mostly through forced intercourse (4)
- The victim:
- Advanced age
- Female gender
- Disability in caring for him/herself
- Dementia or other cognitive impairment
- Social isolation
- Stress: Health, financial, or situational
- The Abuser:
- Mental illness
- Financial dependency
- Substance abuse
- History of violence
- Other antisocial behavior (5)
- Improve patient social contact and support.
- Identify and correct potential risk factors for elder abuse:
- Home visit to identify for potential risks of fall hazards and barriers to ambulation that could lead to fractures and functional decline that could leave the individual vulnerable to abuse.
- Evaluate for assist devices that help the patient independently complete his/her ADLs and prevent caregiver dependence.
- Screen for depression using validated tools like the Geriatric Depression Scale.
- Early identification and treatment of cognitive impairment.
- Identify caregiver stress and burden, refer to community programs that aid with emotional assistance
- Advance life directives planning, including identifying a possible caregivers, choosing a MPOA, estate and will planning, etc.
The etiology of elder abuse is a complex biopsychosocial combination of increased dependence on the caregiver by the abuser in a suboptimal environment with poor behavioral coping methods in the presence of increased stress.