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Elder abuse and neglect is a growing problem in the U.S. Up to 2 million Americans are victims of some form of elder mistreatment annually.1 Between 3% and 5% of all elders are likely to have experienced abuse at some time during their senior years.2 These estimates may be lower than the true prevalence of elder abuse, because they are based only on cases reported to the authorities. Reports of abuse have increased over time3 and may reflect an increase in the prevalence of abuse as well as greater awareness of the problem by health care providers. The prevalence of elder abuse may be rising for a variety of reasons, including an increase in the proportion of older adults in the total population, an increase in the incidence of chronic disabling diseases leading to dependency, and increasing involvement of families in caregiving relationships. These trends are likely to continue into the foreseeable future.

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In spite of a rise in the number of cases reported, elder mistreatment continues to be both underrecognized and underreported by health care workers. It is estimated that only 1 in 14 cases of elder abuse or neglect comes to the attention of the authorities.4 Several factors may account for poor recognition and reporting of elder abuse in health care settings. Health care providers often do not recognize signs and symptoms of abuse. Providers may not be familiar with laws and definitions governing elder mistreatment. Physicians may lack an understanding of reporting mechanisms.5 Even when abuse is suspected, it may be difficult to secure confirmation from the patient. Although patients may be relieved by the physician’s concern, embarrassment, fear of abandonment, fear of retaliation, and fear of nursing home placement can prompt patients to deny abuse.

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Elder abuse can result in a variety of problems for the patient. Elders experiencing abuse have a higher risk of death than elders not experiencing abuse.6 The risk of death for abused elders and neglect is three times higher than for elderly who are not abused.7 Elder abuse is also associated with other adverse life events, such as depression and nursing home placement.8 In addition to the ethical problems associated with elder abuse, mistreatment of the elderly is costly to the health care system. As of 2004, the direct medical costs of violent injuries to the elderly were estimated at $5.3 billion.9

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Definitions

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Elder abuse is an act or omission resulting in harm to the health or welfare of an elderly person. Three key groups have published definitions of elder abuse.10–12 The 1985 Elder Abuse Prevention, Identification and Treatment Act defines abuse as the “willful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish or the willful deprivation by a caretaker of goods or services which are necessary to avoid physical harm, mental anguish or mental ...

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