Elder abuse

Medicine > Medicine of older adult

Differential Diagnosis Schema 🧠

Types of Elder Abuse

Physical abuse: Signs include bruises, fractures, burns, and injuries inconsistent with the history provided
Emotional or psychological abuse: Indicators include anxiety, depression, withdrawal, or fearfulness around a caregiver
Financial abuse: Look for sudden changes in financial situation, unexplained withdrawals, or lack of necessary items like medication
Neglect: Poor hygiene, malnutrition, dehydration, pressure sores, and inadequate living conditions
Sexual abuse: Unexplained genital infections, bruising in the genital area, or torn undergarments
Institutional abuse: May involve any of the above types within a care facility setting, including poor care practices

Key Points in History 🥼

Presentation and Red Flags

Inconsistent history: The explanation provided by the elder or caregiver does not match the injuries or situation
Delay in seeking care: Unexplained delays in seeking medical help for injuries or conditions
Frequent hospital visits: Multiple hospitalizations or emergency visits, particularly for similar injuries
Reluctance to speak: Elder may be hesitant to speak in the presence of the caregiver, or may appear fearful or anxious
Overt control by caregiver: Caregiver speaks for the elder, prevents them from being alone with healthcare providers
Signs of neglect: Poor personal hygiene, untreated medical conditions, or unsafe living conditions

Background

Past medical history: Chronic conditions that may predispose to dependence on others for care
Medication history: Polypharmacy, inappropriate medication use, or lack of access to prescribed drugs
Family dynamics: Tensions within the family, history of violence or substance abuse in the caregiver
Social history: Isolation, lack of social support, or dependency on a single caregiver
Living situation: Assessment of the home environment, presence of safety hazards, or evidence of neglect
Financial history: Recent changes in financial circumstances, unexplained transactions, or lack of funds for basic needs

Possible Investigations 🌡️

Physical Examination

Full body examination: Look for bruises, pressure sores, burns, fractures, or any signs of trauma, particularly in areas typically covered by clothing
Neurological assessment: Assess for signs of cognitive impairment, which may make an elder more vulnerable to abuse
Nutritional status: Check for signs of malnutrition, dehydration, and overall health
Skin assessment: Look for signs of neglect, such as pressure sores or poor hygiene
Genital examination: If sexual abuse is suspected, examine for signs of trauma or infection
Mental state examination: Assess for depression, anxiety, or signs of fearfulness which may indicate emotional abuse

Investigations

Blood tests: Full blood count, electrolytes, and nutritional markers to assess overall health and look for signs of neglect
Imaging: X-rays to identify fractures, particularly in cases of physical abuse where the explanation is inconsistent with the injury
CT/MRI scan: If there is concern for head trauma or neurological injury
Toxicology screen: To check for inappropriate drug levels or substances that may indicate abuse or neglect
Photographic documentation: Take photos of injuries with the elder’s consent, as part of the medical record
Psychological assessment: Involve a mental health professional if there are concerns about psychological or emotional abuse

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