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 Etiology 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 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 most common cause of nonfatal injury to women frequency often underestimated by orthopaedic surgeons 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 short-term relationship cohabitation low-income families/low socioeconomic status Etiology 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