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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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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 ...