Because elder abuse is both a medical and social problem, relevant publications appear in both medical and social-science publications. Therefore, we searched the following databases: Ageline, PubMed, and Sociological Abstracts to 1980. Keywords were “elder abuse”, “elder mistreatment”, “elder neglect”, and “domestic violence in the elderly”. Many publications on this topic are case studies, policy analyses or essays, clinical reviews, or small studies of non-representative samples; we
SeminarElder abuse
Section snippets
Definition and occurrence
The frequency of any clinical event depends on a case definition that ideally meets the criteria of inter-rater reliability and clinical applicability. A major impediment to the understanding of elder abuse has been the use of widely varying (and sometimes poorly constructed) definitions. Fortunately, some consensus is now emerging in the previously controversial area of definitions and classification of elder abuse. From both clinical and research standpoints, two questions arise: what is the
Pathophysiology and risk factors
Progress has been made over the past decade in the empirical identification of risk factors for elder abuse. Various epidemiological designs have been used to elucidate such risk factors ranging from case-control studies to longitudinal designs. Care should be taken because research on risk factors for elder abuse is at an early stage of development, and much further study is needed. We limit ourselves in this review to studies with acceptable designs; specifically, those that involve a
Screening
Should apparently asymptomatic patients be tested for elder abuse? There have been no randomised trials of elder abuse screening in asymptomatic populations, although the 1992 American Medical Association guidelines on elder abuse suggested that all outpatients be screened for family violence.31 By contrast, the US Preventive Medicine Task Force concluded that there was insufficient evidence for or against screening for family violence in outpatients of any age,32 and a Canadian Task force had
Clinical manifestations and diagnosis
Patients for whom elder abuse is suspected (from either a positive screening test or outright clinical findings that might or might not be due to abuse) need further examination for the diagnosis. Attempts to identify diagnostic findings or arrays of findings (akin to so-called shaken baby syndrome in child abuse, for example) have not been successful. A patient with symptoms of elder abuse might or might not have findings clearly attributable to elder abuse, and those not subject to abuse
Course and treatment
In a large longitudinal study of old people,49 those who were mistreated were 3·1 times more likely to die during a 3-year period than those who did not experience abuse, even after adjustment for comorbidity and other factors associated with mortality. At the end of 13 years of follow-up, 9% of those who were mistreated were alive, compared with 41% who had not experienced abuse.49 Elder abuse is also associated with various other adverse life course and health outcomes ranging from depression
Conclusion
Although there are gaps in knowledge with respect to the clinical manifestations and treatment of elder abuse, they should not prevent clinicians from taking an active role in identification and management. Family violence directly affects quality of life, and removal of a patient from an abusive situation is one of the most gratifying experiences for physicians and other health-care professionals. Despite the need for more data on interventions, a reasonable approach is a multidisciplinary
Search strategy and selection criteria
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