Skip to main content

Elder Abuse and Dementia

CME credit available from Harvard Medical School through April 2020.

Published Materials

This program aims to raise awareness of risk factors for elder abuse and to help clinicians provide better evidence-based care for patients with cognitive impairment and dementia.

Elder abuse is common, and occurs in about 10% of elders annually.1 It includes physical, emotional, and psychological abuse and extends to financial exploitation and neglect. However, many cases of elder abuse go unreported to law enforcement or local Area Agencies on Aging.2

Only 1 in every 24 cases is reported

Abuse in older adults increases the risk of:

  • mortality3
  • disability4
  • emergency room visits5
  • hospitalization, including readmissions6
  • nursing home placement7

Given the adverse health outcomes from elder abuse, identifying patients being abused is critical.  A set of nine vulnerability factors may identify those at greatest risk of abuse: 

  • Demographic: age >80, female sex, non-Hispanic black race, income ≥$15,000
  • Health-related: ≥3 medical conditions, cognitive impairment (MMSE <23), physical disability (e.g. difficulty with stairs), depressive symptoms, and limited social network (e.g. <2 visits/month from family or friends)

The prevalence of elder abuse is dramatically higher in patients with multiple vulnerability factors8

In patients with multiple vulnerability factors, a short six-question screen can help identify the abuse9:

For older adults with dementia, the risk of elder abuse is much higher.  Nearly half of patients reported abuse in the past year, with caregivers self-reporting similar frequencies of abusive behaviors.10

Managing dementia and counseling caregivers are both critical to ensuring the health and safety of older adults with dementia.

A framework for managing patients with dementia

Medications, such as cholinesterase inhibitors and memantine, used to manage cognitive impairment provide a modest benefit that is often time limited in most patients. Balance the benefits of the medications with their side effects to determine whether medication should be continued. 
As dementia progresses, behavioral and psychological symptoms of dementia are common. These behaviors can increase the risk of elder abuse,11 and can be managed non-drug approaches and medications, if indicated. 

Managing behavioral and psychological symptoms of dementia

Unpaid caregivers such as family, friends, and neighbors, provide a majority of the care for community-dwelling older adults with dementia.12 Monitoring caregiver stress and health is crucial to providing patients with dementia the safe, supportive care they need. Situational and emotional coping classes can reduce caregiver anger and depression, while increasing positive coping skills.13


Additional Resources for Providers
Additional Resources for Caregivers

Information current at time of publication, April 2017.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.


References
  1. Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. Am J Public Health. 2010;100(2):292-297.
  2. Lachs MSB, J. Under the radar: New York state elder abuse prevalence study. New York, NY: Lifespan of Greater Rochester, Inc.; Weill Cornell Medical Center of Cornell University; and New York City Department for the Aging.;2011.
  3. Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. JAMA. 1998;280(5):428-432.
  4. Schofield MJ, Powers JR, Loxton D. Mortality and disability outcomes of self-reported elder abuse: a 12-year prospective investigation. J Am Geriatr Soc. 2013;61(5):679-685.
  5. Dong X, Simon MA. Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project. Am J Emerg Med. 2013;31(4):693-698.
  6. Dong X, Simon MA. Elder self-neglect is associated with an increased rate of 30-day hospital readmission: findings from the Chicago Health and Aging Project. Gerontology. 2015;61(1):41-50.
  7. Dong X, Simon MA. Association between reported elder abuse and rates of admission to skilled nursing facilities: findings from a longitudinal population-based cohort study. Gerontology. 2013;59(5):464-472.
  8. Dong X, Simon MA. Vulnerability risk index profile for elder abuse in a community-dwelling. J Am Geriatr Soc. 2014;62(1):10-15.
  9. Dong X. Screening for Elder Abuse in Healthcare Settings: Why Should We Care, and Is It a Missed Quality Indicator? J Am Geriatr Soc. 2015;63(8):1686-1688.
  10. Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, Fitzgerald W. Screening for abuse and neglect of people with dementia. J Am Geriatr Soc. 2010;58(3):493-500.
  11. Vandeweerd C, Paveza GJ, Walsh M, Corvin J. Physical mistreatment in persons with Alzheimer's disease. J Aging Res. 2013;2013:920324.
  12. Alzheimer's Association. 2016 Alzheimer's Disease Facts and Figures. 2016.
  13. Coon DW, Thompson L, Steffen A, Sorocco K, Gallagher-Thompson D. Anger and Depression Management: Psychoeducational Skill Training Interventions for Women Caregivers of a Relative With Dementia. The Gerontologist. 2003;43(5):678-689.