Elder abuse

doi:10.1016/S0140-6736(04)17144-4

The Lancet

Volume 364, Issue 9441, 2–8 October 2004, Pages 1263-1272

https://doi.org/10.1016/S0140-6736(04)17144-4 Get rights and content

Summary

Elder abuse has received increasing attention over the past decade as a common problem with serious consequences for the health and wellbeing of old people. Our aim is to assist clinicians by summarising recent international research and clinical findings about elder abuse, and to assess their quality, relevance, and feasibility for health-care providers in clinical practice. This seminar includes issues of definition and frequency of elder abuse and a summary of major known risk factors. The advantages and disadvantages of screening for elder abuse are discussed. We review clinical manifestations and diagnosis of elder abuse, and propose a protocol for medical assessment of a patient with confirmed or suspected abuse. Suggestions for treatment are offered on the basis that elder abuse is multifactorial and needs individual medical and social intervention strategies, preferably in the context of a multidisciplinary team.

Section snippets

Definition and occurrence

The frequency of any clinical event depends on a case definition that ideally meets the criteria of inter-rater reliability and clinical applicability. A major impediment to the understanding of elder abuse has been the use of widely varying (and sometimes poorly constructed) definitions. Fortunately, some consensus is now emerging in the previously controversial area of definitions and classification of elder abuse. From both clinical and research standpoints, two questions arise: what is the

Pathophysiology and risk factors

Progress has been made over the past decade in the empirical identification of risk factors for elder abuse. Various epidemiological designs have been used to elucidate such risk factors ranging from case-control studies to longitudinal designs. Care should be taken because research on risk factors for elder abuse is at an early stage of development, and much further study is needed. We limit ourselves in this review to studies with acceptable designs; specifically, those that involve a

Screening

Should apparently asymptomatic patients be tested for elder abuse? There have been no randomised trials of elder abuse screening in asymptomatic populations, although the 1992 American Medical Association guidelines on elder abuse suggested that all outpatients be screened for family violence.³¹ By contrast, the US Preventive Medicine Task Force concluded that there was insufficient evidence for or against screening for family violence in outpatients of any age,³² and a Canadian Task force had

Clinical manifestations and diagnosis

Patients for whom elder abuse is suspected (from either a positive screening test or outright clinical findings that might or might not be due to abuse) need further examination for the diagnosis. Attempts to identify diagnostic findings or arrays of findings (akin to so-called shaken baby syndrome in child abuse, for example) have not been successful. A patient with symptoms of elder abuse might or might not have findings clearly attributable to elder abuse, and those not subject to abuse

Course and treatment

In a large longitudinal study of old people,⁴⁹ those who were mistreated were 3·1 times more likely to die during a 3-year period than those who did not experience abuse, even after adjustment for comorbidity and other factors associated with mortality. At the end of 13 years of follow-up, 9% of those who were mistreated were alive, compared with 41% who had not experienced abuse.⁴⁹ Elder abuse is also associated with various other adverse life course and health outcomes ranging from depression

Conclusion

Although there are gaps in knowledge with respect to the clinical manifestations and treatment of elder abuse, they should not prevent clinicians from taking an active role in identification and management. Family violence directly affects quality of life, and removal of a patient from an abusive situation is one of the most gratifying experiences for physicians and other health-care professionals. Despite the need for more data on interventions, a reasonable approach is a multidisciplinary

Search strategy and selection criteria

Because elder abuse is both a medical and social problem, relevant publications appear in both medical and social-science publications. Therefore, we searched the following databases: Ageline, PubMed, and Sociological Abstracts to 1980. Keywords were “elder abuse”, “elder mistreatment”, “elder neglect”, and “domestic violence in the elderly”. Many publications on this topic are case studies, policy analyses or essays, clinical reviews, or small studies of non-representative samples; we

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Cited by (416)

Elder Mistreatment: Emergency Department Recognition and Management
2023, Clinics in Geriatric Medicine
Mechanisms and weapons in physical elder abuse injuries: Findings from legally adjudicated cases
2023, Injury
Elder abuse is common, but many characteristics have not been well-described, including injury mechanisms and weapons in physical abuse. Better understanding of these may improve identification of elder abuse among purportedly unintentional injuries. Our goal was to describe mechanisms of injury and weapons used and their relation to injury patterns.
We partnered with District Attorney's offices in 3 counties and systematically examined medical, police, and legal records from 164 successfully prosecuted physical abuse cases of victims aged ≥60 from 2001 to 2014.
Victims sustained 680 injuries (mean 4.1, median 2.0, range 1–35). Most common mechanisms were: blunt assault with hand/fist (44.5%), push/shove, fall during altercation (27.4%), and blunt assault with object (15.2%). Perpetrators more commonly used body parts as weapons (72.6%) than objects (23.8%). Most commonly used body parts were: open hands (55.5% of victims sustaining injuries from body parts), closed fists (53.8%), and feet (16.0%). Most commonly used objects were: knives (35.9% of victims sustaining injuries from objects) and telephones (10.3%). The most frequent mechanism/injury location pair was maxillofacial/dental/neck injury by blunt assault with hand/fist (20.0% of all injuries). The most frequent mechanism/injury type pair was bruising by blunt assault with hand/fist (15.1% of all injuries). Blunt assault with hand/fist injury was positively associated with victim female sex (OR: 2.27, CI: [1.08 – 4.95]; p = 0.031), while blunt assault with object mechanisms was inversely associated with victim female sex (OR: 0.32, CI: [0.12 - 0.81]; p = 0.017).
Physical elder abuse victims are more commonly assaulted with an abuser's body part than an object, and the mechanisms and weapons used impact patterns of injury.
Detecting elder abuse in dermatology: A clinical and practical review
2023, Journal of the American Academy of Dermatology
The pace of aging in our population is dramatically increasing, raising concern for rising prevalence of elder abuse. Given the visual nature of the occupation, dermatologists can play a crucial role in identifying certain types of elder mistreatment, especially physical abuse, sexual abuse, and neglect. Nonetheless, many dermatologists report insufficient training in the diagnosis of elder abuse as well as appropriate interventions. This review article aims to synthesize and assess recent clinical, screening, and practical developments surrounding elder abuse. Implementation of some of these screening methods and recommendations in clinical practice and in dermatology residency curriculums could lead to increased awareness among physicians and improved patient outcomes. Like all other clinicians, dermatologists have a legal, moral, and ethical obligation to report suspicion of mistreatment and help suffering patients. Elder abuse is and will continue to be, an important issue that will require efforts from physicians across all fields to ensure the health and safety of patients.
Elder Abuse
2023, Radiologic Clinics of North America
Study of the characteristics of violence in people over the age of 65. Prospective study at the Medico-Judicial Units of Montpellier and Béziers
2022, Revue de Medecine Legale
La maltraitance des personnes âgées est un phénomène encore peu connu évoluant en parallèle de la dépendance. Des études dans le monde ont analysé différents types de violences et leur caractéristiques. En France, peu de données et d’études existent sur le sujet. Cette étude vise à améliorer la connaissance de la typologie de ces violences sur le plan national.
L’étude descriptive prospective s’est effectuée à partir de données recueillies aux UMJ de Montpellier et de Béziers. Était incluse toute personne âgée de 65 ans et plus s’étant présentée pour n’importe quel motif de violence. Le recueil des données a été réalisé lors de la consultation par le médecin légiste à l’aide d’un questionnaire reprenant les différentes caractéristiques des violences.
Il y avait 68 victimes dont 45 femmes et 23 hommes. L’âge moyen était de 73,8 ans [IC 95 % : 71,91–75,61 ans]. 97 % vivaient à domicile. La violence physique était la plus fréquemment rapportée (85,4 % des cas) suivie par la violence psychologique (39 %). Dans 88,3 % des cas, l’acte de violence était unique. L’agresseur était seul dans 73,1 % des cas et était inconnu de la victime dans 70,7 % des cas.
Cette étude comprend de multiples biais du fait de son faible échantillon et de la spécificité de sa population pouvant limiter sa puissance et induire une sous-évaluation des violences. Néanmoins, elle a permis d’étayer les caractéristiques des violences aux UMJ de Montpellier et de Béziers.
Elder abuse is a still little-known phenomenon that evolves in parallel with dependence. Many studies around the world have analyzed different types of violence and their characteristics. In France, few data and studies exist on the subject. This study aims to improve knowledge of the typology of this violence at the national level.
The prospective descriptive study was carried out using data collected at UMJ in Montpellier and Béziers. All persons 65 years of age and over were included and who had come for any reason for violence. The collection of data was done during the consultation by the medical examiner using a questionnaire containing the different characteristics of the violences.
There were 68 victims including 45 women and 23 men. The average age was 73.8 years [95% CI: 71.91–75.61 years]. 97% lived at home. Physical violence was the most frequently reported (85.4% of cases) followed by psychological abuse (39%). In 88.3% of the cases, the act of violence was unique. The perpetrator was alone in 73.1% of the cases and was unknown to the victim in 70.7% of the cases.
This study includes multiple biases due to its small sample and the specificity of its population, which can limit its power and induce an underestimation of violence. Nonetheless, it allowed to analyze the characteristics of the violence at UMJ.
Barriers to Help Seeking among Victims of Elder Abuse: A Scoping Review and Implications for Public Health Policy in Canada
2022, Canadian Journal on Aging

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View full text

SeminarElder abuse

Summary

Section snippets

Definition and occurrence

Pathophysiology and risk factors

Screening

Clinical manifestations and diagnosis

Course and treatment

Conclusion

Search strategy and selection criteria

Am J Med Sci

Leg Med (Tokyo)

Ann Emerg Med

Ann Emerg Med

Abuse of the Elderly

Missing voices: views of older person on elder abuse

The Toronto declaration on the global prevention of elder abuse

First National Study of Elder Abuse and Neglect: contrast with results from other studies

J Elder Abuse Neglect

The prevalence of elder abuse: a random sample survey

Gerontologist

National survey on abuse of the elderly in Canada

J Elder Abuse Negelct

Psychological distress in victims of elder abuse: the effects of social support and coping

J Gerontol Psychol Sci Soc Sci

Abuse of the elderly in Denmark and Sweden: results from a population study

J Elder Abuse Neglect

Risk factors for reported elder abuse and neglect: a nine-year observational cohort study

Gerontologist

Severe family violence and Alzheimer's disease: prevalence and risk factors

Gerontologist

Violence and violent feelings: what causes them among family givers?

J Gerontol

Financial exploitation of elders: analysis of risk factors based on county adult protective services data

J Elder Abuse Neglect

The high prevalence of depression and dementia in elder abuse or neglect

J Am Geriatr Soc

The clinical and medical forensics of elder abuse and neglect

Abuse of elderly people by their careers

BMJ

A prospective community-based pilot study of risk factors for the investigation of elder abuse

J Am Geriatr Soc

Elder abuse in people with dementia in Northern Ireland: prevalence and predictors in cases referred to a psychiatry of old age service

Int J Geriatr Psychiatry

Abuse is in the eye of the beholder

Scand J Soc Med

Causes of elder abuse: caregiver stress versus problem relatives

Am J Orthopsychiatry

Helping elderly victims: the reality of elder abuse

Risk factor characteristics in carers who physically abuse or neglect their elderly dependents

Aging Ment Health

Seminar
Elder abuse