Elder Abuse and Mistreatment

Author: Nasiya Ahmed, MD, John Halphen, MD, and Kathleen Pace Murphy, PhD, MS, GNP-BC

Key Points

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.

 

Assessment

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: Elder mistreatment screening can be done by asking simple questions such as:

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.

 

Intervention

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.

 

References

Acierno, R., Hernandez, M.A.., Amstadter, A.B., et al. (2010). Prevalence and correlates of emotional, physical, sexual and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. American Journal of Public Health, 100(2), 292-297.

Brandl, B., Dyer C.B., Heisler, C.J., Otto, J., Stiegel, L., Thomas, R. (2006). Elder Abuse Detection and Intervention: A Collaborative Approach. Springer Publishing Company. 

Dong, X., Simon, M., Mendes de Leon, C., Fulmer, T., Beck, T., Hebert, L., et al. (2009) Elder self-neglect and abuse and mortality risk in a community-dwelling population. Journal of the American Medical Association, 302(5), 517-526. 

Dyer, C.B., Goodwin, J.S., Pickens-Pace, S., Burnett, J., Kelly, P.A. (2007). Self-Neglect Among the Elderly: A Model Based on More Than 500 Patients Seen by a Geriatric Medicine Team. American Journal of Public Health, 97:1671-1676. 

Dyer, C.B., Pickens, S., Burnett J. (2007) Vulnerable Elders: When It Is No Longer Safe to Live Alone. Journal of American Medical Association, 298(12):1448-1450. 

Dyer, C.B., Heisler, C.J., Hill, C.A., Kim, L.C. (2005). Community approaches to elder abuse. Clinical Geriatric Medicine; 21:429-447. 

Dyer, C.B., Connolly, M.T., McFelley, P. (2003). The clinical and medical forensics of elder abuse and neglect. In: Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press: 339-381. 

Dyer, C.B., Pavlik, V.N., Murphy, K.P., Hyman, D.J. (2000). The high prevalence of depression and dementia in elder abuse or neglect. Journal of American Geriatric Society, 48(2):205-208. 

Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. (2003). Washington, DC: National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect. 

Fulmer, T., Paveza, G., Abraham, I., Fairchild, S. (2000). Elder neglect in the emergency department. Journal of Emergency Room Nursing, 26(5): 436-443. 

Halphen, J.M., Varas, G.M., Sadowsky, J.M.(2009). Recognizing and reporting elder abuse and neglect. Geriatrics. 64(7):13-18. 

Lachs, M.S., Pillemer, K. (2004). Elder abuse. Lancet;365(9441):1263-1272. 

Naik, A.D., Burnett, J., Pickens-Pace, S., Dyer C.B.(2008). Impairment in instrumental activities of daily living and the geriatric syndrome of self-neglect. Gerontologist;48(3):388-393. 

National Research Council. (2003) Elder mistreatment: Abuse, neglect and exploitation in an aging America. Washington, D.C.: The National Academies Press. 

Reed, K.(2005). When elders lose their cents: financial abuse of the elderly. Clinical Geriatric Medicine;21(2):365-382. 

Stiegel, L., Klem, E.(2007). Explanation of the "Immunity for Good Faith Reporting: Provisions and Citations in Adult Protective Services Laws, by State" and "Immunity for Good Faith Reporting: Criteria in Adult Protective Services Laws, by State" Charts. American Bar Association Commission on Law and Aging . Available at www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/APS/Analysis_State_Laws.aspx 

Teaster, P.B. (2000). A response to the abuse of vulnerable adults: The 2000 survey of statue adult protective services. Retrieved from http://apsnetwork.org/Resources/docs/2002StateSurvey.pdf. 

Texas Human Resources Code, Chapter 48. Investigations and protective services for elderly and disabled persons. http://www.statutes.legis.state.tx.us/