Elder Abuse

Signs and Symptoms of Abuse

Possible physical abuse clues, especially if there has been a delay in seeking treatment:

  • unexplained or implausible injuries
  • multiple ED visits; healthcare “shopping”
  • broken bones, dislocations, sprains
  • multiple injuries in various stages of healing
  • internal injuries
  • head/facial trauma, black eyes, detached retina, ear injuries
  • traumatic, patchy hair loss
  • broken glasses
  • swelling, pinch marks, hand slap or finger marks
  • bruises, especially when not over bony prominences
  • scratches, cuts, lacerations, punctures
  • burns - cigarette, immersion line, or in the shape of hot object such as an iron
  • restraint marks on axilla, wrists or ankles
  • aspiration/choking from forced feeding

Possible sexual abuse clues:

  • bruises on breasts or genital area
  • genital infections or venereal disease
  • vaginal or anal bleeding

Possible signs of neglect (also self neglect):

  • pressure ulcers, especially if not cared for
  • signs of suboptimal living conditions, such as poor hygiene, torn or dirty clothes, flea bites
  • inappropriate or inadequate clothing
  • poor state of dentition
  • malnutrition - weight loss, temporal wasting, low serum albumin and cholesterol
  • dehydration - cracked lips, sunken eyes, impaction (water withheld to decrease incontinence episodes), poor skin turgor, elevated BUN, sodium
  • contractures
  • general deterioration in health
  • failure to keep medical appointments
  • physical or laboratory evidence of over or under dosing medication - draw levels of chronic meds
  • lack of needed healthcare appliances or supplies
  • not providing physical aids such as false teeth, glasses or hearing aids
  • failure to address issues of safety
  • inability to manage activities of daily living

Possible indicators of economic abuse:

  • caregiver refusal to spend money on care items or services
  • lack of appropriate clothing or grooming for the level of income
  • patient complains of missing clothing, jewelry or valuable items
  • lonely patient with new "best friend" at office visits
  • sudden appearance of previously uninvolved relatives
  • unpaid medical bills when caregiver is supposed to be handling this
  • checks "signed" by patient, who is incapable of doing so
  • new will, power of attorney, or healthcare directives "signed" when patient clearly does not have the capacity to understand.


Possible psychological symptoms of abuse

> sudden change in behavior
> decreased grooming
> staring vacantly
> fear
> agitation, anxiety
> unexplained crying
> anger
> confusion, disorientation
> depression
> resignation
> unusual behavior, such as
> biting or rocking
> withdrawal
> shame

  • patient not wanting to be left alone with care giver
  • hesitant to talk around caregiver
  • conflicting accounts of incidents by patient and caregiver
  • caregiver’s refusal to allow patient to be seen alone
  • caregiver’s reluctance to cooperate with care plan
  • caregiver seems to isolate patient from family, friends, activities, information
  • caregiver denies patient right to make decisions about living arrangements, privacy, personal matters, or healthcare choices
  • caregiver anger or indifference to patient
  • caregiver verbal abuse to patient or you
  • caregiver substance abuse or mental illness
  • caregiver history of violence
  • caregiver financial dependence on patient

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