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.