Elder Abuse

Key Points

• Elder abuse is underreported.

• Direct questioning for elder abuse is recommended.

• Physicians should recognize the physical and behavioral signs of abuse.

• A positive screen for elder abuse should be followed by a safety assessment.

• Physician reporting requirements regarding elder abuse vary by state.

Elder abuse is a significant public health issue that physicians need to identify and address in both outpatient and inpatient settings. The prevalence of elder abuse is difficult to determine because its definition varies across U.S. states and other countries and research is still limited in this area (Erlingsson, 2007). In a systematic review of international literature, estimates ranged from 3.2% to 27.5% based on population studies. More than 6% of the general population had reported abuse in the prior month (Cooper et al., 2008).

In the United States, the number of people age 65 and older who have been victims of elder abuse ranges between 1 and 2 million. In 2000, adult protective services (APS) departments received approximately 470,000 reports. Of the types of abuse, elder "self-neglect" is most often reported. A prospective, population-based cohort study found that elder self-neglect was associated with a 5.82 times increased risk for mortality in the year after a report of self-neglect (Dong et al., 2009). From incidence studies, it is estimated that for every case reported, about five go underreported (National Elder Abuse Incidence Study, 1998). Underreporting stems from both patient issues (familial secrecy, denial, fear, shame) and provider issues (lack of awareness) (Kahan and Paris, 2003). Primary care physicians have the opportunity to detect early signs of elder abuse in patients with whom they have well-established relationships (Stiles et al., 2002).

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