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 throughout the world. Clinicians often misinterpret the health effects of elder mistreatment (EM) as caused by underlying disease or the aging process. Clues to mistreatment include the patient's appearance, recurrent urgent-care 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 clinician maintain a therapeutic alliance with the victim and abuser. Victim safety should be the paramount concern. Victims with decisional capacity should be apprised of the chronic, progressive nature of EM. Clinical strategies to stop abuse include hospitalization and closer monitoring through office visits and home nursing. In most U.S. states, laws require that clinicians report at least physical abuse to the local adult protective services agency or to law enforcement. Mandated reporting, while offering potential social and legal remedies, raises ethical concerns regarding the physician-patient relationship.