The physical, financial, or psychological mistreatment or neglect of elderly individuals is called

Prevalence

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In the U.S., about 10% of those 60 yr of age or older have been abused.

Emotional followed by financial abuse are the most common forms.

12-mo U.S. prevalence rates: Emotional abuse 9.0% and 4.6%; financial abuse 3.5% and 5.2%; physical abuse 0.2% and 1.6%; sexual abuse 0.6%; neglect 0.5%.

Elder abuse is underreported overall, with estimates of only 1 in 14 to 1 in 24 cases of abuse reported.

Family members reported 21% of nursing home residents were neglected on one or more occasion in the past 12 mo, and over 24% had been subjected to physical abuse during their entire stay.

In long-term care facilities, abuse of older residents by other residents is more common than abuse by staff members.

Perpetrators of elder abuse are family members of the victim in 60% of cases.

Among caregivers of patients with dementia in the U.K., one half reported behaving abusively at least some of the time, and one third reported “important” levels of abuse. Verbal abuse was common and physical abuse was rare.

Elder abuse is associated with increased risk of mortality, with the highest risk associated with caregiver neglect, functional impairment, and greater emotional distress, including depression, anxiety, and posttraumatic stress.

Elder abuse is also associated with increased risk of hospitalization, long-term care placement, and suicidal ideation.

Abused elders are less likely to have regular medical follow-up and more likely to present to the ED than nonabused older adults. Adult intimate partner violence perpetrators are significantly more likely to have witnessed intimate partner violence as a child than nonperpetrators.

Older women are more likely than older men to be victims of abuse.

Introduction

Elder abuse is a serious but preventable public health threat for many persons in later life (Summers and Hoffman, 2006). Since first identified more than 30 years ago as a social problem, elder abuse, like other forms of family or interpersonal violence, has become recognized as a universal phenomenon that cuts across cultural and socioeconomic lines. The mistreatment of older people is a complex issue with moral, sociocultural, political, and personal ramifications that often crosses health care, legal, human rights, and ethical domains within society's major institutions. The level of research as well as public and professional understanding about the issue still lags 20 or more years behind other types of interpersonal or family violence.

The emerging concept of elder abuse is markedly influenced by the rapidity of socioeconomic change, weakening of the extended family, the growth in the numbers of elderly populations and growing concern for human rights, equality, and justice. Dramatic demographic changes all over the globe have meant many more people successfully live to old age, which in itself is an important societal achievement (WHO, n.d.). However, the same trend may result in more older people being at risk of abuse or neglect if social conditions fail to meet their needs. Today, concern about elder abuse has driven a worldwide effort to increase awareness of the problem and encourage development of appropriate prevention and assistance programs. These efforts are predicated on the belief that elders are entitled to live out their advancing years in peace, dignity, good health, and security.

Identifying Elder Abuse and Neglect in the Emergency Department

The ED visit is an important and often underutilized opportunity to identify elder abuse or neglect, which may otherwise remain undiscovered. For many older adults, assessment by health care providers is their only contact outside the family. Emergency clinicians, therefore, have a unique opportunity to diagnose and report suspected elder abuse and initiate further evaluation by elder abuse teams and adult protective services (APS). Emergency clinicians, who typically manage acute injuries and illnesses, are particularly well-positioned to identify abuse. Despite this, only 1.4% of cases reported to APS come from emergency clinicians, and, in a survey of APS workers, of 17 occupational groups, physicians were among the least helpful in reporting abuse. Several reasons exist for this missed opportunity, including lack of awareness, inadequate training, insufficient information about available resources, lack of time to conduct a thorough evaluation for abuse, misinterpretation of the sequelae of elder abuse or neglect as the result of accidental injury or illness, concern about involvement in the legal system, and desire to protect clinician-patient confidentiality. Despite these challenges, it is critical that emergency clinicians explore the potential for elder abuse and neglect when assessing older adult patients.

1 Introduction

Risk Factors for Elder Abuse

Because of increased opportunities for contact and thus for conflict and tension, a shared living arrangement is a major risk factor for elder abuse23. Abuse also occurs in residential and nursing care facilities, and nearly one-third of such facilities have been cited for an abuse violation24. Elderly individuals living alone are more likely to be victims of financial abuse, but they are at lower risk for other forms of abuse25. Physical abuse is reported to occur more frequently in elders with dementia, especially those with a history of aggressive behavior. Social isolation has also been identified as a risk factor, with victims more likely to be isolated from friends and family other than the person with whom they are living than are non-victims21. Pathologic characteristics of perpetrators of elder abuse include mental illness, particularly depression, and alcohol abuse. Additionally, people who abuse elders may actually be dependent (e.g. financially) on the person they are abusing. In some cases, abuse stems from attempts by relatives (particularly adult offspring) to obtain the victim's resources26,27.

Institutions

Although most elder abuse occurs outside of institutions, this setting remains one of concern for families and the elders themselves. Within an institution, any of the aforementioned types of abuse may occur. The elder resident of an institution is usually vulnerable, mentally and/or physically frail, and isolated. In too many cases, the family rarely visits, adding to the isolation of the elder. The perpetrator in cases of institutional abuse may be a resident or a visitor, but is usually a worker. The typical worker perpetrator is young, less educated, and in an institution with a high employee turnover. The isolation and inability of the elder victim to report the abuse prevents discovery as does the fact that very few institutionalized elder deaths are investigated. In one study, <1% of these deaths were autopsied.

Elder abuse knows no boundaries – older adults of all ages, genders, races, incomes, and cultures experience abuse. In the United States, at least 1 in 10 adults aged 60 and older living in their own homes experiences abuse, neglect, or exploitation annually. The risk for abuse increases among vulnerable community-dwelling older adults, including individuals who have physical or cognitive impairments or persons who are socially isolated and alone. Some of the harm to victims of elder abuse is obvious, such as physical injuries or the loss of money and valued possessions. Not as immediately evident are the less tangible consequences of elder abuse. Long-term outcomes may include emotional or psychological distress, new or exacerbated health problems and hospitalizations, premature institutionalization, and a hastened death. Community-level initiatives to prevent and address elder abuse vary considerably across the United States. Promising programs often incorporate multidisciplinary response teams, inter-agency collaboration, and comprehensive, coordinated community education efforts. Although many legislation and policy initiatives have addressed elder abuse at the state and national level, the Elder Justice Act in 2010 (Public Law 111-148) is considered the most comprehensive federal bill ever passed to combat elder abuse.

Publisher Summary

Elder abuse is a significant public health problem estimated to affect up to 10% of Americans aged 65 years or older. Any professional who works with older adults needs to be aware of the current state of assessment and intervention research in order to help combat the problem. This chapter introduces the topic of elder abuse from legal, regulatory, and funding perspectives in order to provide a common foundation of knowledge to a diversity of professionals representing social services, psychology, medicine, and law. It provides standardized definitions of elder abuse and related terms in order to help establish a common language across disciplines for both clinicians and researchers. In reviewing the epidemiology of elder abuse and outlining the full scope of the problem, it discusses the importance of establishing more rigorous research methods that will inform future policy development and federal initiatives. It incorporates case studies to exemplify common clinical scenarios and reviews current screening tools and assessment methods. It explores special issues and ethical dilemmas encountered by practitioners working in the field.

32 What are forms of mistreatment of older adults?

Elder abuse and neglect is unfortunately common, with 500,000 reports to authorities and many more unreported. Types of elder abuse include abandonment, physical abuse, financial exploitation, neglect, and psychologic abuse. Diagnosis hinges on a high degree of suspicion and monitoring interaction between a senior and their caregiver.

Key Points: Frailty

The geriatric population is physiologically different than adults, and additional preoperative assessment for frailty should be performed.

Frailty is a term used to describe physiologic vulnerability in older adults. Quantifying frailty assists with optimizing perioperative outcomes.

Delirium is the most common postoperative complication in the elderly population. Delirium prevention protocols are essential for older adults in the postoperative setting.

Websites

http://www.americangeriatrics.org/

http://www.facs.org/∼/media/files/quality%20programs/geriatric/acs%20nsqip%20geriatric%202016%20guidelines.ashx

https://www.facs.org/quality-programs/acs-nsqip/geriatric-periop-guideline

Introduction

Elder abuse, also called mistreatment or maltreatment, is harmful behavior directed toward older persons by informal or formal caregivers who the older person loves or trusts, or on whom they depend for assistance. The destructive behavior can cause physical, psychological, or material injury to the older person, resulting in unnecessary distress, suffering, and sometimes death. Historically, there has been no generally accepted definition of elder abuse, but there is a growing international consensus about the types of actions to be included in the definition. There are usually five agreed-upon categories of abuse, with some disagreement about whether self-neglect and abandonment are forms of elder abuse. Physical abuse includes any act that involves the intentional infliction of physical discomfort, pain, or injury. Examples of physical abuse include such behaviors as restraining, slapping, kicking, cutting, or burning. Medical maltreatment is sometimes considered an example of physical abuse. Sexual abuse or assault covers any kind of nonconsensual sexual contact with an older person, such as unwanted touching, all types of sexual battery, such as rape, or coerced nudity. Psychological abuse, sometimes referred to as verbal or emotional abuse, involves the intentional infliction of mental anguish or the provocation of fear of violence or isolation in the older person. Psychological abuse can take various forms, such as name-calling, humiliation, intimidation, or threats of placement in a nursing home. Material abuse, often referred to as financial abuse, involves the intentional, illegal, or improper exploitation of the older person's material property or financial resources by the abuser. Material abuse can include fraud, theft, or use of money or property without the older person's consent. Neglect generally refers to the intended or unintended failure of a formal or informal caregiver to fulfill any part of a caregiving obligation. Examples include failure to provide an older person with the necessities of life such as food, water, clothing, shelter, medicine, or comfort. Acts such as theft, physical assault, rape, or burglary by a person outside of a trusting relationship with the older person usually would not be classified as elder abuse, but rather as crimes. Crimes against the elderly include some, but not all, forms of elder abuse.

These categories of abuse have been strongly influenced by research in Canada, the United Kingdom, Europe, and the United States. Studies conducted in other countries such as China, India, and South Africa have used different definitions that reflect the values within their societies. In China, where harmony and respect are core societal values, neglecting the care of an older person is considered elder abuse. In one of the first attempts to classify abuse in a developing country, focus groups held in South Africa added to western definitions such categories as accusations of witchcraft, loss of respect for elders, and abuse by systems such as health clinics and pension offices.

The abuse of older people by family members did not come to light until after child and wife abuse had entered the public domain in the mid-1960s. Elder abuse was first described as late as 1975 in British scientific journals as ‘granny battering’ but rapidly came to be regarded a significant social problem in developed countries in the 1980s. With the realization of the dramatic increases in the aging populations in developing countries in the 1990s, elder abuse became a global issue. This article reviews the extent of elder abuse in domestic and institutional settings, the risk factors for mistreatment, the theoretical frameworks used to explain abuse, and global responses to the problem.