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Elder Abuse and Reporting

Overview | Clinical Scenarios | Additional Tips | References
By Jacqueline Landess, MD, JD

OVERVIEW

General Principles

  • Every state has laws identifying specific parties who are required to report suspected or confirmed abuse or neglect of children. Nearly all states also require or permit physicians to report suspected or confirmed abuse of vulnerable adults, which includes elder, dependent or incapacitated adults.
  • Abuse, neglect and exploitation is defined broadly and usually includes: psychological or physical abuse, sexual abuse, financial exploitation and neglect. This NEJM article further discusses types of abuse and signs.1
  • The standard for reporting may vary but generally is a low bar. Many states use a “reasonable cause or basis to believe” standard, similar to mandated child abuse reporting laws.

Jurisdictional Considerations

Laws define who is required to report, how the protected population is defined, what situations the provider must report, and to whom the provider should report. Laws vary by state and examples are listed below. Look up your state law here.

  • Who is required to report: physicians (nearly all states), “any person,” psychologists, other health care providers, attorneys, accountants, nursing home administrators
  • Protected population: any adult, elderly person, resident in long term facility, incapacitated/dependent adult, vulnerable person
  • How to report: Usually to Adult Protective Services or equivalent, oral and/or written, most states have 24-hour hotlines

CLINICAL SCENARIOS

Scenario #1: A 78-year-old patient is admitted to your inpatient unit for depression and suspected psychosis. He is adamant that his family is stealing money from him. You discover that he has no other signs of psychosis and his family has been non-communicative with your team.

Scenario #2: A 28-year-old woman with a history of mild intellectual disability sees you in clinic for an intake. She lives with and is cared for by her mother, who is her guardian. You notice several large bruises on her arms and shoulders. When you asked her about them, she stated: “I don’t know” and changed the topic.

  • In both cases, there is probably inadequate information to know, at this point, whether there is reasonable cause to suspect abuse or exploitation of these patients.
  • Additional information should be gathered, including interview of collateral informants with patient consent, while also being mindful of improperly disclosing information which would increase risk of harm to the patient.
  • Subtle cases where abuse is not certain present complex ethical challenges for the reporting physician or psychologist3.

ADDITIONAL TIPS

  1. First, in both cases, complete a full clinical assessment, including obtaining collateral from caregivers. Interview guide found here.
  2. Consult with your state law to determine who, how and when to report.
  3. Discuss with your supervisor and/or risk management if necessary.
  4. Remember the standard for reporting is generally low, and you are usually indemnified by law if the report is made in good faith.
  5. If you have concern that the patient may be at increased risk of harm by a caregiver once you report, mitigate harm to the patient by creating a safety plan.

Documentation Tips

  1. Seek multiple sources for collateral information (other healthcare providers, family and caregivers) and document these conversations.
  2. Use direct quotes from patient and caregiver when possible.
  3. Consider use of screening tools.
  4. Document your decision-making, rationale, and steps taken if abuse is suspected or confirmed.
  5. Take steps to mitigate harm to the patient (see Additional Reading).

REFERENCES

  1. Lachs MS, Pillemer KA. Elder Abuse. N Engl J Med. 2015 Nov 12;373(20):1947-56.
  2. Rodríguez MA, Wallace SP, Woolf NH, Mangione CM. Mandatory reporting of elder abuse: between a rock and a hard place. Ann Fam Med. 2006 Sep-Oct;4(5):403-9. Available from: https://www.annfammed.org/content/annalsfm/4/5/403.full.pdf
  3. Zeranski L, Halgin RP. Ethical Issues In Elder Abuse Reporting: A Professional Psychologist’s Guide. Professional Psychology: Research and Practice. 2011; 42(4): 294-300. Available from: https://psycnet.apa.org/fulltext/2011-08643-001.pdf.

Additional Reading

  1. Jackson SL, Hafemeister TL. Enhancing the safety of elderly victims after the close of an APS investigation. J Interpers Violence. 2013 Apr;28(6):1223-39.
  2. Patel K, Bunachita S, Chiu H, Suresh P, Patel UK. Elder Abuse: A Comprehensive Overview and Physician-Associated Challenges. Cureus. 2021 Apr 8;13(4):e14375.  Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110289/.
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