New England Journal of Medicine
November 12, 2015 Vol. 373 No. 20
http://www.nejm.org/toc/nejm/medical-journal

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Review Article
Elder Abuse
Edward W. Campion, M.D., Editor
Mark S. Lachs, M.D., M.P.H., and Karl A. Pillemer, Ph.D.
N Engl J Med 2015; 373:1947-1956 November 12, 2015 DOI: 10.1056/NEJMra1404688

Although it has probably existed since antiquity, elder abuse was first described in the medical literature in the 1970s.1 Many initial attempts to define the clinical spectrum of the phenomenon and to formulate effective intervention strategies were limited by their anecdotal nature or were epidemiologically flawed. The past decade, however, has seen improvements in the quality of research on elder abuse that should be of interest to clinicians who care for older adults and their families. Financial exploitation of older adults, which was explored only minimally in the initial studies, has recently been identified as a virtual epidemic and as a problem that may be detected or suspected by an alert physician.

In the field of long-term care, studies have uncovered high rates of interpersonal violence and aggression toward older adults; in particular, abuse of older residents by other residents in long-term care facilities is now recognized as a problem that is more common than physical abuse by staff.2,3 The use of interdisciplinary or interprofessional teams, also referred to as multidisciplinary teams in the context of elder abuse, has emerged as one of the intervention strategies to address the complex and multidimensional needs and problems of victims of elder abuse, and such teams are an important resource for physicians.4,5 These new developments suggest an expanded role for physicians in assessing and treating victims of elder abuse and in referring them for further care.

In this review, we summarize research and clinical evidence on the extent, assessment, and management of elder abuse, derived from our analysis of high-quality studies and recent systematic studies and reviews of the literature on elder abuse.6-10…

…Conclusions
Because victims of elder abuse tend to be isolated, their interactions with physicians, which may be intermittent or rare, present critically important opportunities to recognize elder abuse and to intervene or refer the victims to appropriate providers. Advances in our understanding of the many manifestations of elder abuse and the emergence of interprofessional-team approaches also point to an important role for physicians in addressing this major public health problem. Both research and clinical experience suggest that cases of elder abuse can rarely, if ever, be successfully treated by the physician alone. Therefore, the response of the medical professional must include connecting with specialists in other disciplines, including social work, law enforcement, and protective services, ideally in the context of an interprofessional-team approach.