Elder abuse: definitions and implications for medical education.

Elder abuse is a growing problem as the number of dependent older persons increases and the proportions of middle-aged and younger children--who themselves are struggling with problems of their own families and finances--decline. As this occurs, older women increasingly will dominate the ranks of the elderly. These realities make it imperative for medical students to become familiar with the care of older persons, including abused older persons, who, at present, constitute at least 2% of the population over 65. The author outlines the causes of elder abuse (e.g., previous abusive relationships in a family increase the likelihood of elder abuse); lists important barriers to diagnosis and management of the abused (e.g., the physician's uncomfortable position between protecting confidentiality, serving as an advocate for the patient, and needing to collaborate with the family--and often the abuser); and outlines the various forms of intervention that are available (e.g., assistance of adult protection services). Education in elder abuse should be distributed across the entire medical student curriculum (many examples are given) and should be dominated by case-based learning at a variety of sites, such as hospitals, clinics, and subacute care units. The author closes by reiterating the urgent need to prepare physicians now to deal with a problem of increasing magnitude, severity, and ugliness.