Because the elderly use emergency services more frequently than younger Americans, emergency physicians are in a unique position to detect and intervene in cases of elder abuse.

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ACEP Now: Vol 33 – No 12 – December 2014

The Case

A 75-year-old female presents to the emergency department with a chief complaint of altered mental status. You recognize her because her daughter (her full-time caregiver) frequently brings her to the ED for back pain. She has gotten multiple prescriptions for opioids but always seems to be out of her medications. Today, the patient is lethargic, and her daughter states that yesterday morning was the last time she saw the patient normal. Physical exam reveals the injury shown in Figure 1.

Elder Mistreatment

The U.S. population is aging. The 2010 US census recorded 40.3 million people age 65 and older, or 13 percent of the population.¹ It is estimated that by 2020 more than 52 million Americans will fall into this age group.² As America ages, the impact of elder mistreatment will continue to grow.

Although it is difficult to estimate the incidence of elder mistreatment, recent studies found an incidence of 7.6–10 percent among study participants.^3,4 Because the elderly use emergency services more frequently than younger Americans, emergency physicians are in a unique position to detect and intervene in cases of elder abuse.

The National Center on Elder Abuse (NCEA) defines seven types of elder abuse:⁵

1. Physical abuse: Use of physical force that may result in bodily injury, physical pain, or impairment.
2. Sexual abuse: Nonconsensual sexual contact of any kind with an elderly person.
3. Emotional abuse: Infliction of anguish, pain, or distress through verbal or nonverbal acts. May also include failure to provide social stimulation.
4. Financial/material exploitation: Illegal or improper use of an elder’s funds, property, or assets.
5. Neglect: The refusal or failure to fulfill any part of a person’s obligations or duties to an elderly person.
6. Abandonment: The desertion of an elderly person by an individual who has physical custody of the elder or by a person who has assumed responsibility for providing care to the elder.
7. 7. Self-neglect: Behaviors of an elderly person that threaten the elder’s health or safety.

Elders who experienced abuse have a 300 percent higher risk of death compared to nonabused elders.⁶ It has been estimated that the direct medical cost associated with violent injuries to older adults is more than $5.3 billion.⁷ Because victims of elder mistreatment rarely self-report, health care providers must maintain a high index of suspicion.