Elder Abuse

One of the most under-diagnosed and under-reported problems in our society today is Elder Abuse. In fact, it is such an under-identified social crisis that national statistics for incidence doesn’t even exist nor does a uniform reporting system to record occurrences. Estimates suggest that approximately 2 million Americans who are 65 years and older have been the victims of Elder Abuse.

Since health care and legal professionals are often not witnesses to this type of abuse, it is often difficult to determine these cases from physiological and psychological changes that normally occur in aging. Markers that can be used to determine if abuse has occurred are: abrasions, lacerations, bruising, fractures, restraints, skin breakdown, weight loss, dehydration, burns, cognitive and mental health problems, hygiene issues, and sexual abuse.

Signs of physical abuse are bruises, abrasions, lacerations and fractures. Bruises occur more frequently and heal more slowly than in younger persons, sometimes up to a month. Falls are a common occurrence in and often resulting in bruising in the elderly. However, identification of a fall as a cause to bruising deserves further investigation. It is important to note that abusive or neglectful caregivers have successfully attributed abuse that was intentional to accidental falls.

Abrasions sometimes occur if the elder abuse victim is pulled or dragged across a surface. Abrasions have been noted to retain the pattern of the causative agent better than any other form of injury. Careful documentation is imperative in being able to determine the mode of injury.

Bone fractures in the elderly can occur more often because their bones are thinner and less dense. Fractures that more often are indicative of abuse are those of the head, spine, and trunk. Bone fractures with a rotational component and spiral fractures of a large bone should also raise suspicion and bring about investigation into other collaborating signs of abuse. Rib and thoracic cage fractures may occur when force is exerted to the chest wall if a victim is forced to the floor.

Elder neglect, again often under-reported and under-diagnosed, is most often defined as the failure of a designated caregiver to meet the needs of the dependent elderly person. A common physical manifestation of neglect is dehydration. Dehydration again is common in the elderly because their thirst drives are due to medications they may be taking. However, it is prudent that the health care practioner performs an assessment and identifies the true cause of dehydration. Other signs of neglect can be malnutrition, choking or aspiration of food, overdosing or withholding of medication and deep wound breakdown in multiple sites. One study found that 40% of burn cases in patients over 60 were due to abuse and neglect, and 36% of the cases were due to negligence.

Elderly rape victims are often a neglected group because even the most experienced and skilled clinicians may feel emotionally uncomfortable raising sensitive questions, and may be even uninformed about the incidence of elderly rape or feel powerless to intervene on those occasions where sexual abuse is suspected. Bruising to the inner thighs is a common finding in sexual assault victims. Clinicians should also be alert to elders who have a difficult time sitting, walking, newly diagnosed sexually transmitted disease or bruising of the palate. Behavioral changes may also be noted and include; withdrawal, fear, depression, anger, insomnia or aggressive behavior.

Clinicians who frequently work with the elderly should be aware of the many forensic biomarkers that may indicate abuse or neglect. Thorough exams that include patient interviews are imperative to properly advocate for the elder patient. Identifying abuse in this population can be extremely difficult because so many of the signs of abuse mimic other aging/disease processes. However, this population deserves a voice. While it may be difficult to screen and identify, it is imperative that it is done to prevent the victims from becoming victimized all over again.

Medical Jurisprudence is committed to assisting in those cases that seek to help those populations that are often underrepresented. If this is an area that you practice in, call us today to receive even more insight on how our legal nurse consulting services can further your ability to advocate for this population.

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Reference Used:
Pearsall, Catherine. Forensic Biomarkers of Elder Abuse: What Clinicians Need to Know. Journal of Forensic Nursing. 2005;1(4):182-186. Retrieved August 2006 from www.medscape.com/viewarticle/521362

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