General Principles in Older Adults
Elder mistreatment is a common yet underappreciated health issue affecting an increasing number of older adults each year.
Elder mistreatment can have a detrimental impact on victims’ health and well-being and add significant costs to the health care system. Yet barriers to reporting incidences of elder mistreatment are significant. Patients may be unable to report because of cognitive impairment or social isolation. They may feel afraid, embarrassed, or ashamed, and perhaps worry about the repercussions of reporting (ie, retribution from those who are mistreating them, including caregivers or nursing home staff). Health care providers may have concerns about making the situation worse with reporting or intervention, may lack training in recognizing mistreatment, may be uncomfortable confronting the possible abuser, may be afraid of retaliation against the victim, or may not want to be involved in the legal system. That caregivers and family members are themselves most likely to be responsible for mistreatment in the community is a further challenge. As a result, it is estimated that as many as 4 of 5 cases of elder mistreatment remain unreported. By identifying instances of potential elder mistreatment, health care professionals play an important role for victims whose physical and mental health is at risk. The importance of this role is underscored by studies showing that elder mistreatment victims experience a significant increase in mortality. One large longitudinal study found that 9% of victims of elder mistreatment were alive after 13-year follow-up compared to 41% who had not experienced abuse and that victims of elder mistreatment were 3 times more likely to die during one 3-year period. Elder mistreatment victims are also at higher risk for other adverse outcomes including nursing home placement and depression.
According to the National Elder Abuse Incidence Study, 510,000 adults age 60 years and older experience some form of mistreatment each year. Only 21% of cases were reported to and verified by adult protective services (APS) agencies. A growing number of cases are occurring in nursing homes and other long-term care facilities, where some form of abuse is one of the most common complaints among residents. Abuse commonly reported in nursing homes includes physical abuse, neglect, sexual abuse, and financial abuse or misappropriation of property. State long-term care ombudsman programs are now federally mandated to report events of elder mistreatment that occur in institutions, though the majority of complaints to the state programs are filed by residents, family, and others. There were approximately 269,000 complaints of elder mistreatment in long-term care facilities reported to the National Ombudsman Reporting System in 2008, a number that is likely to grow as the population in nursing homes expands to meet the needs of our aging society.
Defining Elder Mistreatment
There are various definitions of elder mistreatment. The American Medical Association describes elder mistreatment as an act ...