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Recognizing the Signs of Elder Abuse

Currently, more than 36 million people in the United States are older than 65 and 600,000 older adults require assistance with activities of daily living. The number of American adults older than 60 is expected to double by 2050,3 with adults over age 85 serving as the fastest growing cohort. This aging population is at risk for abuse and neglect, which are frequently underreported, underestimated, undetected, and often perpetrated by family members.

How to Spot the Signs of Elder Mistreatment

Currently, more than 36 million people in the United States are older than 65 and 600,000 older adults require assistance with activities of daily living. The number of American adults older than 60 is expected to double by 2050, with adults over age 85 serving as the fastest growing cohort. This aging population is at risk for abuse and neglect, which are frequently underreported, underestimated, undetected, and often perpetrated by family members.

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Developed Relationships

Oral health professionals typically see patients every 3 months to 6 months, while patients may see their primary care physicians much less. Dental hygienists have frequent interaction with older adults and are well positioned to provide risk assessment, detect signs and symptoms of mistreatment, and promote strategies to improve patients’ quality of life.

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What Is Abuse?

Abuse is defined as the inflection or injury, confinement, intimidation, or punishment that results in physical harm, pain, or mental distress. Elder abuse is a single or repeated act or lack of responsibility occurring where there was an expectation of trust, which causes harm or distress to an older person. Assessing the prevalence of abuse is difficult because each state has different regulations and legal definitions of abuse.

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Sobering Statistics

A systematic review found the prevalence of elder abuse in the US ranges from 3.2% to 27.5%. The World Health Organization estimates that one in six older adults is mistreated in some form. One in 10 older adults reported being emotionally, physically, or sexually abused, or neglected between 2009 and 2010. The more vulnerable a patient is, the more likely he or she is to be abused and the more serious the nature of abuse. Of the 17% of adults who are mistreated, 11.6% are psychological/emotional abuse, 2.6% are physical abuse, 6.8% are financial abuse or extortion, 0.9% are sexual abuse, and 4.2% are neglect. It is estimated that only 1% of abuse cases are reported. More than 90% of abuse cases are perpetrated by a family member, usually an adult child acting as a caregiver.

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The Role of the Dental Hygienist

Dental hygienists should assess a patient’s medical and dental history, emotional status, physical characteristics, and extra- and intraoral manifestations. Patients who appear anxious, withdrawn, depressed, overly eager to cooperate, aggressive, irritable, or note that they may not be in control of their own finances may be experiencing some form of mistreatment. Patients experiencing abuse will often provide illogical explanations or quickly jump or dodge motions from another person.

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Seeing the Signs

Signs of physical abuse include: bruises at various stages of healing, welts or patterned marks from rope or belt, repeated injuries, burns, bite marks, facial or mandible fractures, facial or eye bruising, lip trauma, temporomandibular pain, traumatic alopecia, avulsed or fractured teeth, and fractured dentures. Unresponsive attitude, lack of communication, unreasonable fear, evasiveness, and lack of social interest are common signs of emotional abuse. Signs of sexual abuse are self-reporting of sexually transmitted infection (STI) or medications prescribed for an STI, or intraoral signs of STI, such as condyloma acuminatum, syphilis chancre, or primary herpetic gingivostomatitis. Palatal petechiae or bruised edentulous areas are signs of forced oral sex. Signs of neglect include sunken eyes, extreme thirst, unexplained weight loss, poor personal or oral hygiene, inappropriate clothing for the season, dirty clothing, rampant decay, untreated perio­dontitis, lack of denture, ill-fitting denture causing lesions and sore areas like epulis fissuratum or atopic candidiasis, untreated medical conditions, malnutrition, and dehydration.

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Reporting Requirement

The dental hygienist who suspects a patient is in an abusive or neglectful situation should decide if contacting authorities is the proper decision and, if so, make the proper report immediately. A reasonable suspicion about a patient’s physical or mental condition is all that is necessary to initiate an Adult Protective Service (APS) report. APS is designed to receive reports of potential elder abuse or neglect, investigate allegations, determine if the allegations are valid, and arrange for victims’ services, if needed. APS also provides medical, social, legal, financial, housing, and other resources to abuse victims.

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