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Key Features

  • Defined as "actions that cause harm or create a serious risk of harm to an older adult by a caregiver or other person who stands in a trust relationship to the older adult, or failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm"

  • Self neglect is the most common form of elder mistreatment and occurs among all demographic strata of the aging population

  • In the United States, according to the best available estimates,

    • About 14% of adults over age 70 experience some sort of abuse annually

      • About 12% experience psychological abuse

      • Almost 2% experience physical abuse

    • Each year, 5–7% of elders may be victims of financial abuse or scams

  • Laws in most states require health care providers to report suspected abuse or neglect to Adult Protective Services

    • Agencies are available in all 50 states to assist in cases of suspected elder abuse

    • The Web site for the National Center for Elder Abuse is https://www.elderabusecenter.org/

Clinical Findings

  • Clues to the possibility of elder abuse include

    • Behavioral changes in the presence of the caregiver

    • Delays between occurrence of injuries and when treatment was sought

    • Inconsistencies between an observed injury and associated explanation

    • Lack of appropriate clothing or hygiene

    • Not filling prescriptions

  • Many elders with cognitive impairment become targets of financial abuse

Diagnosis

  • It is helpful to observe and talk with every older person alone for at least part of a visit to ask questions directly about possible abuse and neglect, such as

    • "Has anyone hurt you?"

    • "Are you afraid of anybody?"

    • "Is anyone taking or using your money without your permission?"

  • When self neglect is suspected, it is critical to establish whether the patient has decision making capacity in order to determine what course of action needs to be taken

  • A patient who has full decision making capacity should be provided with help and support but can choose to live in conditions of self neglect, providing that the public is not endangered by the actions of the person

  • In contrast, a patient with self-neglect who lacks decision making capacity requires more aggressive intervention, which may include guardianship, in-home help, or placement in a supervised setting

  • Montreal Cognitive Assessment score may provide some insight into the patient's cognitive status but is not designed to assess decision making capacity

  • A standardized tool for determining decision making capacity, such as the "Aid to Capacity Evaluation," is easy to administer, has good performance characteristics, and is available free online at www.jointcentreforbioethics.ca/tools/ace_download.shtml

Treatment

  • Hospital admission is appropriate when a patient is unsafe in the community and an alternate plan cannot be put into place in a timely manner

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