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- Define levels of abuse
- Discuss patient assessment
- Review prehospital treatment of the abused geriatric patient
We were called for an 88-year-old female who had fallen, and her husband and daughter were unable to lift her. Expecting a routine lift assist, we were surprised to find Collette prone and covered in several blankets on the floor of an unheated porch. Even with a steady draft of cold fresh air, the stench of stale urine, feces and infected flesh was overwhelming.
"When did Collette fall?" I asked.
"Dad's not sure," the daughter, a geriatric patient herself, answered. "It has been a week since I was last here."
Collette responded to verbal stimuli, had rapid, shallow breathing and was shockingly emaciated. In addition to severe dehydration, there were numerous pressure sores on her chest, chin, wrists, elbows and several other bone prominences that had been in contact with the cold floor for days.
A bowl of water and a plate with a stale-looking sandwich were near her head. Her husband tried to explain that he thought she was OK and didn't want to bother anyone. He was clearly over-burdened caring for his aging wife, who had a history of dementia and frequent falls. Was his lack of action abuse? Did other caregivers have responsibilities for Collette they were neglecting? Was this current episode part of a larger pattern of abuse and neglect?
With a growing elderly population in the United States, EMS professionals are more frequently assessing, treating and transporting geriatric patients. They are also more likely to encounter elder abuse, neglect and financial exploitation than ever before. Knowing signs and symptoms of abuse and neglect, as well as the risk factors and traits of abusers, is important for every EMS professional.
Definitions and Scope
Elder abuse is specifically defined in state statute. The Texas Family Code, for example, defines an elderly person as someone over 65 years of age, and specifically defines abuse as "the negligent or willful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical or emotional harm or pain to an elderly or disabled person by the person's caretaker, family member or other individual who has an ongoing relationship with the person."1 The Texas code also includes specific definitions for sexual abuse, neglect and exploitation.
In general, abuse of elders, like abuse of children or intimate partners, is a recurring "pattern of coercive tactics that abusers use to gain and maintain power and control over the elderly." The National Clearinghouse on Abuse in Later Life (NCALL) states that elder abuse is "various types of abuse against someone age 60 or 65 and older." The abuse may have begun well before the patient became elderly. Intimate partner violence can persist for decades. Relationships also change or worsen over time with life and health changes. Types of abuse can include physical, sexual and emotional.2
Physical abuse is to cause injury, pain or impairment through blunt and/or penetrating trauma. Slapping, punching, choking, hair-pulling, pushing, restraining, tripping and burning are forces that can cause injury.3,4
Sexual abuse is non-consensual sexual contact of any kind. Examples of sexual abuse include unwanted touching, sexual contact with a person incapable of consenting, sexual assault or battery, and sexually explicit photography.1,3,5
Emotional abuse, also known as psychological abuse, is a pattern of behaviors including withholding of affection, humiliation, condescension, yelling, name-calling and blaming to gain and maintain control over the victim.6