Mistreatment of the elderly: A case for dermatology

Violence against older people is a still neglected public health problem. One professional group could help change that: Dermatologists.

What do we know about abuse of the elderly so far?

There are five types: physical, psychological, verbal or sexual abuse, financial exploitation, and neglect.
Women, people with low socio-economic status, with disabilities or cognitive impairment, and people with non-white skin colour are particularly at risk.
The perpetrators are often caring relatives such as spouses, children or grandchildren. Alcoholism, substance abuse, mental health problems, financial dependence or their own experiences of abuse and violence are often involved.
Abuse is associated with depression, increased morbidity, and mortality.

Physicians should take a closer look

An estimated 10% of all older people in the US have experienced some form of abuse. However, only a fraction of this is reported. Physicians are also often unsure and do not know how to act adequately. Dermatologists, with their trained eye for external lesions, have a special responsibility here.

Signs of the use of force may include haematomas, lacerations or lacerations, fractures, traumatic alopecia and scabies. Neglect may be indicated by ulcers, recurrent genital dermatitis, and untreated skin diseases. Also alert to repeated falls, previous trauma, untreated old injuries, and multiple injuries in different areas.

Screening tools can help

All this requires training and practice. But the study authors alert that this is precisely what is lacking. They encourage the use of screening tools that can detect suspected cases on the basis of a few questions. For example, the Elder Abuse Suspicion Index (EASI) consists of five simple questions that can be answered in a few minutes. Other proven screening tools are the Brief Abuse Screen for the Elderly (BASE), the Conflict Tactics Scale (CTS), the Caregiver Abuse Screen (CASE), and the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).

Tools for the emergency room

A new two-step process for detecting abuse can be well integrated into emergency departments. The first step is to ask two direct questions about experiences of violence. If one of them is answered in the affirmative, a detailed screening, the Emergency Department Senior Abuse Identification (ED Senior AID) Tool, is used. It is collected by the nursing staff and is also suitable for patients with cognitive impairment. It targets all forms of violence, from physical and psychological abuse to neglect.

Show consideration towards the victims

The authors conclude by saying that it is important to always interview potential victims and perpetrators separately and to create an examination atmosphere that is as pleasant as possible for the patients. After all, experiences of abuse can be fraught with great fear, embarrassment, and shame.

Watch for signs of violence

Physicians have both a legal and moral obligation to report suspected cases of elder abuse. Skin specialists in particular should pay close attention to outward signs of violence. Simple screening tools that can be easily integrated into the daily routine of the practice or clinic can help.

Source:

Brown A, Kim SJ, Detecting Elder Abuse in Dermatology: A Clinical and Practical Review, Journal of the American Academy of Dermatology (2023), doi: https://doi.org/10.1016/j.jaad.2023.02.003.