Description

• 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:
  • Physical
  • Sexual
  • Financial
  • Neglect
  • Psychological or emotional
  • Self-neglect: Being the most common form of abuse (1)
  • Taken advantage of: Misinformation and unregulated online pharmaceutical, financial companies, etc. that specifically target the elderly leading to deleterious outcomes (2).

Epidemiology

Incidence
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).

• 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)

Risk Factors

• The victim:
  • Advanced age
  • Female gender
  • Disability in caring for him/herself
  • Dementia or other cognitive impairment
  • Depression
  • Social isolation
  • Stress: Health, financial, or situational
• The Abuser:
  • Mental illness
  • Financial dependency
  • Substance abuse
  • History of violence
  • Other antisocial behavior (5)

Genetics
Non contributory

General Prevention

• 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.

Etiology

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.

Commonly Associated Conditions

Most common associated conditions with elder abuse are also identified as risk factors, social isolation, increased dependence for ADL/IADL's, depression, cognitive impairment and aggressive behavior (4,5).