Psych · Old age psychiatry — risk and safeguarding
Elder abuse and vulnerability
Also known as Elder mistreatment · Elder neglect · Abuse of older people · Financial exploitation of older adults · Self-neglect in older adults · Adult safeguarding older people
Exam-exhaustive fellowship reference on elder abuse and vulnerability — subtypes (physical, sexual, psychological, financial, neglect, self-neglect), epidemiology and mortality, risk ecology, assessment including private interview and capacity, multi-agency safeguarding and jurisdiction-aware reporting principles without invented statutes, psychiatry interface with dementia and late-life mental illness. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Immediate danger from alleged abuser in the home or facility — separate, secure environment; do not discharge to an unsafe destination
- Patterned or unexplained injuries, sexual assault suspicion, or severe neglect (dehydration, pressure injury, untreated illness) — medical stabilisation plus safeguarding escalation
- Coercive control of finances or access while cognitive impairment is present — assess capacity decision-by-decision and protect assets via lawful pathways
- Alleged abuser refuses to leave the room, answers for the patient, or blocks collateral — treat as high-risk interview dynamics
- Active suicidal ideation, severe depression, or PTSD after abuse — same-day risk management and least-restrictive psychiatric pathway as indicated
- Self-neglect with unclear capacity — do not equate age or squalor with incapacity; optimise assessment and escalate multi-agency support
Meet the patient
An 84-year-old woman arrives in ED with a fractured wrist and bruises on the upper arm arranged in the shape of a grip. Her son answers every question. When you ask her how she fell, she looks at him before she answers.[1][13]
The triage note reads: mechanical fall, poor mobility, refer social work. Her repeat prescriptions have not been dispensed for three months and she has lost weight since her last admission, despite what the file calls full-time care at home.[1][13]
Two questions are now live and both belong to you. What actually happened to that arm? And can I get five minutes in a room with her alone? The second question is the harder one, and this topic is built around it.[1][6]
References16ShowHide
- [1]Lachs MS, Pillemer KA Elder Abuse N Engl J Med, 2015.PMID 26559573
- [2]Pillemer K, Burnes D, Riffin C, Lachs MS Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies Gerontologist, 2016.PMID 26994260
- [3]Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME The mortality of elder mistreatment JAMA, 1998.PMID 9701077
- [4]Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study Am J Public Health, 2010.PMID 20019303
- [5]Yon Y, Mikton CR, Gassoumis ZD, Wilber KH Elder abuse prevalence in community settings: a systematic review and meta-analysis Lancet Glob Health, 2017.PMID 28104184
- [6]Cooper C, Selwood A, Livingston G Knowledge, detection, and reporting of abuse by health and social care professionals: a systematic review Am J Geriatr Psychiatry, 2009.PMID 19916205
- [7]Cooper C, Selwood A, Blanchard M, Walker Z, Blizard R, et al. The determinants of family carers' abusive behaviour to people with dementia: results of the CARD study J Affect Disord, 2010.PMID 19446884
- [8]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [9]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
- [10]Sessums LL, Zembrzuska H, Jackson JL Does this patient have medical decision-making capacity? JAMA, 2011.PMID 21791691
- [11]Dong X, Simon MA Elder abuse as a risk factor for hospitalization in older persons JAMA Intern Med, 2013.PMID 23567991
- [12]Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, et al. Screening for abuse and neglect of people with dementia J Am Geriatr Soc, 2010.PMID 20398118
- [13]Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach Ann Emerg Med, 2016.PMID 27005448
- [14]Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CR Jr, et al. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study J Am Geriatr Soc, 2015.PMID 26312573
- [15]Gallione C, Dal Molin A, Cristina FVB, Ferns H, Mattioli M, et al. Screening tools for identification of elder abuse: a systematic review J Clin Nurs, 2017.PMID 28042891
- [16]Lachs MS, Pillemer K Abuse and neglect of elderly persons N Engl J Med, 1995.PMID 7632211