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How to Spot Elder Abuse

October 23, 2020

Written by Vivian Lei

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Elder abuse victims are more likely to have facial injuries, particularly on their left side, and injuries of the head and neck in the absence of upper and lower extremity injuries.

Why does this matter?
Elder abuse is common (estimated at 5-10% of older adults annually) but frequently under-recognized. Many victims in this vulnerable patient population may be seen in the Emergency Department with injuries attributed to an unintentional fall. Identifying injury patterns concerning for abuse is an important skillset for physicians who may be in a unique position to report and address these cases.

Not just another fall from standing
This was a case-control study of injury patterns in 78 elder abuse cases with visible injury matched to a similar group of 78 patients presenting to a large, urban, academic ED with unintentional falls. The elder abuse cases were pulled from legal records of successfully prosecuted cases of physical abuse in victims over 60 years of age.

Compared to patients with unintentional falls, abuse victims were more likely to have:

  • Bruising (78% vs. 54%)

  • Injury to the maxillofacial, dental, or neck region (67% vs. 28%)

    • Left cheek and zygoma (22% vs. 3%)

    • Ears (6% vs. 0%)

    • Neck (15% vs. 0%)

  • Injury to the chest, abdomen, or back (19% vs. 4%)

Abuse victims were less likely to have:

  • Fractures (8% vs. 22%)

  • Injuries to the lower extremities (9% vs. 41%)

Abuse victims were much more likely to have injuries of the head and neck area without upper and lower extremity injuries (50% vs. 8%). Of the 22 elder abuse victims who did not sustain a visible injury, pain was most commonly reported in the chest, abdomen, back, face, jaw, and upper extremities. Consider these patterns as red flags when treating elderly patients presenting to the ED with unexplained injuries.

Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases. Ann Emerg Med. 2020 Sep;76(3):266-276. doi: 10.1016/j.annemergmed.2020.03.020. Epub 2020 Jun 10.

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