Continuing medical educationGeriatric dermatology: Part II. Risk factors and cutaneous signs of elder mistreatment for the dermatologist
Section snippets
Scope and impact of the problem
Multiple studies have suggested that elder mistreatment is a highly prevalent yet underreported phenomenon.2, 3, 4, 5, 6, 7, 8 In 2003, the National Research Council reported that an estimated 1 to 2 million Americans ≥65 years of age have been mistreated by a caregiver.3 Other estimates are similar, ranging from 1% to 10% of the population >60 years of age that are believed to have been abused.2, 3, 4, 5 The reporting rate in noninstitutional settings is lower than that in nursing homes, with
Definition of elder abuse and neglect
Elder abuse describes a range of acts that cause harm or potential for harm, intentionally or by neglect, to an older adult.7 While elder abuse can be categorized in several ways, types of abuse with visible cutaneous manifestations include physical abuse (including sexual abuse) and neglect (including self-neglect).7 In the community setting, self-neglect is more common than elder abuse or neglect.17 The definition of self-neglect includes failure to provide oneself with means to physical
Risk factors for elder abuse and neglect
Key point Recognition of key risk factors can flag the most vulnerable older patients for a more comprehensive skin examination
Physicians’ limited knowledge of key risk factors for elder mistreatment can be a barrier to appropriate detection and response.17 Demographic and psychosocial risk factors based on reported data in the medical literature are listed in Table II, Table III. Table II outlines risk factors of potential victims, and Table III summarizes risk factors predicting abusive caregivers. In
Cutaneous manifestations of elder abuse
Key points Cutaneous signs of elder abuse, such as purpura and petechiae from intentional trauma, must be differentiated from vasculitis, vasculopathy, and unintentional injury, such as from falls Elder physical abuse includes sexual abuse and should be suspected when older patients without decision-making ability present with cutaneous signs of sexually transmitted disease
Recognizing important risk factors for elder abuse can flag patients for a more comprehensive skin examination for cutaneous signs of
Cutaneous manifestations of elder neglect
Key points Nutritional deficiencies from elder neglect (including self-neglect) can lead to a variety of skin manifestations, and must be distinguished from conditions such as photosensitive dermatitis from nonnutritional causes, paraneoplastic syndromes, and drug side effects Pressure ulcers can be a sign of elder neglect from lack of repositioning, but nutritional deficiency, another sign of elder neglect, can also lead to poor wound healing
Elder neglect is more common than elder abuse and may be
Responding to suspected cases of elder abuse or neglect
Key points In cases of suspected elder mistreatment, interview the patient apart from the caregiver if possible When the medical history and skin examination are not congruent, elder mistreatment may be suspected Reporting suspected cases of elder mistreatment to Adult Protective Services is mandated by law, even though many patients with decision-making capacity may eventually decline the services offered
After the consideration of risk factors, history, and skin findings, timely management of suspected
Conclusion
Given the prevalence of elder abuse and neglect and the underreporting of such cases by physicians, a dermatologist should be aware of risk factors and cutaneous manifestations along with their differential diagnoses. There are several potential barriers in detecting and managing elder abuse or neglect, and recognizing these barriers is the first step to reducing them. Having a plan to report or refer suspected elder abuse may be life-saving, and will better serve our growing population of
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Cited by (22)
Dermatology and Gender Violence
2024, Actas Dermo-SifiliograficasElder Mistreatment: Emergency Department Recognition and Management
2023, Clinics in Geriatric MedicineDetecting elder abuse in dermatology: A clinical and practical review
2023, Journal of the American Academy of DermatologyOrthopedic Manifestations of Abuse
2021, American Journal of MedicineCitation Excerpt :Physicians should be especially aware of injuries to areas not commonly injured, such as the inner thigh, top of the feet, inner ankles, palms/soles, and posterior neck, as these areas are not commonly involved in daily activities or accidental trauma.13 More commonly, elderly patients will present with bruises and burns; physicians should take note of unusual locations, such as those not over bony prominences, or patterns, such as a stocking-glove distribution, which may suggest an abusive injury.13-15 Additionally, diaphyseal fracture of the ulna is an injury uncommon in accidental trauma that has been associated with elder abuse.16
Dermatology education in geriatric fellowship programs: A nationwide survey of program directors
2020, Journal of the American Academy of DermatologyIdentifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department
2018, Clinics in Geriatric Medicine
Supported in part by the D. W. Reynolds Foundation, American Federation for Aging Research, and the John A. Hartford Foundation (Dr Endo).
Dr Chang is an investigator in clinical trials sponsored by Genentech, Novartis, Galderma, and Nuskin.