eMedicine Specialties > Emergency Medicine > Psychosocial

Elder Abuse: Differential Diagnoses & Workup

Author: Monique I Sellas, MD, Staff Physician, Department of Emergency Medicine, Massachusetts General Hospital; Clinical Instructor, Harvard Medical School
Coauthor(s): Laurel H Krouse, MD, Staff Physician, Department of Emergency Medicine, Paoli Hospital
Contributor Information and Disclosures

Updated: Apr 20, 2009

Differential Diagnoses

Abdominal Trauma, Blunt
Domestic Violence
Alcohol and Substance Abuse Evaluation
Epidural Hematoma
Bites, Human
Sexual Assault
Burns, Thermal
Subdural Hematoma
Depression and Suicide

Other Problems to Be Considered

Apathy
Dehydration
Falls
Gait disturbances
Pathologic fractures

Workup

Laboratory Studies

  • Evaluate for evidence of infection, dehydration, electrolyte abnormalities, malnutrition, improper medication administration, and substance abuse in patients who have been abused.
    • CBC
    • Chem-7
    • Urinalysis
    • Calcium, magnesium, phosphorus
    • Serum levels of relevant medications
    • Urine drug screen
    • Ethanol level

Imaging Studies

  • X-rays of relevant body parts - To detect fractures (unusual or pathologic)
  • Head CT scan - To detect intracranial bleeding as a result of abuse or to detect a possible explanation for injuries (hydrocephalus causing ataxia leading to falls) or altered mental status

Procedures

  • Pelvic examination with forensic evidence collection in cases of sexual assault

More on Elder Abuse

Overview: Elder Abuse
Differential Diagnoses & Workup: Elder Abuse
Treatment & Medication: Elder Abuse
Follow-up: Elder Abuse
References
Further Reading

References

  1. U.S. Population Projections. U.S. Census Bureau: Population Division; August 2008. [Full Text].

  2. National Center on Elder Abuse. Types of abuse. Updated September 28, 2007. Available at http://www.ncea.aoa.gov/NCEAroot/Main_Site/FAQ/Basics/Types_Of_Abuse.aspx. Accessed April 20, 2009.

  3. Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. Washington, DC: National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect; 2003.

  4. American Medical Association. Diagnostic treatment guidelines on elder abuse and neglect. Chicago, IL: American Medical Association; 1992:4-37.

  5. Heath JM, Kobylarz FA, Brown M, Castano S. Interventions from home-based geriatric assessments of adult protective service clients suffering elder mistreatment. J Am Geriatr Soc. Sep 2005;53(9):1538-42. [Medline].

  6. Allison EJ, Ellis PC, Wilson SE. Elder abuse and neglect: the emergency medicine perspective. Eur J Emerg Med. Sep 1998;5(3):355-63. [Medline].

  7. American College of Emergency Physicians. Management of elder abuse and neglect. Policy statement. Ann Emerg Med. Jan 1998;31(1):149-150. [Medline].

  8. Birrer R, Singh U, Kumar DN. Disability and dementia in the emergency department. Emerg Med Clin North Am. May 1999;17(2):505-17, xiii. [Medline].

  9. Carney MT, Kahan FS, Paris BE BE. Elder abuse: is every bruise a sign of abuse?. Mt Sinai J Med. Mar 2003;70(2):69-74. [Medline].

  10. Ciccarello MJ. Recent legal trends affecting your older patients. Clin Obstet Gynecol. Sep 2007;50(3):790-9. [Medline].

  11. Clarke ME, Pierson W. Management of elder abuse in the emergency department. Emerg Med Clin North Am. Aug 1999;17(3):631-44, vi. [Medline].

  12. Dyer CB, Heisler CJ, Hill CA, Kim LC. Community approaches to elder abuse. Clin Geriatr Med. May 2005;21(2):429-47. [Medline].

  13. Fulmer T, Guadagno L, Bitondo Dyer C, Connolly MT. Progress in elder abuse screening and assessment instruments. J Am Geriatr Soc. Feb 2004;52(2):297-304. [Medline].

  14. Jogerst GJ, Daly JM, Brinig MF. Domestic elder abuse and the law. Am J Public Health. Dec 2003;93(12):2131-6. [Medline].

  15. Jones JS, Holstege C, Holstege H. Elder abuse and neglect: understanding the causes and potential risk factors. Am J Emerg Med. 1997;15(6):579-583. [Medline].

  16. Jones JS, Veenstra TR, Seamon JP, Krohmer J. Elder mistreatment: national survey of emergency physicians. Ann Emerg Med. 1997;30(4):473-479. [Medline].

  17. Kahan FS, Paris BE BE. Why elder abuse continues to elude the health care system. Mt Sinai J Med. Jan 2003;70(1):62-8. [Medline].

  18. Kennedy RD. Elder abuse and neglect: the experience, knowledge, and attitudes of primary care physicians. Fam Med. Jul-Aug 2005;37(7):481-5. [Medline].

  19. Kleinschmidt KC. Elder abuse: a review. Ann Emerg Med. Oct 1997;30(4):463-72. [Medline].

  20. Koenig RJ, DeGuerre CR. The legal and governmental response to domestic elder abuse. Clin Geriatr Med. May 2005;21(2):383-98. [Medline].

  21. Kruger RM, Moon CH. Can you spot the signs of elder mistreatment?. Postgrad Med. Aug 1999;106(2):169-73, 177-8, 183. [Medline].

  22. Lachs MS, Pillemer K. Abuse and neglect of elderly persons. N Engl J Med. Feb 16 1995;332(7):437-43. [Medline].

  23. Lachs MS, Pillemer K. Elder abuse. Lancet. Oct 2-8 2004;364(9441):1263-72. [Medline].

  24. Lachs MS, Williams CS, O'Brien S, et al. ED use by older victims of family violence. Ann Emerg Med. 1997;30(4):448-454. [Medline].

  25. McDonald AJ, Abrahams ST. Social emergencies in the elderly. Emerg Med Clin North Am. May 1990;8(2):443-59. [Medline].

  26. Nelson HD, Nygren P, McInerney Y, Klein J. Screening women and elderly adults for family and intimate partner violence: a review of the evidence for the U. S. Preventive Services Task Force. Ann Intern Med. Mar 2 2004;140(5):387-96. [Medline].

  27. Paris BE, Meier DE, Goldstein T, et al. Elder abuse and neglect: how to recognize warning signs and intervene. Geriatrics. Apr 1995;50(4):47-51. [Medline].

  28. Profiles of General Demographic Characteristics. 2000 Census of Population and Housing: United States. U.S. Census Bureau: Population Division; May 2001. [Full Text].

  29. Quinn K, Zielke H. Elder abuse, neglect, and exploitation: policy issues. Clin Geriatr Med. May 2005;21(2):449-57. [Medline].

  30. Rosenblatt DE, Cho K, Durance PW. Reporting mistreatment of older adults: the role of physicians. J Am Geriatr Soc. 1996;44:65-70. [Medline].

  31. Swagerty DL, Takayashi PY. Elder mistreatment. American Family Physician. 1999;59(10).

  32. Tintinalli JE, Ruiz E, Krome RL. Emergency Medicine: A Comprehensive Study Guide. McGraw Hill Text; 1996:1377-78.

Further Reading

Clinical guidelines

Elder abuse prevention. Daly JM. Elder abuse prevention. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2004 Dec. 68 p

Keywords

elder mistreatment, elder abuse, elderly abuse, domestic violence, abusive relationship, elder neglect, self-neglect in elderly persons, elder abuse prevention

Contributor Information and Disclosures

Author

Monique I Sellas, MD, Staff Physician, Department of Emergency Medicine, Massachusetts General Hospital; Clinical Instructor, Harvard Medical School
Monique I Sellas, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Laurel H Krouse, MD, Staff Physician, Department of Emergency Medicine, Paoli Hospital
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert Harwood, MD, MPH, FACEP, FAAEM, Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine
Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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