Abuse in the Elderly and Impaired

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Abuse in the Elderly and Impaired

• Tintinallis 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

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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

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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

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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?

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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.

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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)

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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

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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

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The End