Elder Mistreatment & Self Neglect

Key Features

• Elder abuse is defined as "acts whereby a trusted person causes or creates risk of harm to an older adult"

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

• In the United States, about 10% of adults over age 60 have experienced some sort of abuse or neglect in the previous year

• Financial abuse is on the rise, and older adults with cognitive impairment are particularly vulnerable

• Each year, at least 5% of elders are victims of financial abuse or scams

• Elder abuse and self-neglect can cause many health consequences including long-term care placement, anxiety, depression, and death

Clinical Findings

• Clues to the possibility of elder mistreatment include

  • Behavioral changes in the presence of the caregiver

  • Delays between occurrence of injuries and treatment seeking

  • Inconsistencies between an observed injury and its associated explanation

  • Lack of appropriate clothing or hygiene

  • Not filling prescriptions

• Many elders with cognitive impairment become targets of financial abuse

Diagnosis

• When self-neglect is suspected, it is critical to establish whether a patient has decision-making capacity regarding the suspected neglectful behavior

• Cognitive assessment may provide some insight into contributing cognitive impairment, but these tools are not designed to assess decision-making capacity

• A standardized tool, such as the "Aid to Capacity Evaluation," is easy to administer, has good performance characteristics for determining decision-making capacity, and is available free online at http://www.jcb.utoronto.ca/tools/documents/ace.pdf

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