Chapter 43: Elder Abuse

GENERAL CONSIDERATIONS

As hidden as the other forms of family violence may be, domestic elder abuse is even more concealed within our society. As the baby boomers age, the number of elders in the United States will continue to increase. The societal cost for the identification and treatment of elder abuse is also projected to rise as the baby boomers enter the elder years. Elder abuse is now recognized as a pervasive and growing problem. Vastly underreported, for every case of elder abuse and neglect that is reported to authorities, as many as five cases are not reported.

Many physicians feel ill-equipped to address this important social and medical problem. The most common reporters of abuse are family members (17%) and social services agency staff (11%). Physicians reported only 1.4% of the cases. Healthcare professionals consistently underestimate the prevalence of elder abuse. Concerns for patient safety and retaliation by the caregiver, violation of the physician-patient relationship, patient autonomy, confidentiality, and trust issues are quoted as reasons for low reporting. Studies have shown that healthcare professionals attest to viewing cases of suspected elder abuse but yet fail to report them. One study revealed that physicians report only 2% of all suspected cases.

Older victims who suffer from neglect or physical abuse are likely to seek care from their primary care physician or gain entry into the medical care system through an emergency department. Except for the older person’s caregivers, physicians may be the only ones to see an abused elderly patient.

A. Definition and Types of Abuse

Elder abuse encompasses all types of mistreatment and abusive behaviors toward older adults. The mistreatment can be either acts of commission (abuse) or acts of omission (neglect). The National Center on Elder Abuse (NCEA) describes seven different types of elder abuse: physical abuse, sexual abuse, emotional abuse, financial exploitation, neglect, abandonment, and self-neglect (Table 43-1). Self-neglect is defined as the behavior of an elderly person that threatens her/his own health and safety. Labeling a behavior as abusive, neglectful, or exploitative is difficult and can depend on the frequency, duration, intensity, severity, consequences, and cultural context. Currently, state laws define elder abuse and definitions vary considerably from one jurisdiction to another.