Elder abuse in dementia caregiving (MEQ)

(i) Definition and subtypes. Elder abuse is harm or distress to an older person from acts or omissions within a relationship of trust. Major subtypes: physical, sexual, psychological/emotional, financial/material exploitation, and neglect by others; self-neglect is often framed separately but is clinically critical.^[1]

(ii) Immediate assessment. Prioritise medical stabilisation of dehydration and injuries. Create a private interview (security if the son obstructs). Use open, non-judgemental questions; document injuries and quotes factually; consider local forensic photo protocols with consent/capacity. Assess cognition and decision-specific capacity (understand, appreciate, reason/weigh, communicate) for placement, contact with son, medical care, and finances — dementia does not equal global incapacity.^[4][6] Screen depression and suicide risk. Gather collateral carefully without tipping off the alleged abuser prematurely. Do not discharge to an unsafe home.^[1][5]

(iii) Risk factors and evidence. Victim: dementia, dependency, isolation. Perpetrator/context: sole family carer, controlling interview behaviour, possible financial exploitation (unpaid bills despite resources). CARD study links carer/care-situation factors to abusive behaviour toward people with dementia. Mistreatment associated with increased mortality (Lachs et al. JAMA 1998).^[2][3]

(iv) Multi-agency and reporting. Coordinate health, social work/aged care, adult safeguarding or equivalent, and police if crime/imminent harm. Financial protection via bank alerts and lawful review of enduring powers/public trustee pathways as indicated. Reporting duties are jurisdiction-specific (including possible residential care reportable frameworks in other scenarios) — state principles, escalate via designated local channels, document the basis for information-sharing; do not invent section numbers.^[1][5]

(v) Psychiatric care and disposition. Treat depression/trauma symptoms and any substance issues; avoid antipsychotics for reality-based fear. Offer carer support only if safe and appropriate — safety overrides carer rehabilitation when harm is serious. Safe disposition requires a named alternative place of care if home is unsafe, multi-agency follow-up owner, and review plan.^[1][6]