Why elder abuse continues to elude the health care system.

Elderly men and women of all socioeconomic and ethnic backgrounds are vulnerable to mistreatment, and most often it goes undetected. For many elderly victims of abuse, the hospital is the only potential site for outside contact and support. An elder abuse program has been created at The Mount Sinai Hospital in New York City, and funding was granted to assist victims with compensation claims; provide counsel and advocacy for victims; and provide support via ongoing telephone contact and referrals to community agencies. Simultaneously, hospital-wide educational seminars and rounds have provided the staff and students with information concerning detection of abuse and neglect. Over a 2-year period, 182 cases were identified and assessed. More than 50% of these cases involved patients with a diagnosis of memory impairment. Five percent of the cases involved a long history of domestic violence. In most cases a family member was identified as the abuser, and in a majority of instances the victim either denied the suspected abuse or tried to rationalize the behavior of the abuser. Patients were afraid of reporting abuse or changing their situation, despite being informed of possible resources. To combat this escalating problem in our growing elderly population, interdisciplinary collaboration between physicians and social workers is often crucial. Communication via the medical record can be key to monitoring patients in the community. There also needs to be ongoing education of all hospital staff in an effort to continually heighten awareness of this problem.