The management of elder mistreatment: the physician's role

The physical abuse, psychological abuse, exploitation, and neglect of older adults constitute a serious and under-recognized public health problem thr ough out the world. Clinicians often misinterpret the health effects of eld er mistreatment (EM) as caused by underlying disease or the aging process. Clues to mistreatment include the patient's appearance, recurrent urgent-ca re visits for the same diagnosis, missed appointments, suspicious physical findings, and implausible explanations for injuries. Avoiding confrontation and emphasizing treatment of abuse-related health conditions help the clin ician maintain a therapeutic alliance with the victim and abuser. Victim sa fety should be the paramount concern. Victims with decisional capacity shou ld be apprised of the chronic, progressive nature of EM. Clinical strategie s to stop abuse include hospitalization and closer monitoring through offic e visits and home nursing. In most U.S. states, laws require that clinician s report at least physical abuse to the local adult protective services age ncy or to law enforcement. Mandated reporting, while offering potential soc ial and legal remedies, raises ethical concerns regarding the physician-pat ient relationship.