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At least 10% of older adults experience elder abuse

Physicians need to be alert for cases of elder abuse, which researchers estimate is prevalent in at least 10% of people 60 years of age or older, according to a review in The New England Journal of Medicine.

Mark S. Lachs, MD, MPH, a physician specializing in geriatric medicine at Cornell University, and colleague detailed types of abuse, how they manifest in patients and the role of physicians in their review.

The researchers explained that elder abuse can appear in five different forms: neglect, financial exploitation, sexual abuse, physical abuse and psychological or verbal abuse. These abuses can manifest as conditions including bruises, fractures, depression, anxiety, newly-acquired STIs, UTIs, inability to pay for medicine or medical care, nonadherence to medication regimen, malnutrition or poor hydration.

Risk factors for elder abuse include being a woman, being younger, a shared living environment, having a lower income, isolation, functional impairment and poor physical health.

Lachs and colleague also identified characteristics associated with abusers.

"On the basis of limited evidence available, perpetrators are most likely to be adult children or spouses, and they are more likely to be male, to have a history of past or current substance abuse, to have mental or physical health problems, to have a history of trouble with the police, to be socially isolated, to be unemployed or have financial problems, and to be experiencing major stress," they wrote.

Studies have shown that victims of elder abuse are at increased risk for various negative outcomes, including depression, anxiety, hospitalization and death. They are also more likely to be placed in a nursing home.

Lachs and colleague acknowledge that evaluation and treatment of elder abuse may be difficult, but physicians should employ specific assessment strategies to identify possible victims. Physicians should interview suspected perpetrators or victims both separately and alone, using indirect questions or direct questions similar to those used in other cases of domestic abuse.

"The most important tasks for the physician are to recognize and identify elder abuse, to become familiar with resources for intervention that are available in the local community, and to refer the patient to and coordinate care with those resources," Lachs and colleague stated.

The researchers listed groups that can aid in assessment and intervention, including Adult Protective Services, home health care agencies, nonprofit programs, police and financial services industry.

"Because victims of elder abuse tend to be isolated, their interactions with physicians, which may be intermittent or rare, present critically important opportunities to recognize elder abuse and to intervene or refer the victims to appropriate providers," Lachs and colleague wrote. "The response of the medical professional must include connecting with specialists in other disciplines, including social work, law enforcement, and protective services, ideally in the context of an interprofessional-team approach." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.