Signs of physical abuse and neglect in the mature patient

Publication date: Available online 5 October 2017
Source:Clinics in Dermatology
Author(s): Karlijn Clarysse, Coleen Kivlahan, Ingo Beyer, Jan Gutermuth
Neglect and physical abuse of elderly is a worrisome health problem, which is expected to grow even further, considering the 'aging of the population.' By 2060, the number of people over 65 is expected to double, whereas birth rates are low. This trend will cause a significant imbalance between different age groups and put more senior adults at risk for abuse. Risk factors, associated with abuse and neglect, are well established and can be categorized in socio-demographic, victim or perpetrator related risk factors. The impacts of these risk factors depend mainly on the setting, which can be community-dwelling or institutionalized older adults. In community-based settings, 90% of perpetrators are family members. In each setting, suspicious physical injuries should be recognized and addressed promptly. This can be very challenging in elderly, amongst others due to the age-related skin changes, which can mimic abuse; however, there are some cutaneous clues that should always raise suspicion of abuse, such as patterned shape or distribution, different healing stages of wounds, parallel injuries, signs of blunt trauma, and irregular patches of alopecia. General awareness is needed, and the advice of dermatologists, who are best trained to differentiate between those lesions, should be systematically sought, in order to reduce false positive and negative interpretations.