Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

suspected older adult abuse

1st line – social services evaluation

Back
INITIAL
|
suspected older adult abuse
1st line – 

social services evaluation

In managing abused older people, it is important to ensure the patients' safety and honour their dignity. Patient preferences in a competent individual have to be respected even in situations that place that person at risk.

Depending where the patient is being evaluated, there may be several options: temporary hospitalisation, obtaining a court protective order, or placing the patient in a safe home in the community.

While the exact procedures may differ, most counties and countries have mandatory reporting requirements for confirmed older adult abuse. In the US, some states, such as California, encourage anyone, and require physicians and all healthcare personnel, to report even suspected cases of abuse.

Social workers and Adult Protective Services take on the reporting aspects when involved.

Older adult abuse is often an ongoing process. If the diagnosis of abuse is being considered, carers must be informed of all relevant investigations and referrals.

ACUTE

confirmed older adult abuse

1st line – report to authorities

Back
ACUTE
|
confirmed older adult abuse
1st line – 

report to authorities

Doctors are required to share information with other agencies (e.g., law enforcement bodies, legal professionals) to ensure that the older person’s needs are met and that the patient is protected from harm.[40][51]

While the exact procedures may differ, all counties and countries have mandatory reporting requirements.

Plus – intervention strategies

Back
ACUTE
|
confirmed older adult abuse
Plus – 

intervention strategies

Treatment recommended for ALL patients in selected patient group

These are best accomplished using a multi-disciplinary approach, and should be individualised to each older adult.[36]

The following may be considered:[53]

Linkages with appropriate resources, such as home health services, adult day care, or respite care. Assistance with development of informal support systems. Guardianship.

Referral to counselling and inter-disciplinary support groups.

Financial or legal assistance.

Housing assistance. Placement in a convalescent home.

Emergency responses for housing, food, and physical and mental health. Dietary assistance.

Resolution of disposition problems resulting from carer exhaustion. Counselling the abuser.

Occasionally, the patient wishes to return home and refuses intervention. If the patient has decision-making capacity and understands the choices being offered, the patient's decision needs to be respected and the patient can return home after appropriate education.[36]

Appropriate education and close follow-up are recommended.

Plus – treatment of injuries

Back
ACUTE
|
confirmed older adult abuse
|
physical abuse
Plus – 

treatment of injuries

Treatment recommended for ALL patients in selected patient group

Individual injuries should be managed as appropriate, irrespective of whether they are caused by abuse or accident.[47][55]

However, where abuse is considered, the physician should ensure that an appropriate search for additional or hidden injuries is also carried out.

Patients with dementia, depression or disorientation will require psychiatry consultation to determine issues of capacity. Those with fractures will require orthopaedic consultation and those with signs of neurological injury will require neurology or neurosurgical consultation.

Any signs of volume depletion, infection, malnutrition, pressure ulcers, or genital injury from sexual abuse need to be addressed.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer