History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors for elder abuse include: age >75 years; dementia; dependence on a carer for personal care; depression or other mental illness in the carer; substance abuse in the older adult or carer; and financial dependence of the carer on the older adult.

Other diagnostic factors

common

self-report

Any report of abuse by the older person should be considered accurate and should be investigated as such. The older person's account of the situation may be questioned because of underlying dementia or other cognitive decline.

inconsistent history

Inconsistencies in patient history, either between patient and carer or between carers, should alert suspicion of older adult abuse. Likewise, inconsistencies between history and physical findings, medical regimen, laboratory values, or living conditions are causes for concern.

agitated state

Unexplained fear, withdrawn attitude, failure to make any eye contact, presence of agitation, or behaviour not appropriate for level of dementia or depression can sometimes be a sign of older adult abuse.[5]​[40]​​​​

social isolation

Risk factor for emotional/psychological or self-inflicted abuse.[5]

physical injuries

Presence of physical injuries (bruises, cuts, punctures, restraint marks, fractures) can be an indication of physical abuse.[5][40]

malnutrition and volume depletion

Can be due to deprivation of nutrition and are a warning sign of neglect and abandonment.[5]

improper medicine use

The older adult being over- or under-medicated can indicate abuse.[39]

substance misuse

Presence of substances that the patient has not been prescribed can indicate abuse.[39]

carer dominance

Refusal of the carer to let the patient answer any of the questions during an interview, or refusal of the carer to let the older patient be interviewed separately, can indicate abuse.[5]

pressure ulcers

Multiple untreated sores suggest abuse.[5]

overall neglected or unkempt appearance

Patient smelling of urine and faeces, or overall neglected or unkempt appearance, suggest older adult abuse.[5]

uncommon

genital bleed or wound

Presence of any genital bleeding, especially when accompanied by bruising and other signs of violence, is indicative of sexual abuse.[5]

Risk factors

strong

age >75 years

Age is a key risk factor for older adult abuse. The older and more frail a person is, the more likely they are to be dependent on a carer and this therefore increases the possibility of abuse.[20][21][22][23][24]

cognitive impairment

Cognitive impairment is a strong risk factor for older adult abuse.[24]​​ Older people with cognitive impairment are more likely to be abused than those who are cognitively intact.[25] This may be related to increased dependence on carers or to a lower likelihood of seeking help.[20][23]

dependence on a carer for personal care

General physical decline and therefore dependence on others for personal care tends be associated with higher rates of abuse.[15]​[26]​​[27]

depression or other mental illness in the carer

The presence of depression or other psychiatric illness in the carer increases the likelihood of older adult abuse.[28][29][30]

substance misuse by the older person or the carer

Substance misuse by the older person or the carer is a risk factor for older adult abuse.[28][29][30]

financial dependence of the carer on the older adult

Over-reliance of the carer on the older person for financial assistance, accommodation, and other material items increases the risk of older adult abuse.[18]

social isolation or loneliness

Perceived or objective social isolation and loneliness is a risk factor for abuse of older adults and for other poor health outcomes.[24]​ Social isolation and associated health effects was intensified during the COVID-19 pandemic.[31]

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