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As hidden as the other forms of family violence may be, domestic elder abuse is even more concealed within our society. Elder abuse was first described in the literature in 1975, when the first reports of "granny battering" appeared. Vastly underreported, only one in four domestic elder abuse incidents (excluding the incidents of self-neglect) come to the attention of authorities.

The most common reporters of abuse are family members (17%) and social services agency staff (11%). Physicians reported only 1.4% of the cases. Although physicians are mandatory reporters in all states, many physicians feel ill-equipped to address this important social and medical problem. Health care 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. A recent survey indicates that more than one-third of health care professionals had detected cases of elder abuse in the past year.

Family physicians are particularly well positioned to assist in identifying and managing elder abuse. Family medicine residencies focus on training residents regarding elder abuse more comprehensively than other primary care programs. Except for the primary caregivers, they may be the only ones to see an abused elderly patient. Older victims who suffer from neglect, self-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.

In the 2000 census, 35 million people in the United States were 65 years of age and older. Adults 85 years and older showed the highest percentage increase of any age group (38%), from 3.1 million to 4.2 million. 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.

Cooper C, Selwood A, Livingston G. Knowledge detection and reporting of abuse by health and social care professionals: A systematic review. Am J Geriatr Psychiatry 2009;17(10):826-838.  [PubMed: 19916205]
Feldhaus KM: Physician's knowledge of and attitudes toward a domestic violence mandatory reporting law. Ann Emerg Med 2003;41:159.  [PubMed: 12526132]
Lachs MS, Pillemer K: Elder abuse. Lancet 2004;364:1263.  [PubMed: 15464188]
Wagenaar DB, Rosenbaum R, Herman S, Page G. Elder abuse education in primary care residency programs: A cluster group analysis. Fam Med 2009;41(7):481-486.  [PubMed: 19582632]

Definition and Types of Abuse

Elder abuse is an all-inclusive term that describes all types of mistreatment and abusive behaviors toward older adults. The mistreatment can be either acts of commission (abuse) or acts of omission (neglect). Labeling a behavior as abusive, neglectful, or exploitative can depend on the frequency, duration, intensity, severity, consequences, and cultural context. Currently, state ...

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