eMedicine Specialties > Emergency Medicine > Psychosocial

Elder Abuse: Treatment & Medication

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

Treatment

Emergency Department Care

Medical visits are often the only times victims leave their homes or are allowed out by the abuser. Because older adults do not usually self-report instances of elder abuse, the responsibility for identification, reporting, and intervention rests largely with healthcare professionals, social service agencies, and police departments.

Many factors are involved in the management of older persons who have been abused, including immediate care, long-term assessment and care, education, and prevention.

Elder abuse and neglect are not problems that can be assessed quickly. Intervention can be a lengthy process, especially in a busy ED. Due to the wide variations of types of abuse, interventions vary from simple social service referral to the extreme of removing the patient from the home. The clinician's highest priority in suspected abuse cases is in balancing the safety versus the autonomy of the patient. The ultimate goal is to provide the aging adult with a more fulfilling and enjoyable life.

Once it is suspected, elder mistreatment should be reported to adult protective services. However, most healthcare professionals feel unprepared to fulfill this role, lacking guidance on how to proceed. Most hospitals have no protocols for identifying or addressing elder abuse; therefore, even if the physician did recognize a case, he or she may not know the proper management involved. The NCEA web site is a valuable tool in identifying state-specific resources to assist in the reporting of elder abuse to the appropriate authorities.

More research on elder mistreatment is needed to inform practice. Despite the need for more data on interventions, a reasonable approach is a multidisciplinary one, specifically tailored to the situation, ideally involving multiple team members with varied expertise. The multidisciplinary team should include physicians, nurses, office-based social workers, community-based social workers, visiting nurses, and Adult Protective Services case workers.

Immediate care in the emergency department focuses on treating the physical manifestations of abuse and assuring the safety of the patient. This may include the following:

  • Admitting the patient to the hospital
  • Obtaining a court protective order
  • Placing the patient in a safe home
  • Permitting return home if the patient has the capacity to make an informed decision and refuses intervention

Referral to social services and Adult Protective Services are also vital to decrease morbidity and mortality and to further guide patient care after the ED encounter.

Consultations

  • Psychiatry consultation - For patients who are demented, depressed, suicidal, disoriented, or to determine issues of capacity
  • Geriatrics consultation - For specialized care of the geriatric patient
  • Neurology or neurosurgical consultation - For patients with focal neurological findings, or intracranial injuries
  • Orthopedics consultation - For patients with fractures

Medication

No specific medication is used to treat elder abuse. Avoid anxiolytics and hypnotics because they make patients less able to defend themselves against acts of abuse.

More on Elder Abuse

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

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  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].

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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

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Keywords

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

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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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