Elder Abuse

Elder abuse is a criminal offence (Criminal Code of Canada)

  • Physical
  • Sexual
  • Psychosocial
  • Financial
  • Abandonment
  • Neglect
  • Self-neglect

Issues

  • Growing elderly population
  • Shift away from institutionalized care of the elderly
  • Under-reported (unwillingness, inability to report)



Frequency

  • 4% in private homes
  • ~7% emotional or financial abuse by family or caregiver within last 5 years (1999 General Social Survey on Victimization)
  • #1 material abuse, #2 verbal aggression, #3 physical (spousal)

Red flags

  • Depression, fear, anxiety, passivity
  • Unexplained physical injuries (implausible or vague)
  • Dehydration, malnutrition or lack of food
  • Poor hygiene, rashes, pressure sores
  • Over-sedation
  • Delay in seeking medical care
  • Disparity in histories
  • Frequent ER visits
  • Presentation of functionally impaired patient without designated caregiver
  • Lab findings inconsistent with history

Victim risk factors:

  • Greater frailness
  • Older age (80 and above)
  • Female gender
  • Dependence on the abuser
  • Cognitive impairment or disability in activities of daily living
  • Living in isolation.

Perpetrator risk factors:

  • Suffering from caregiver stress
  • Poor mental health or psychiatric illness
  • Alcohol or drug dependence
  • Financial dependence on the victim
  • Male gender

It is the physician’s responsibility to protect the patient’s safety but still respect their autonomy.  If patient consents to intervention consider urgent placement, hospital admission or protective court order.  If patient does not consent, educate them about elder abuse and how it is likely to worsen with time.  It is important to offer written information, set up a safety plan for the patient and ensure follow up.  If the patient is incompetent a proxy should be identified (government-appointed guardian, power of attorney, relative). A public guardian and trustee may be necessary if the proxy is not acting in the patient’s best interest.

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