Elder Abuse & Neglect — Community Context

The 82-year-old patient is underweight, unkempt, and frightened — and the caregiver daughter answers every question for the patient. The community health nurse recognizes this pattern because it is the same one every time.

Elder abuse includes physical abuse, emotional/psychological abuse, sexual abuse, neglect (failure to provide basic needs), abandonment, and financial exploitation. An estimated 1 in 10 adults aged 60 and older experience some form of abuse, and the majority of cases are never reported. Risk factors for victimization include cognitive impairment, social isolation, physical dependence on the abuser, and living with the abuser. Risk factors for perpetration include caregiver burden and stress, substance use, financial dependence on the elder, history of family violence, and mental illness. The community health nurse identifies abuse through assessment: unexplained injuries or injuries inconsistent with the explanation provided, poor hygiene or malnutrition in a patient with a caregiver, pressure sores in a patient receiving home care, fearful behavior when the caregiver is present, withdrawal of the elder from social activities, unusual financial transactions or missing belongings, and caregiver's refusal to allow the nurse to see the patient alone. Assessment should be conducted privately — interview the elder separately from the caregiver. Validated screening tools include the Elder Abuse Suspicion Index (EASI). Nurses should follow state law and facility policy; suspected elder or vulnerable adult abuse is commonly reportable to APS. Reports go to Adult Protective Services (APS), not child protective services. The nurse documents findings objectively, reports suspected abuse to APS, and develops a safety plan that may include respite care for the caregiver, community support services, legal resources (protective orders), and alternative living arrangements. If the elder is competent and refuses help, the nurse respects autonomy while continuing to provide resources and monitor the situation at subsequent visits.

Key Distinctions

Elder abuse is reported to Adult Protective Services (APS); child abuse is reported to Child Protective Services (CPS) — different agencies, different laws. Self-neglect (an elder living alone who cannot care for themselves) is distinct from caregiver neglect and may also warrant APS referral. A cognitively intact elder has the right to refuse services even if the nurse believes the situation is unsafe — autonomy is preserved unless the person lacks decision-making capacity. Financial exploitation is the most common form of elder abuse and is often perpetrated by family members.

Clinical Pearl

Interview the elder alone. If the caregiver insists on staying, that insistence is itself a red flag. The nurse makes the report on suspicion — proof is the investigator's job, not the nurse's.