Older adult abuse

Last updated: July 25, 2023

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Summarytoggle arrow icon

Older adult abuse, also referred to as elder abuse, is any form of maltreatment of an individual ≥ 60 years of age by a trusted person or caregiver. Signs of older adult abuse include lack of control of medical conditions, delays in seeking appropriate medical care, and unexplained soft tissue injuries. Screening recommendations for older adult abuse vary, and there are no tests or screening tools to definitively confirm the diagnosis. If older adult abuse is suspected on clinical evaluation or on laboratory analysis (e.g., evidence of dehydration, malnutrition, and/or medication nonadherence), further evaluation is warranted. Management includes treating acute medical conditions, ensuring patient safety, and mandatory reporting in most states.

Definitiontoggle arrow icon

  • Older adult abuse: any form of physical, emotional, sexual, psychological, or financial mistreatment or neglect of an adult ≥ 60 years of age by a caregiver or someone the individual trusts [2][3]

Epidemiologytoggle arrow icon

Approximately 10% of older adults experience older adult abuse. [2][4][5]

Epidemiological data refers to the US, unless otherwise specified.

Risk factorstoggle arrow icon

  • Female sex
  • Large household
  • Residence in an assisted living facility
  • Dementia
  • Functional impairment or poor physical health
  • Social isolation and/or lack of support
  • Low income
  • Financial dependency of the caregiver on the older adult

Not all individuals with these risk factors are mistreated or abused. Not all individuals who experience abuse have these risk factors. [6]

Red flagstoggle arrow icon

On history [2][6][7]

  • Delay between onset of illness or injury and seeking medical care
  • Lack of control of medical conditions despite an adequate care plan
  • Frequent ED visits
  • Reports of theft or unusual loss of belongings or money
  • Depression, suicidal ideation

On examination [2][6]

Observed interactions with caregivers [2][6][7]

  • An inconsistent history between the patient and caregiver
  • Patient shows fearful, avoidant, or hostile behavior (e.g., avoiding eye contact), especially if this is reported to be new behavior.
  • Caregiver is frustrated, overwhelmed, or lacks knowledge about the patient's needs.

Screeningtoggle arrow icon

Indications for screening [8][9]

Screening recommendations for older adult abuse and neglect (including self-neglect) vary.

  • The American Medical Association, American College of Emergency Physicians, and American Academy of Neurology make general recommendations for routine screening, but without specifying any particular tool. [10][11][12]
  • The American Academy of Family Physicians suggests routine screening for risk factors for older adult abuse. [6]
  • According to the USPSTF, there is insufficient evidence to recommend either for or against routine screening for older adult abuse. [3]

Consider routine screening for older adult abuse in all individuals > 60 years of age.

Screening tools [9]

  • There is insufficient evidence on the best method to screen for older adult abuse. [3][9]
  • Follow hospital protocols when available.
  • Screening for cognitive impairment is recommended before screening for abuse. [6]
  • Examples of tools include:
    • Elder Abuse Suspicion Index for use in ambulatory care settings [6]
    • Emergency department senior abuse identification tool, which incorporates cognitive screening, for use in the ED [9][13][14]

If there is any suspicion of older adult abuse, refer the patient to Adult Protective Services, social services, or their equivalent, for further evaluation. [6]

Managementtoggle arrow icon

  • General principles [6][8]
    • If presenting in the emergency room, conduct a primary survey; see “Trauma in older adults.”
    • Obtain informed consent for every diagnostic and management step.
    • Attempt to speak to the patient privately.
    • Maintain a low threshold for notifying hospital security about suspected older adult abuse to ensure the safety of the patient and staff.
    • Involve a multidisciplinary team early.
    • Follow local protocols for preparing accurate medical documentation for potential criminal proceedings.

Diagnostic evaluationtoggle arrow icon

Approach [2][6]

There are no diagnostic studies that can definitively confirm older adult abuse.

  • Perform a clinical evaluation in patients with either of the following:
  • Consider additional diagnostic studies, based on clinical suspicion, to:
    • Identify findings that may be consistent with older adult abuse
    • Exclude organic causes of signs and symptoms

Signs of older adult abuse may be difficult to distinguish from features of age-related conditions (e.g., poor wound healing, osteoporosis, dementia) or adverse effects of prescribed medication (e.g., steroid purpura). [6]

Clinical evaluation [2][6][8]

The goal of clinical evaluation is to identify and/or further evaluate red flags for older adult abuse to determine whether there is a reasonable suspicion for abuse. It is essential to interview patients and their caregivers separately.

Patients' self-reported clinical history may be unreliable, e.g., due to cognitive impairment, fear, shame, or cultural and/or language barriers. [2][6][9]

Laboratory studies [4][6]

Imaging [4][6]

  • Obtain imaging studies based on history and physical examination.
  • Notify the radiologist if abuse of an older adult is suspected.

Subsequent managementtoggle arrow icon

Treatment [4]

  • Treat traumatic injuries (e.g., fractures) and acute medical conditions.
  • Manage any exacerbations of chronic conditions.
  • See also “Trauma in older adults.”

Reporting [8]

General principles

  • Physicians have a legal obligation to protect their patients and report older adult abuse in most states, even if reporting goes against the patient's wishes. [8][16]
  • State-specific information can be found on the state's Department of Health website. [17]

Specific scenarios [18][19][20]


Admit to the hospital or create a safe discharge plan.

In the US, the appropriate agency for reporting older adult abuse can be found by calling Eldercare Locator (1-800-677-1116) or visiting the National Adult Protective Services Association website ( [4][8]

Referencestoggle arrow icon

  1. $Contributor Disclosures - Older adult abuse. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy.
  2. Hoover RM, Polson M. Detecting elder abuse and neglect: assessment and intervention. Am Fam Physician. 2014; 89 (6): p.453-60.
  3. Lachs MS, Pillemer KA. Elder Abuse. N Engl J Med. 2015; 373 (20): p.1947-1956.doi: 10.1056/nejmra1404688 . | Open in Read by QxMD
  4. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  5. Richmond NL, Zimmerman S, Reeve BB, et al. Ability of Older Adults to Report Elder Abuse: An Emergency Department–Based Cross‐Sectional Study. J Am Geriatr Soc. 2020; 68 (1): p.170-175.doi: 10.1111/jgs.16211 . | Open in Read by QxMD
  6. Rosen T, Platts-Mills TF, Fulmer T. Screening for elder mistreatment in emergency departments: current progress and recommendations for next steps. J Elder Abuse Negl. 2020; 32 (3): p.295-315.doi: 10.1080/08946566.2020.1768997 . | Open in Read by QxMD
  7. Cimino-Fiallos N, Rosen T. Elder Abuse—A Guide to Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am. 2021; 39 (2): p.405-417.doi: 10.1016/j.emc.2021.01.009 . | Open in Read by QxMD
  8. Patel K, Bunachita S, Chiu H, Suresh P, Patel UK. Elder Abuse: A Comprehensive Overview and Physician-Associated Challenges. Cureus. 2021.doi: 10.7759/cureus.14375 . | Open in Read by QxMD
  9. Adult Protective Services Reporting Chart. Updated: December 1, 2019. Accessed: October 26, 2021.
  10. How do I report elder abuse or abuse of an older person or senior?. Updated: September 11, 2014. Accessed: October 26, 2021.
  11. Weinmeyer R. Statutes to combat elder abuse in nursing homes.. Virtual Mentor. 2014; 16 (5): p.359-64.doi: 10.1001/virtualmentor.2014.16.05.hlaw1-1405 . | Open in Read by QxMD
  12. Intervention Partners. . Accessed: October 26, 2021.
  13. Rosen T, Stern ME, Elman A, Mulcare MR. Identifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department. Clin Geriatr Med. 2018; 34 (3): p.435-451.doi: 10.1016/j.cger.2018.04.007 . | Open in Read by QxMD
  14. Curry SJ, Krist AH, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. JAMA. 2018; 320 (16): p.1678.doi: 10.1001/jama.2018.14741 . | Open in Read by QxMD
  15. Preventing Elder Abuse. Updated: June 2, 2021. Accessed: August 25, 2021.
  16. Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF. Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach. Ann Emerg Med. 2016; 68 (3): p.378-382.doi: 10.1016/j.annemergmed.2016.01.037 . | Open in Read by QxMD
  17. Preventing, Identifying & Treating Violence & Abuse. . Accessed: May 19, 2023.
  18. American College of Emergency Physicians. Domestic Family Violence. Ann Emerg Med. 2019; 74 (3): p.e32-e33.doi: 10.1016/j.annemergmed.2019.05.005 . | Open in Read by QxMD
  19. Schulman EA, Hohler AD. The American Academy of Neurology position statement on abuse and violence. Neurology. 2012; 78 (6): p.433-5.doi: 10.1212/WNL.0b013e318245d21c . | Open in Read by QxMD
  20. Platts-Mills TF, Hurka-Richardson K, Shams RB, et al. Multicenter Validation of an Emergency Department–Based Screening Tool to Identify Elder Abuse. Ann Emerg Med. 2020; 76 (3): p.280-290.doi: 10.1016/j.annemergmed.2020.07.005 . | Open in Read by QxMD
  21. Platts-Mills TF, Dayaa JA, Reeve BB, et al. Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool. J Elder Abuse Negl. 2018; 30 (4): p.247-270.doi: 10.1080/08946566.2018.1460285 . | Open in Read by QxMD

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