History and warning signs for elder mistreatment/abuse

History

Advanced age (>80 years)

Disability in self-care

Dementia

Depression

History of hip fracture

History of stroke

Social isolation

Poor socioeconomic status

External family stressors

Unfavorable caretaker characteristics*

Indicators of financial exploitation^¶

Institutional staffing shortages

Inappropriate or excessive medications; failure to get needed medications; lack of appropriate monitoring of medications and their effects

Substance abuse

Physical/mental status examination

Indicators of sexual abuse: pain, bruises, lacerations, bleeding in anal-genital areas; bruised breasts or abdomen; signs of venereal diseases

Lacerations (including large skin tears, abrasions, burns, and bruises) without adequate explanation, especially on the trunk or other unusual locations

Suspicious fractures in sites other than those seen in osteoporotic fractures, ie, wrist, hip, or vertebral body

Malnutrition

Focal findings on neurologic examination

Signs of dehydration

Pressure ulcers

Dementia, psychiatric disorders, lack of mental capacity

* Unfavorable caretaker characteristics: mental illness, substance abuse, history of violent or antisocial behavior, depression, or financial dependency on the victim.^[1,2]
¶ Indicators of financial exploitation: inability to pay for services (utilities, rent, medications, food) that the older adult was previously able to pay for. Transfers of property when the older adult lacks the capacity to consent.^[3]

References:

Lachs MS, Pillemer K. Elder abuse. Lancet 2004; 364:1265.
Lachs MS, Pillemer K. Abuse and neglect of elderly persons. N Engl J Med 1995; 332:437.
Reed K. When elders lose their cents: Financial abuse of the elderly. Clin Geriatr Med 2005; 21:365.

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History and warning signs for elder mistreatment/abuse