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For further information, see CMDT Part 4-04: Management of Common Geriatric Problems

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

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