Domestic and Elder Abuse

Topic updated on 07/24/16 10:33pm
Elder abuse 
  •  Introduction
    • can be in the form of mental or physical abuse, neglect, financial wrongdoings or abandonment
    • epidemiology 
      • affects around 2 million Americans per year
      • approximately 1 in 25 individuals over 65 y/o experiences abuse or neglect 
    • risk factors of victims for elder abuse 
      • increasing age
      • functional disability 
      • child abuse within the regional population 
      • cognitive impairment
      • gender is NOT a risk factor
    • caretaker risk factors for elder abuse
      • financial dependence on the elder person
      • substance abuse
      • perceiving the caretaking duty as burdensome
    • associated injuries
      • long bone fractures
      • rib fractures
      • bruises caused from abuse are
        • commonly over 5cm in size 
        • located on the face, neck or back
  • Clinical signs of elder abuse
    • unexplained injuries
    • delays in seeking care
    • repeated fractures, burns, lacerations, etc
    • change in behavior
    • poor hygiene
  • Treatment
    • duty to report
      • physicians are mandated reporters of abuse on elders in almost all states
      • elder abuse is very commonly under reported
    • admit to hospital
      • if the patient is in immediate danger, the patient should be admitted to the hospital
Domestic, spousal or intimate partner abuse
  • Introduction
    • epidemiology
      • as many as 35% of women presenting to the ER with injuries are a result of domestic violence
      • approximately 25% of women experience domestic violence
      • 15% of males are victims of domestic violence
      • over 8.5% reported prior history of abuse
      • children abused in close to 50% of homes where domestic violence occurs
    • risks for domestic abuse  
      • female
      • 19-29 years
      • pregnant 
      • low-income families/low socioeconomic status
    • characteristic injuries or patterns
      • injuries inconsistent with history
      • long delay between injury and treatment
      • repeat injuries
    • characteristics of abused patient
      • change in affect
      • constantly seeking partner approval
      • finding excuses to stay in treatment facility for prolonged period of time
      • repeated visits to the emergency department 
      • significant time missed at work or decreased productivity at work
    • characteristics of the abuser
      • refuses to leave patient alone
      • overly attentive
      • aggressive or hostile
      • refuses to let the patient answer their own questions
    • barrier to reporting
      • fear of retaliation
      • shame
      • difficulty reporting to male physicians
      • fear of custody conflicts
  • Treatment
    • duty to act
      • health care workers should inquire into the safety environment at home in cases of suspected abuse   
      • emotional abuse is more difficult to discern than physical violence
      • reporting requirements for adult abuse is not standardized among states 
        • a physician does not have authority to provide protection to abused spouses in most states
        • should encourage victim to seek protection and report case to law enforcement 
      • physician should document encounter completely and be familiar with their state laws


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Qbank (10 Questions)

(OBQ12.80) A 29-year-old healthy Caucasian female presents to the emergency department with her boyfriend with a left anterior shoulder dislocation and several facial abrasions after tripping in the shower approximately three hours prior to arrival. She is 5’7’’ and weights 120 lbs (BMI 18.8). The patient notes that she has not had a menstrual period in three months and that she is training for a long-distance triathlon. Physical examination reveals no other obvious injuries. Basic serum laboratory values are unremarkable. A urine pregnancy test is positive. In addition to treating her shoulder dislocation, the orthopaedic surgeon should Topic Review Topic

1. Perform a skeletal survey to evaluate for other fractures or dislocations
2. Question the patient in private about the specific details of this injury and her sense of safety in the home
3. Refer the patient to a nutritionist given the patient’s BMI of 18.8
4. Obtain additional laboratory studies and admit the patient to the hospital for treatment of anorexia nervosa
5. Obtain advanced imaging of the shoulder to evaluate for underlying pathologic lesions

(OBQ12.179) Risk factors for intimate partner violence after musculoskeletal injury includes all of the following EXCEPT? Topic Review Topic

1. Shorter length of relationship
2. Younger age
3. Current pregnancy
4. Alcohol dependency
5. History of prior divorce

(OBQ11.45) Which of the following is true regarding intimate partner violence (IPV)? Topic Review Topic

1. Most patients do not have a fear of domestic retaliation upon reporting
2. Victims of IPV rarely have a history of injury during the previous 12 months
3. Interdisciplinary collaboration yields positive outcomes
4. Emotional abuse is easily identifiable in patients suffering from IPV
5. Victims of IPV feel comfortable discussing their issues to male physcians

(OBQ10.115) Regarding the role of the orthopaedic surgeon in addressing domestic and family violence, all of the following statements are true EXCEPT: Topic Review Topic

1. Report all cases of child abuse, as this is required by all states
2. Report all cases of adult spousal or intimate partner abuse, as this is required by all states
3. Hospitalize elderly victims who are in immediate danger and help develop a plan to ensure their safety
4. Advocate for appropriate legislation and public policy on violence and abuse related to health care
5. Orthopedic surgeons are responsible for knowing the reporting laws and procedures for suspected abuse

(OBQ07.272) An 78-year-old woman who lives in a nursing home sustains an injury to her left forearm. Radiograph is shown in Figure A. It is determined that the injury occurred as the result of elder abuse. All of the following are considered risk factors for elder abuse EXCEPT? Topic Review Topic
FIGURES: A          

1. Dementia
2. Disruptive behavior by the victim
3. Gender
4. Poverty
5. Poor physical health of the victim

(OBQ06.25) Each of the following are guidelines for management of a domestic violence victim EXCEPT:
Topic Review Topic

1. Socioeconomic status should not preclude evaluation for domestic violence
2. Interview the patient outside the presence of other non-medical personnel
3. Federal law mandates photographs be taken of injuries
4. Document your opinion if the patient’s injuries are not consistent with the offered explanation
5. Physicians should check requirements to see if there is mandatory reporting statute in their state

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