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Elder abuse 
  •  Introduction
    • can be in the form of mental or physical abuse, neglect, financial wrongdoings or abandonment
    • epidemiology 
      • affects around 2 million Americans per year
      • approximately 1 in 25 individuals over 65 y/o experiences abuse or neglect 
    • risk factors of victims for elder abuse 
      • increasing age
      • functional disability 
      • child abuse within the regional population 
      • cognitive impairment
      • gender is NOT a risk factor
    • caretaker risk factors for elder abuse
      • financial dependence on the elder person
      • substance abuse
      • perceiving the caretaking duty as burdensome
    • associated injuries
      • long bone fractures
      • rib fractures
      • bruises caused from abuse are
        • commonly over 5cm in size 
        • located on the face, neck or back
  • Clinical signs of elder abuse
    • unexplained injuries
    • delays in seeking care
    • repeated fractures, burns, lacerations, etc
    • change in behavior
    • poor hygiene
  • Treatment
    • duty to report
      • physicians are mandated reporters of abuse on elders in almost all states
      • elder abuse is very commonly under reported
    • admit to hospital
      • if the patient is in immediate danger, the patient should be admitted to the hospital
Domestic, spousal or intimate partner abuse
  • Introduction
    • epidemiology
      • as many as 35% of women presenting to the ER with injuries are a result of domestic violence
      • approximately 25% of women experience domestic violence
      • 15% of males are victims of domestic violence
      • over 8.5% reported prior history of abuse
      • children abused in close to 50% of homes where domestic violence occurs
    • risks for domestic abuse  
      • female
      • 19-29 years
      • pregnant 
      • low-income families/low socioeconomic status
    • characteristic injuries or patterns
      • injuries inconsistent with history
      • long delay between injury and treatment
      • repeat injuries
    • characteristics of abused patient
      • change in affect
      • constantly seeking partner approval
      • finding excuses to stay in treatment facility for prolonged period of time
      • repeated visits to the emergency department 
      • significant time missed at work or decreased productivity at work
    • characteristics of the abuser
      • refuses to leave patient alone
      • overly attentive
      • aggressive or hostile
      • refuses to let the patient answer their own questions
    • barrier to reporting
      • fear of retaliation
      • shame
      • difficulty reporting to male physicians
      • fear of custody conflicts
  • Treatment
    • duty to act
      • health care workers should inquire into the safety environment at home in cases of suspected abuse   
      • emotional abuse is more difficult to discern than physical violence
      • reporting requirements for adult abuse is not standardized among states 
        • a physician does not have authority to provide protection to abused spouses in most states
        • should encourage victim to seek protection and report case to law enforcement 
      • physician should document encounter completely and be familiar with their state laws

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