Caregiver mistreating elderly man via shutterstock
In an article published in the New England Journal of Medicine, researchers from Weill Cornell Medical College in New York delve into the topic of elder abuse. Following media coverage detailing the plight of the late hollywood legend Mickey Rooney, at the hands of his allegedly abusive wife and stepson, this typically under-reported issue is finally being highlighted.
Prior research estimates the prevalence of self-reported abuse at approximately 10 percent of the elder population. However, ask any clinician and he or she will likely disagree.
Many of the elderly at risk suffer from dementia (a proven risk factor for elder abuse in and of itself), and lack the awareness to identify the abuse. In the event that they do though, many are either afraid to articulate this to others or simply lack the cognitive capacity to do so.
Elder abuse can present in various forms: physical, verbal or psychological, sexual, financial and neglect. Among the elderly, it's interesting to note that those at the younger end of that age spectrum, affectionately called the "young old," have a greater risk of abuse. The authors highlight that the "young old" often live with a spouse or adult children, who are, in fact, the most common perpetrators.
The consequences of elder abuse not only manifest physically in the form of bruises from restraints, pressure sores, burns, and unexplained fractures, but also in psychological abuse discovered when interviewing the elder. Depression, anxiety, and fear can be noted. Inability to pay for necessities, failure to renew prescriptions, and malnutrition or weight loss with no attributable medical cause are all manifestations of financial abuse, notably the most common form of abuse experienced by elders living with dementia.
Often the abused will defer answering any questions posed by a physician in the presence of a caregiver (who may or may not be the abuser), particularly questions that address how comfortable or safe the elder feels in their home. Physicians are advised to always excuse the accompanying caregiver (whether family member or otherwise) at some point during the doctor's visit and interview the elder separately, assuring them that they are able to speak freely, with no fear of retribution or judgment.
And what happens if elder abuse is suspected? A natural response would be to remove the elder from the environment immediately. However, this is not what happens in most instances. Every case of elder abuse is different and will require tailored interventions.
For clinicians, 49 states, excluding New York, have instituted mandatory reporting laws if elder abuse is suspected. Suspected cases can be referred to organizations such as Adult Protective Services (APS). Once elder abuse is confirmed, a mutli-discplinary approach (proven to be most effective) to the healing process is the next step. This can involve community outreach participants, social workers, physicians, law enforcement and legal counsel, depending on the nature of the issues.