Elder abuse is mistreatment of older adults. It can include physical, sexual, psychological, financial abuse and neglect. Risk factors include age, disability, dementia, social isolation, family stressors, and low socioeconomic status. A comprehensive geriatric assessment identifies abuse. A multidisciplinary team manages cases and includes geriatricians, social workers, and community care. Two case examples are described. The first involves an 82-year-old woman neglected by her son, appearing unkempt with bruises. The second is a 90-year-old woman in an elder's home with skin damage and malnutrition, suggesting neglect. Education and a multidisciplinary approach can help address elder abuse issues.

1. Elder Abuse
DR ANOJA RAJAPAKSE
CONSULTANT GERIATRICIAN

2. Definition
Elder abuse is a single or repeated act, or lack of appropriate
action, occurring within any relationship where there is an
expectation of trust, which causes harm or distress to an older
person (aged 60 years and older).
-
WHO

3. • Prevalence or awareness of all forms of abuse have increased
• Current Covid pandemic and social distancing has further contributed
• Serious loss of dignity and respect.
• Less likely to complain due to cognitive issues, fear of removal from home, or other
implications
• Increase morbidity and mortality
• Health professionals treating older patients have a legal and moral obligation to act

4. Types of elder abuse
• Physical abuse - intentional use of physical force
• Sexual abuse – forced, unwanted, unconsented behaviour.
Could be verbal or behavioural
• Psychological/emotional abuse – verbal or nonverbal
behaviour causing anguish, mental pain, fear or distress
• Financial abuse/exploitation – non consensual use of funds
for someone else’s use
• Neglect – not protect from harm, or not provide for the essential
needs. Include self-neglect and abandonment

5. • Consensual – decision freely and knowingly made by a person with
mental capacity to make such decisions
• Mental capacity – Ability to make (decision capacity) and carry out
(executive capacity) decisions regarding one’s self-care and
protection.
• Vulnerable elder – reduced capacity to self-care and protect
themself
• Caregiver/caretaker –who has the duty, or has taken on the duty to
care for and protect an older adult.

6. Risk factors
• Age, Gender
• Disability,
• Dementia, Depression
• History of hip fracture and stroke
• Social isolation
• Family stressors
• Unfavourable caretaker
• Lower socioeconomic status, lower education status
• Institutional staff shortage
• History of abuse in the carer

7. Comprehensive Geriatric Assessment (CGA)
is a model for evaluation and identification of
elder abuse and self neglect

8. Multidisciplinary team approach
(Safeguarding team)
• Geriatrician lead
• Dietician
• Mental health Liaison nurse
• Continence nurse
• Tissue viability nurses
• Physiotherapist
• Community care team
• Social worker
• Family

9. Patient one
• An 82-year-old Mrs. M was brought to the emergency department by her
son complaining poor oral intake and reduced responsiveness. She was
essentially bed ridden following right fracture neck of femur. Other than
hypertension she did not have significant past medical history.
• She was independent of activities of daily living and lived alone until 6
months ago. Husband was a retired teacher who died 3 years ago. She
receives her husband’s pension. She has 3 children. Elder son lives
abroad with his family. Daughter who is a widow lives 250km away.
Younger son who lives locally is unemployed. Mrs. M used to give financial
support to daughter and younger son when she receives the pension.
However, younger son frequently asks more money and used to have
quarrels with her.

10. Patient one
• Mrs. M had a fall a 6 months ago resulted right sided fracture
neck of femur for which she was not hospitalized. Mrs. M was
treated by a local practitioner and she was bed bound since
then. Younger son took her to his place to care for her as per
the request of elder brother who lives abroad. To cover her
expenses, he sends money monthly about Rs 15000/-.
• On examination, Mrs. M was drowsy, dehydrated and pale. She
looked unkempt, hair was not combed and infested with head
louse and there was an offensive body odor. ETU medical
officer noted that there were few bruises in the both arms and
right leg.

11. Panel discussion

12. Patient two
• Mrs. P 90-year-old, brought to see the Consultant Gynecologist with
offensive vaginal discharge. Recently completed a course of antibiotics for
a urinary tract infection. Caregiver says she is prone to recurrent UTI.
• She is frail and needs help with personal hygiene, feeding and mobility.
She has cognitive impairment but able to recognize her only child and
have a sensible conversation with her. No other medical problems. She
lives in a elders’ home as her daughter lives in the US. She calls regularly
and fully supports financially.
• Examining doctor noticed a malnourished lady with skin damage, and no
gynecological pathology.

13. Patient two

14. Panel discussion

15. Whom can we ask for help
• National Secretariate for Elders

16. Education
• Healthcare workers
• Our patients
• Their family and care takers
• Public