Etiology

The etiology of older adult abuse is multifaceted. It tends to result from a complex interaction of factors related to the older patient, the abuser, and a number of social and familial issues.

Several theories have been proposed:[17]

  • Physical and cognitive decline: older patients are predisposed to abuse, but observational data have not shown any direct correlation.

  • Psychosocial abnormalities in the abuser: this theory is based on the premise that abuse occurs when the abuser has a psychological imbalance and may also have other factors influencing behavior, such as drug or alcohol misuse.

  • Caregiver stress: this theory attempts to link stresses that arise from caregiving and other environmental factors to older adult abuse.

Older adult abuse may also be domestic violence grown old. A relationship between spouses that has always been abusive becomes more manifest when they are older and one person is dependent on the other. Domestic violence significantly impacts the health status of women as they are more likely to experience physical and mental health problems than those who have not experienced abuse.[18]

Pathophysiology

Injuries caused by physical abuse include bruising, fractures, head injuries, abdominal injuries, and burns. Mental abuse can cause depression, posttraumatic stress disorder, anxiety, and panic attacks. The pathophysiology depends on the individual type of injury. Financial abuse may cause poverty, malnutrition, and an inability to pay for medications.

Classification

Types of older adult abuse and neglect

There is now consensus that there are five major types of older adult abuse and neglect.[1][3][4]

  • Physical abuse: use of physical force that may result in bodily injury or pain.

  • Emotional or psychological abuse: a situation where verbal or nonverbal acts cause intimidation and pain.

  • Sexual abuse: any nonconsensual sexual contact.

  • Financial abuse: misuse or appropriation of funds or other assets, fraudulent scams, and improper use of guardianship.

  • Neglect: disregard for an older person's basic requirements and safety, and lack of care or supervision.

World Health Organization definition

The abuse of older people, also known as 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.[2] WHO: abuse of older people factsheet Opens in new window

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