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Physical abuse

Changes in the description of facts, which are in any case improbable or in

Presence of lesions, especially multiple and with differing levels of

conflict with the wounds.

deepness and healing. Dehydration or malnutrition. Fractures of unde- termined causes. Presence of wounds which were not taken care of. Signs that the individual may have been tied, bound, or hit. Sexually transmis- sible diseases.

PAGE 84

2.2  Diagnosis of the problem

  • e symptoms of abuse and neglect of a frail or dependent older person may take on different

forms, and it is recommended that should there be a suspicion of abuse or mistreatment, the doctor undertakes a thorough evaluation of the patient, both through a physical exam and a private interview. Table 1.2 presents the most common indicators of abuse or mistreatment.

  • e critical paths of the diagnosis of the problem are presented in the Diagram 1.1.

Table 1.2 – Indications on the Possibility of Elder Abuse or Neglect32

Type

History

Physical exam

Neglect

– Recurring episodes of illness, de- spite proper education and support.

Hygiene problems, undernourish- ment, hypothermia, untreated ulcers,

– Untreated medical problems.

under-medication.

32.

Modification of: Yoshikawa TT, Cobbs EL, Brummel-Smith K: Elder Mistreatment: Abuse and Neglect. In: Practical Ambulatory Geriatrics, p. 134, 1998 (2nd Ed.).

By medication

Frequent medical admissions or con- sultations due to medication mistakes.

Signs of intoxication due to overmedi- cation, or under-medication.

Psychological abuse

History of conflict between the older person and the family or caregiver.

in general the commentaries and explanations diverge when the caregiver and patient are interviewed separately. it has been observed com- mentaries on the part of the caregiver which lowers the esteem or infanti- lizes the older person. it also has been observed that the older person has difficulty speaking in the presence of the caregiver.

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