The Problem

Elder abuse is the mistreatment of an older adult – aged 60 or older – by a person in a position with an expectation of trust or when an older adult is targeted because of their age or disabilities. This abuse may include physical abuse, sexual abuse, neglect, psychological abuse, and financial exploitation. Many victims suffer multiple types of abuse concurrently.

Elder abuse is common, and it has serious consequences. As many as 10% of older adults experience abuse or neglect each year. Victimization increases the risk of mortality, nursing-home placement, exacerbations of chronic illnesses, and depression. Unfortunately, elder mistreatment is often under-recognized and underreported, with as few as 1 in 24 cases reported to the authorities.

The Emergency Department (ED) offers an ideal opportunity to identify and intervene. An evaluation for acute injury or illness in an ED may be the only time an isolated, vulnerable, abused older adult ever leaves their home.  In fact, abuse victims are less likely to see a primary-care provider than to present to an ED, where acute injuries and illnesses are managed. In the ED, ability to identify abuse is increased because various disciplines – from EMS, triage providers, patient escorts, nurses, radiologists, social workers, and case managers – can observe a patient during an evaluation that typically lasts multiple hours. Additionally, if abuse is detected, resources are available 24/7 to facilitate intervention.

Risk Factors

ED clinicians should be able to identify risk factors for elder abuse victimization as well as factors contributing to one becoming an abuser.

Risk Factors for Becoming a Victim

Functional dependence or disability

Poor physical health

Cognitive impairment/dementia

Poor mental health

Low income/socio-economic status

Social isolation/low social support

Previous history of family violence

Previous traumatic-event exposure

Substance abuse


Risk Factors for Becoming a Perpetrator

History of mental illness

History of substance abuse

Undergoing caregiver stress

Previous history of family violence

Financial dependence on the older adult

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