Author: Nasiya Ahmed, MD, John Halphen, MD, and Kathleen Pace Murphy, PhD, MS, GNP-BC
Elder abuse and neglect are estimated to affect 700,000 to 1.2 million U.S. elders annually.
Although reporting suspected abuse and mistreatment are mandated in most states, research estimates that only 1 in 14 cases of elder abuse are reported (National Research Council, 2003).
Only 7.6 – 10% of elders self-report being abused (Acierno, Hernandez, Armstadter et al, 2010)
The majority of elder abuse survivors are female (65.7 %). Approximately 43% are aged 80 years and older.
The vast majority of elder abuse and mistreatment cases occur in domestic settings (89.3%).
Elders who have been abused are at a 300% higher risk of mortality when compared to non-abused elder cohorts (Dong, Simon, Mendes de Leon, 2009).
Self-neglect is the most commonly reported form of elder abuse or mistreatment and is increasing.
In older adults who self-neglect, African-American older adults had a higher mortality rate compared to whites.
Elder abuse is strongly correlated with low social support and previous traumatic events.
In assessing an elder person for abuse and mistreatment, the health care provider needs to be familiar with the various types of elder mistreatment. There are six major types of elder mistreatment: Physical abuse, sexual abuse, emotional or psychological abuse, neglect, self-neglect and financial exploitation. More than one type of elder abuse can be manifest in the same individual.Risk factors and warning signs of elder mistreatment include:
Unsatisfactory answers to these questions should prompt further evaluation.
The Elder Assessment Instrument (EAI) is a formal 41 question mistreatment assessment instrument that takes approximately 15 minutes to administer (Fulmer, Pavez, Abraham, and Fairchild, 2000).
An approach to screening and identification of suspected cases of elder mistreatment involves performing a comprehensive history and physical exam, including psychosocial assessments, cognitive assessments, functional assessments, and utilizing information from all reasonably available sources, including reports of family, neighbors and government agencies.
In many instances, capacity assessment is appropriate. The health care provider must provide clear, comprehensive documentation in the medical record, treat underlying medical illnesses and geriatric syndromes, and report suspected cases of abuse or neglect to the appropriate authorities.
If a clinician suspects elder abuse, mistreatment, neglect, self-neglect or exploitation by caretakers, he or she has a duty to report it to the authorities. Not reporting suspected abuse and mistreatment, depending on state law, may result in charges being filed against the health care provider.
In most jurisdictions, good-faith reporters are protected from criminal and civil liability for erroneous reports and testimony. In some jurisdictions, reporting can be anonymous. Verification of the accuracy of the suspicion is not required of the clinician. That is the government agency's job.
All jurisdictions in the United States have an adult protective services agency (APS),
APS takes reports and intervenes in community elder abuse, neglect & exploitation.
Police, as well as APS, should be contacted if immediate jeopardy to the elder exists.
Clinicians should work closely with the authorities and agencies to treat medical issues, determine capacity for self-care and self-protection, and accurately document findings.
Without intervention, all forms of elder mistreatment may lead to adverse health and safety events since these vulnerable elders are often less physically, psychologically, cognitively, socially and financially resilient.
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