Elder abuse: a review.

Elder abuse exists in many forms: physical, emotional, financial, and sexual; neglect; and self-neglect. As many as 2.5 million older people are abused each year, and the number of cases will likely increase as this population grows. Elder abuse receives less attention than other forms of domestic violence, and fewer than 10% of cases are reported. Although all states have legislation addressing elder abuse, financial support for evaluation and protective services is lacking. Most states have mandatory reporting; however, it may infringe on the autonomy of competent geriatric individuals. Physicians infrequently report elder abuse because they are not familiar with reporting laws, fear offending patients, are concerned with time limitations, and believe they do not have appropriate evaluation skills. Victims often have low self-esteem, blame themselves for the abuse, and do not want to admit their vulnerabilities or betray their families. The "caregiver stress hypothesis," which suggests abuse stems from caregiver stress and resentment resulting from chronic care of dependent geriatric patients, is a misconception. Abuse is actually better correlated with the emotional and financial dependence of the caregivers on the geriatric victims. Older patients are most commonly abused by the people with whom they live. Older men and women have similar per capita abuse rates. Assessment and management should be supportive without assigning blame and should focus on both the patient and the caregiver. Patients in immediate danger should be hospitalized or placed in emergency shelters. Suspected abuse should be reported directly to the appropriate state agency, which can provide a thorough long-term assessment.