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
CAREGIVER RED FLAGS
- 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