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Elder mistreatment: Abuse, neglect, and financial exploitation

Authors
John M Halphen, JD, MD
Carmel B Dyer, MD, FACP, AGSF
Section Editor
Kenneth E Schmader, MD
Deputy Editor
H Nancy Sokol, MD

INTRODUCTION

The problems of elder abuse, neglect (including self-neglect), and exploitation are common. Abuse of older individuals is associated with depression, cognitive impairment, loss of functional capacity, and increased mortality [1].

Health professionals who take care of elders have an opportunity to impact the health consequences of abuse, as well as a legal and moral obligation to identify victims and intervene when maltreatment is suspected. Health care workers encounter mistreated elders in emergency departments, nursing homes, hospitals, and outpatient settings. It is crucial to be aware of the manifestations of elder mistreatment and how to respond.

This topic addresses abuse, neglect, and exploitation as defined in civil statutes or governmental regulations. Self-neglect exposes older persons to significant harm and is discussed here as well [2-4].

DEFINITIONS

Elder mistreatment is perpetrated by those with an ongoing relationship that involves an expectation of responsibility toward the victim. Abuse, neglect, and financial exploitation by strangers are not considered elder mistreatment unless someone who is expected to be responsible for the victim, such as a caretaker, breaches a duty to protect the elder.

Definitions vary among jurisdictions and authorities who have written on elder mistreatment. The following is an attempt to consolidate and simplify these definitions [5-8]:

                                     

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 04 00:00:00 GMT+00:00 2016.
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References
Top
  1. Lachs MS, Pillemer K. Elder abuse. Lancet 2004; 364:1263.
  2. Tierney MC, Snow WG, Charles J, et al. Neuropsychological predictors of self-neglect in cognitively impaired older people who live alone. Am J Geriatr Psychiatry 2007; 15:140.
  3. Tierney MC, Charles J, Naglie G, et al. Risk factors for harm in cognitively impaired seniors who live alone: a prospective study. J Am Geriatr Soc 2004; 52:1435.
  4. Mosqueda L, Dong X. Elder abuse and self-neglect: "I don't care anything about going to the doctor, to be honest...". JAMA 2011; 306:532.
  5. Brandl B, Dyer CB, Heisler CJ, et al. Defining Elder Abuse. In: Elder Abuse Detection and Intervention: A Collaborative Approach, Publishing Company, New York 2007. p.17.
  6. Teaster, PB, Dugar, TA, Mendiondo, MS, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older; Prepared for The National Center on Elder Abuse 2006. p. 26. Available at: www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf (Accessed on March 09, 2009).
  7. Tatara T. The National Elder Abuse Incidence Study. The National Center on Elder Abuse, 1998. Available at: www.ncea.aoa.gov/ncearoot/Main_Site/Library/Statistics_Research/National_Incident.aspx (Accessed on March 09, 2009).
  8. Elder Abuse: abuse, neglect and exploitation in an aging America, Bonnie RJ, Wallace RB (Eds), National Academy Press, Washington, DC 2002.
  9. Fulmer T, Guadagno L, Bitondo Dyer C, Connolly MT. Progress in elder abuse screening and assessment instruments. J Am Geriatr Soc 2004; 52:297.
  10. Naik AD, Pickens S, Burnett J, et al. Assessing capacity in the setting of self-neglect: development of a novel screening tool for decision-making capacity. J Elder Abuse Negl 2006; 18:79.
  11. Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med 2007; 357:1834.
  12. Naik AD, Lai JM, Kunik ME, Dyer CB. Assessing capacity in suspected cases of self-neglect. Geriatrics 2008; 63:24.
  13. Stiegel L, Klem E. Types of Abuse: Provisions and Citations in Adult Protective Services Laws, by State (Laws Current as of 12/31/06). American Bar Association Commission on Law and Aging 2007. Available at: www.abanet.org/aging/elderabuse.shtml (Accessed on May 07, 2009).
  14. Stiegel L, Klem E. Information About Laws Related To Elder Abuse. American Bar Association Commission on Law and Aging 2007. Available at: www.abanet.org/aging/elderabuse.shtml (Accessed on May 07, 2009).
  15. European report on preventing elder maltreatment. World Health Organization, Regional office for Europe. 2011. http://www.euro.who.int/__data/assets/pdf_file/0010/144676/e95110.pdf (Accessed on December 02, 2011).
  16. Dong XQ. Elder Abuse: Systematic Review and Implications for Practice. J Am Geriatr Soc 2015; 63:1214.
  17. Cooper C, Selwood A, Livingston G. The prevalence of elder abuse and neglect: a systematic review. Age Ageing 2008; 37:151.
  18. Disability and Activity Limitations. A Profile of Older Americans: 2007. Available at: www.aoa.gov/AoAroot/Aging_Statistics/Profile/2007/docs/2007profile.pdf (Accessed on May 07, 2009).
  19. Laumann EO, Leitsch SA, Waite LJ. Elder mistreatment in the United States: prevalence estimates from a nationally representative study. J Gerontol B Psychol Sci Soc Sci 2008; 63:S248.
  20. Pillemer K, Finkelhor D. The prevalence of elder abuse: a random sample survey. Gerontologist 1988; 28:51.
  21. Podnieks E, Pillemer K, Nicholson J, et al. National survey on abuse of the elderly in Canada. Preliminary findings. Office of Reserach and Innovation, Ryerson Polytechnical Institute, Toronto 1989.
  22. Wolf R, Daichman L. Abuse of the elderly. In: World report on violence and health. Krug E, et al (Eds). World Health Organization, Geneva 2002. p.123. Available at: http://whqlibdoc.who.int/publications/2002/9241545615_eng.pdf (Accessed on April 24, 2009).
  23. Cooper C, Selwood A, Blanchard M, et al. Abuse of people with dementia by family carers: representative cross sectional survey. BMJ 2009; 338:b155.
  24. Wiglesworth A, Mosqueda L, Mulnard R, et al. Screening for abuse and neglect of people with dementia. J Am Geriatr Soc 2010; 58:493.
  25. Hawes C. Elder Abuse in Residential Long-Term Care settings: What is Known and What Information is Needed?. In: Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America, Bonnie RJ, Wallace RB (Eds), National Academies Press, Washington, DC 2002.
  26. State Ombudsman Data: Nursing Home Complaints. Office of Inspector General, Department of Health and Human Services. Available at: www.oig.hhs.gov/ (Accessed on July 01, 2003).
  27. Wei GS, Herbers JE Jr. Reporting elder abuse: a medical, legal, and ethical overview. J Am Med Womens Assoc 2004; 59:248.
  28. 2008 National Ombudsman Reporting System Data Tables, U.S. Administration on Aging Department of Health and Human Services. Available at: www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Ombudsman/National_State_Data/2008/Index.aspx (Accessed on May 07, 2010).
  29. Dyer CB, Connolly MT, McFeeley P. The Clinical and Medical Forensics of Elder Abuse and Neglect. In: Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America, Bonnie RJ, Wallace RB (Eds), National Academies Press, Washington DC 2002. p.340.
  30. Lachs MS, Williams CS, O'Brien S, et al. The mortality of elder mistreatment. JAMA 1998; 280:428.
  31. Dong X, Simon M, Mendes de Leon C, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA 2009; 302:517.
  32. Baker MW, LaCroix AZ, Wu C, et al. Mortality risk associated with physical and verbal abuse in women aged 50 to 79. J Am Geriatr Soc 2009; 57:1799.
  33. Dyer CB, Pickens S, Burnett J. Vulnerable elders: when it is no longer safe to live alone. JAMA 2007; 298:1448.
  34. Friedman LS, Avila S, Tanouye K, Joseph K. A case-control study of severe physical abuse of older adults. J Am Geriatr Soc 2011; 59:417.
  35. Abrams RC, Lachs M, McAvay G, et al. Predictors of self-neglect in community-dwelling elders. Am J Psychiatry 2002; 159:1724.
  36. Naik AD, Burnett J, Pickens-Pace S, Dyer CB. Impairment in instrumental activities of daily living and the geriatric syndrome of self-neglect. Gerontologist 2008; 48:388.
  37. Dong X, Simon MA, Wilson RS, et al. Decline in cognitive function and risk of elder self-neglect: finding from the Chicago Health Aging Project. J Am Geriatr Soc 2010; 58:2292.
  38. Dyer CB, Pavlik VN, Murphy KP, Hyman DJ. The high prevalence of depression and dementia in elder abuse or neglect. J Am Geriatr Soc 2000; 48:205.
  39. Burnett J, Regev T, Pickens S, et al. Social networks: a profile of the elderly who self-neglect. J Elder Abuse Negl 2006; 18:35.
  40. Dong X, Simon MA, Gorbien M, et al. Loneliness in older chinese adults: a risk factor for elder mistreatment. J Am Geriatr Soc 2007; 55:1831.
  41. Lachs MS, Pillemer K. Abuse and neglect of elderly persons. N Engl J Med 1995; 332:437.
  42. Dyer CB, Connolly MT, McFeeley P. The clinical and medical forensics of elder abuse and neglect. In: Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America, Bonnie RJ, Wallace RB (Eds), The National Academies Press, Washington DC 2002. p.339.
  43. Malone ML, Rozario N, Gavinski M, Goodwin J. The epidemiology of skin tears in the institutionalized elderly. J Am Geriatr Soc 1991; 39:591.
  44. Griffiths CE. Aging of the skin. In: Brocklehursts's Textbook of Geriatric Medicine and Gerontology, 5th ed, Tufts R, Fillet H, Brocklehurst JC (Eds), Harcourt Brace & Co, London 1998.
  45. Mosqueda L, Burnight K, Liao S. The life cycle of bruises in older adults. J Am Geriatr Soc 2005; 53:1339.
  46. Reed K. When elders lose their cents: financial abuse of the elderly. Clin Geriatr Med 2005; 21:365.
  47. Peterson JC, Burnes DP, Caccamise PL, et al. Financial exploitation of older adults: a population-based prevalence study. J Gen Intern Med 2014; 29:1615.
  48. Lachs MS, Han SD. Age-Associated Financial Vulnerability: An Emerging Public Health Issue. Ann Intern Med 2015; 163:877.
  49. Mosqueda L, Burnight K, Gironda MW, et al. The Abuse Intervention Model: A Pragmatic Approach to Intervention for Elder Mistreatment. J Am Geriatr Soc 2016; 64:1879.
  50. Aravanis SC, Adelman RD, Breckman R, et al. Diagnostic and treatment guidelines on elder abuse and neglect. Arch Fam Med 1993; 2:371.
  51. Nelson HD, Nygren P, McInerney Y, Klein J. Screening Women and Elderly Adults for Family and Intimate Partner Violence. U.S. Preventive Services Task Force. March 2004. Available at: www.ahrq.gov/clinic/3rduspstf/famviolence/famviolrev.htm (Accessed on September 01, 2008).
  52. Nelson HD, Nygren P, McInerney Y, et al. 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 2004; 140:387.
  53. Lachs MS. Screening for family violence: what's an evidence-based doctor to do? Ann Intern Med 2004; 140:399.
  54. MDS 2.0 for Nursing Home Nursing Home Quality Initiative. https://www.cms.gov/NursingHomeQualityInits/50_NHQIMDS20.asp (Accessed on April 28, 2009).
  55. American Medical Association. American Medical Association. Available at: www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion202.shtml (Accessed on April 28, 2009).
  56. 2009 Standard: PC.01.02.09. Provision of Care, Treatment and Services. In: Accreditation Program: Ambulatory Health Care, CAMAC Additional Resources, The Joint Commission, 2009.
  57. Schulman EA, Hohler AD. The American Academy of Neurology position statement on abuse and violence. Neurology 2012; 78:433.
  58. Summaries for patients. Screening for intimate partner violence and abuse of vulnerable adults: U.S. Preventive Services Task Force recommendation. Ann Intern Med 2013; 158:I.
  59. Moyer VA, U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement. Ann Intern Med 2013; 158:478.
  60. Screening and Case Identification in Clinical Settings. In: Elder Abuse: abuse, neglect, and exploitation in an aging America, Bonnie RJ, Wallace RB (Eds), National Academy Press, Washington, DC 2002. p.109.
  61. Reis M, Nahmiash D. When seniors are abused: an intervention model. Gerontologist 1995; 35:666.
  62. Reis M, Nahmiash D. Validation of the indicators of abuse (IOA) screen. Gerontologist 1998; 38:471.
  63. Fulmer T, Paveza G, Abraham I, Fairchild S. Elder neglect assessment in the emergency department. J Emerg Nurs 2000; 26:436.
  64. Fulmer T, Street S, Carr K. Abuse of the elderly: screening and detection. J Emerg Nurs 1984; 10:131.
  65. Straus MA. Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scale-Form. A J Marriage Fam 1979; 41:75. Available at: http://74.125.93.132/search?q=cache:i4Hoh87SwzgJ:pubpages.unh.edu/~mas2/CTS41%2520(CTS2x- (Accessed on April 28, 2009).
  66. Reis M, Nahmiash D. Validation of the Caregiver Abuse Screen (CASE). Can J Aging 1995; 14:45.
  67. Neale AV, Hwalek MA, Scott RO, et al. Validation of the Hwalek-Sengstock Elder Abuse Screening Test. J Appl Gerontol 1991; 10:406.
  68. Straus MA. The Conflicts Tactics Scale. In: Handbook of Family Measurement Techniques, Touliatos J, Perlmutter B, Straus M (Eds), Sage Publications, Newbury Park, CA 2001.
  69. Teaster PB, Dugar TA, Mendiondo MS, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older. The National Committee for the Prevention of Elder Abuse and The National Adult Protective Services Association 2006. p. 26. Available at: www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf (Accessed on April 28, 2007).
  70. Dyer CB, Kelly PA, Pavlik VN, et al. The making of a self-neglect severity scale. J Elder Abuse Negl 2006; 18:13.
  71. Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 2002; 346:905.
  72. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc 2004; 52:1417.
  73. Riccio D, Solinas A, Astara G, Mantovani G. Comprehensive geriatric assessment in female elderly patients with Alzheimer disease and other types of dementia. Arch Gerontol Geriatr 2007; 44 Suppl 1:343.
  74. Dyer CB, Goins AM. The role of the interdisciplinary geriatric assessment in addressing self-neglect of the elderly. Generations 2000; 24:23.
  75. Dyer CB, Goodwin JS, Pickens-Pace S, et al. Self-neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team. Am J Public Health 2007; 97:1671.
  76. Pickens S, Naik AD, Burnett J, et al. The utility of the Kohlman Evaluation of Living Skills test is associated with substantiated cases of elder self-neglect. J Am Acad Nurse Pract 2007; 19:137.
  77. Judicial Determination of Capacity of Older Adults in Guardianship Proceedings. American Bar Association Commission on Law and Aging - American Psychological Association 2006. Available at: http://www.apa.org/pi/aging/resources/guides/judges-diminished.pdf (Accessed on April 28, 2009).
  78. Moye J, Butz SW, Marson DC, et al. A conceptual model and assessment template for capacity evaluation in adult guardianship. Gerontologist 2007; 47:591.
  79. Stiegle L, Klem E. Explanation of the "Emergency or involuntary services to victims: Comparison Chart of Provisions in Adult Protective Services Laws with Citations by State" Chart. American Bar Association Commission on Law and Aging 2007. Available at: www.abanet.org/aging/about/pdfs/emergency_or_involuntary_services_explanation.pdf (Accessed on April 28, 2009).
  80. Evaluating Interventions. In: Elder Abuse: abuse, neglect, and exploitation in an aging America, Bonnie RJ, Wallace RB (Eds), National Academy Press, Washington, DC 2002.
  81. Welfel ER, Danzinger PR, Santoro S. Mandated Reporting of Abuse/Maltreatment of Older Adults: A Primer for Counselors. Journal of Counseling & Development 2000; 78:284.
  82. Stiegel L, Klem E. Explanation of the "Immunity for Good Faith Reporting: Provisions and Citations in Adult Protective Services Laws, by State" and "Immunity for Good Faith Reporting: Criteria in Adult Protective Services Laws, by State" Charts. American Bar Association Commission on Law and Aging 2007. Available at: www.abanet.org/aging/about/pdfs/Immunity_for_Good_Faith_Reporting_Explanation.pdf (Accessed on April 28, 2009).
  83. Baker PR, Francis DP, Hairi NN, et al. Interventions for preventing abuse in the elderly. Cochrane Database Syst Rev 2016; :CD010321.
  84. Halphen JM, Varas GM, Sadowsky JM. Recognizing and reporting elder abuse and neglect. Geriatrics 2009; 64:13.
  85. Rosen T, Pillemer K, Lachs M. Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem. Aggress Violent Behav 2008; 13:77.
  86. Rosen T, Lachs MS, Pillemer K. Sexual aggression between residents in nursing homes: literature synthesis of an underrecognized problem. J Am Geriatr Soc 2010; 58:1970.
  87. Natan MB, Lowenstein A, Eisikovits Z. Psycho-social factors affecting elders' maltreatment in long-term care facilities. Int Nurs Rev 2010; 57:113.
  88. Lindbloom EJ, Brandt J, Hough LD, Meadows SE. Elder mistreatment in the nursing home: a systematic review. J Am Med Dir Assoc 2007; 8:610.
  89. Jogerst GJ, Daly JM, Hartz AJ. State policies and nursing home characteristics associated with rates of resident mistreatment. J Am Med Dir Assoc 2008; 9:648.