eMedicine Specialties > Emergency Medicine > Psychosocial

Elder Abuse: Follow-up

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

Follow-up

Further Outpatient Care

  • Long-term assessment and care vary with the needs of the patient. Assessment usually involves a visit to the home to evaluate the patient's functional status, living environment, and the condition of the caregiver. The services needed to optimize the care of the patient can be determined only after a home visit.
    • In a descriptive study of in-home geriatric assessment in two New Jersey counties, it was discovered that this assessment was able to contribute at least one relevant intervention for 81% of referred adult protective services (APS) clients to collaboratively help mitigate elder mistreatment circumstances.5 This underscores the importance of referral to the appropriate services and agencies.
  • Stress to competent patients who refuse help that abuse rarely resolves—it usually escalates. Inform patients that a number of agencies can provide help; provide phone numbers and addresses of these agencies. Develop safety and follow-up plans before the patient leaves the ED.

Patient Education

National Committee for the Prevention of Elder Abuse

National Adult Protective Services Association

The National Center for Victims of Crime

National Center on Elder Abuse

U.S. Administration on Aging - Eldercare Locator 
1-800-677-1116

Miscellaneous

Medicolegal Pitfalls

  • No federal statute is specifically dedicated to preventing the mistreatment of elderly persons similar to those targeted at child abuse and domestic violence. Currently, elder abuse is defined by state laws, but state definitions vary considerably from one jurisdiction to another. They contain multiple sections regarding who is protected, who must report, definitions of reportable behavior, requirements for investigation of reports, penalties, and guardianship.
  • Mandatory reporting laws for healthcare providers exist in all 50 states and the District of Columbia for confirmed cases of elder abuse and 43 states mandate reporting of suspected cases. Cases of suspected elder abuse should be reported to Adult Protective Services.
  • Thirty states have penalties for failing to report suspected elder abuse, and some states require that licensed professionals who have not fulfilled their obligations to report elder abuse can be reported to the appropriate licensing authority.
  • Every state has at least one statute providing immunity from civil or criminal liability to anyone who makes a report of abuse in good faith.
  • Physicians must educate themselves concerning the laws, legislation, and channels for reporting abuse in their province.
  • Mandatory reporting of elder abuse in competent patients is a controversial topic.
    • Many feel that mandatory reporting of abuse of mentally competent victims of elder abuse disempowers the abused individual.
    • The laws created for elder abuse were based upon child abuse laws; therefore, the inability of patients to make decisions in their own best interests was presumed. The laws are weak on matters such as financial abuse, since children generally have no money to exploit.
  • Nonetheless, while the state laws are not perfect, a diagnosis of elder abuse is reportable.

Special Concerns

  • Barriers to recognizing and reporting elder abuse also must be addressed. The lack of uniform definitions has been a major obstacle. Conceptual problems in defining elder abuse have hampered clinical, educational, and research efforts.
  • Various factors serve as barriers to reporting elder abuse. These include lack of knowledge, denial, ageism, fear of making the situation worse, desire to maintain family relationships, fear of ending up in court, or lack of belief that the situation will improve. The key to eradicating these barriers is education that increases both public and professional awareness.
  • Increasing awareness is considered instrumental in the prevention of elder abuse. Services for seniors, such as meals on wheels, home health care, homemaker, and chore services, are thought to aid in abuse prevention, although preventing elder abuse needs further study.
 


More on Elder Abuse

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

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.

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.