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Updated: Mar 11 2024

Domestic and Elder Abuse

Images abuse.jpg
  • 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
      • 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
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