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Identifying Elder Abuse

On this page find information on:

• Bruising in the Geriatric Population
• Determining Abuse as a Cause of Elder Death
• Potential Markers for Elder Mistreatment
• Better Tools to Assess Psychological and Financial Abuse

Bruising in the Geriatric Population

Documenting normal bruising patterns in this population is the first step toward differentiating accidental from suspicious bruising. An NIJ-funded study found that:

• Accidental bruises occur in a predictable pattern.
• Most accidental large bruises are on the extremities.
• The initial color and appearance of bruises changes over time and is less predictable than previously thought.
• Individuals who are on medications known to make bruising more severe and those with compromised functional ability are more likely to have multiple bruises. [1]

The second step in differentiating accidental from suspicious bruising is to document bruises in elderly individuals who are confirmed victims of elder mistreatment. A follow-up study funded by NIJ found that:

• Sixty percent of examined bruises were inflicted, 14 percent were accidental and 26 percent were of unknown causes.  Most participants from the study of non-abused elders (71 percent) could not identify the cause of any of their bruises.
• A majority of abused elders (56 percent) had a large bruise (>5 cm), which is much higher than the percent of non-abused elders from the previous study with a large bruise (7 percent).
• Abused older adults were more likely than non-abused elders to have bruises on the head, neck or torso. [2]

Determining Abuse as a Cause of Elder Death

An NIJ-funded study examined how medical examiners make determinations in cases of suspicious elder deaths and found that they rarely can differentiate symptoms of illness from signs of abuse in elderly decedents. As a result, signs of abuse that are commonly recognized in younger decedents are missed in elders, and abuse is rarely seen as a cause of death. These findings call for additional research on both the decisionmaking practices of medical examiners and the forensic markers of elder mistreatment. They also highlight the need for medical examiners to receive additional training on this issue. [3]

Potential Markers for Elder Mistreatment

Researchers in Arkansas identified specific characteristics within four categories of markers that investigators can look for to determine whether elder mistreatment is occurring or has occurred — see table Potential Markers for Elder Mistreatment. [4]

This study is ongoing; the researchers hope to:

• Determine whether the Arkansas Long-Term Care Reporting law has actually made a difference in quality of care.
• Further elucidate markers.
• Development of an adaptive investigative model for coroners and medical examiners.

Better Tools to Assess Psychological and Financial Abuse

NIJ-funded researchers have developed and tested two measurement tools that give the field better ways to assess financial and psychological abuse of elders:  [5]

• Older Adults Psychological Abuse Measure, which has 31 items.
• Older Adults Financial Exploitation Measure, which has 30 items.

The researchers used concept mapping [6] to develop measurements of abuse. They tested the tools on 226 clients of adult protective services with substantiated cases of abuse.

Adult Protective Services in six sites in Illinois are using the two new measures along with assessment tools to measure physical and sexual abuse and neglect. They are doing so as part of an NIJ-funded followup project designed to pilot test a prototype for an electronic Elder Abuse Decision Support System — a computer-based application of the developed measures to help practitioners identify abuse.

Next section: Perpetrators of Elder Abuse.