Elder maltreatment


Elder maltreatment is becoming an increased social problem gaining higher level of scrutiny. Medical programs have limited formal education on the recognition of the different forms of elder maltreatment. The natural changes of aging reflected in pathopysiology can make it difficult to distinguish physical changes of abuse from those of aging.

Elder maltreatment can be classified in six categories: physical abuse, sexual abuse, neglect, psychological abuse, financial and material exploitation and violation of rights. Clinician must be versed in normal pathopysiology of ageing so assessment findings will not be mistaken as trauma or neglect. The victims and perpetrators, scenarios, risk factors, common anatomic and clinical findings, the pathopysiology ageing and limitations of abuse need to be understood.

The American Medical Association defines elder maltreatment as an act or omission that results in harm or threatened harm to the halt health and welfare of an elderly person. The 2004 report of the National Center an Elder Abuse stated that 83 cases of abuse are reported for 1000 elder Americans. This paper will focus on physical abuse, sexual abuse and neglect.

It is important to have a knowledge base of typical victim and perpetrator characteristic to detect or prevent elder maltreatment. Common characteristics are:
• Age : >75 years old
• Dependency upon one person for ADL-IADL
• Lacks a social net work and has cognitive and physical impairment.
• Perpetrator: Transgeneration violence pattern in family. Perpetrator may be under period stress, substance abuser or have mental illness.

Physical abuse is an act carried with the intention of causing physical pain or injury. Physical abuse makes up 14% of all elder traumas. Clinicians must work to determine if assessment finding are a result of secondary or accidental trauma. Location of trauma in areas of body not commonly impacted during daily activities invite closer inspection. Such areas would be inner thigh, top or bottom of feet, inner wrists or ankle, abdomen, axilla or posterior neck. Areas that are likely non-accidental are also the eye, nose, and inner mouth. Injuries at different stages in healing would indicate repeated pattern of trauma. Imprint pattern of injury needs to be assessed for similar shape and size.

Hair loss from forehead and front temporal region is common in males and postmenopausal females. However, single or multiple patches of alopecia is a sign of traumatic alopecia. The scalp around the patch would show normal hair distribution. Scalp hemorrhage or a hematoma may be a result of hair being forcibly pulled out.

Anogentital injury or vaginal hematomas should be investigated. Elderly females are prone to vaginal injury due decreased estrogen, vaginal dryness and thinning of the vaginal wall.

A nurse doing an assessment of the integumentary system should be alert to these various patterns of symptoms. Forensic nurses would be trained to these signs and social interactions between patient and care givers. This group of nurses could serve to bridge this knowledge to other members of the medical team. The medical community should anticipate an increase in elder abuse with the escalating numbers of elders in the community.


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