Elder abuse. Using clinical tools to identify clues of mistreatment.

Elder abuse occurs most commonly in residential rather than institutional settings, and the most likely perpetrators are known by the victim. Although a defined set of risk factors has not been developed, careful questioning and assessment can help determine whether a patient is at increased risk. The common types of elder maltreatment include caregiver and self-neglect, emotional and psychological abuse, fiduciary exploitation, and physical abuse. Assessment consists of comprehensive physical examination, including scrutiny of the musculoskelatal and genitourinary systems, neurologic and cognitive testing, and detailed social and sexual histories. Clues that cannot be explained medically may signal elder abuse. To properly intervene, clinicians should be familiar with state laws governing reporting procedures and patient privacy.