Elder abuse: A call to action

An estimated 2 million people a year are victims of elder abuse, which rang es from neglect and mistreatment to physical abuse. By the year 2020, a ful l 22% of the population will be aged 65 or older. This demographic explosio n demands that we identify and protect those at risk. To investigate the in cidence of elder abuse or neglect (EAN) and to determine clinician awarenes s of associated risk factors, we conducted a I-year retrospective review of thermally injured patients aged 60 or older. Data included age, total body surface area burned, mechanism of injury, length of hospital stay, mortali ty, abuse or neglect risk factors, and referral to the appropriate social a gency. We found that our elderly patients (n = 28) were poorly screened for EAN. While 64% to 96% of patients were screened for cognitive impairment, overall health, and financial resources, none were screened for risk factor s of emotional isolation. None of the patient's caregivers, including any s pouses, roommates, or guardians, were screened for risk factors of substanc e abuse, familial violence, dependency needs, or external stresses. With th e use of available data, we were able to place 11 patients on the following levels of abuse or neglect: 1) low risk for abuse; 2) self-neglect; 3) neg lect; and 4) abuse. By this scale, 7 patients (64%) were victims of self-ne glect, 3 patients (27%) were victims of neglect, and 1 patient (9%) was a v ictim of abuse. Adult Protective Services intervened in 2 cases. Recognizin g that all cases of EAN should be preventable, we cannot accept the socioec onomic impact of this entity. The II patients identified as victims of negl ect, self-neglect, or abuse accounted for 135 hospital days and 8 fatalitie s. Before we can address EAN, health care personnel must be made aware of t he problem and routine screening for risk factors must be implemented. The true incidence of EAN is likely underestimated because health care provider s have difficulty recognizing its features. A standard assessment tool to s creen for neglect or abuse should be used for each older adult admission.