geriatrics
Elder Abuse
Prevention of Elder Abuse
A physician or other health care practitioner may be the only person an abuse victim has contact with other than the perpetrator and should therefore be vigilant for risk factors and Physical examination . Recognizing high-risk situations can prevent elder abuse—eg, when a frail or cognitively impaired person is being cared for by someone with a history of substance abuse, violence, a psychiatric disorder, or caregiver burden. Physicians should pay particular attention when a frail older person (eg, a person with a recent history of stroke or a newly diagnosed condition) is discharged into a precarious home environment. Physicians should also remember that perpetrators and victims may not fit stereotypes. Older people often agree to share their homes with family members who have drug or alcohol problems or serious psychiatric disorders. A family member may have been discharged from a mental or other institution to an older person’s home without having been screened for risk of causing abuse. Physicians should therefore counsel patients considering such living arrangements, especially if the relationship was fraught with tension in the past. Additional considerations should be made for the screening and hiring of in-home helpers, both from formal service agencies and informal private arrangements. A small, but meaningful, proportion of patients who use in-home helpers report concerns of theft, neglect, or mistreatment. Screening and training for such workers may help in preventing mistreatment. Patients can also actively decrease their risk of abuse (eg, by maintaining social relationships, by increasing social and community contacts). They should seek legal advice before signing any documents related to where they live or who makes financial decisions for them. 