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Vol. 67, No. 1 2016
Northeast Florida Medicine
DCMS online
. org
CME
The Affected Individuals
I. Elders:
Another form of domestic violence is elder abuse, which
is also prevalent world-wide. Often overlooked, it does not
usually receive the same prevention and screening awareness
as intimate partner abuse. The prevalence of elder abuse
ranges from approximately 10 percent of cognitively-intact
elders to 45-50 percent of those elders who suffer from
dementia. Per the National Elder Abuse Incidence Study,
19 percent of the population in the U.S. is over the age
of 80, and over half of all reports of abuse are within this
age range.
13
Types of elder abuse include physical, mental,
emotional/psychological and sexual abuse, neglect, aban-
donment, poor and improper medical care and financial
exploitation. Risk factors that can predispose an elderly
individual to abuse include disability, depression, dementia,
social isolation, poor socioeconomic status, external family
stressors and substance abuse.
Elder abuse can occur in any setting. In the home, it
is usually a daughter or son who takes over the role of
“parenting the parent” and becomes frustrated with this
additional responsibility. Characteristics of those who
abuse the elderly include those with the inability to cope
with stress, a lack of support or family structure for the
caregiver, a history of substance abuse or depression and
a progressively increasing perception that taking care of
the elder is burdensome and financially difficult with little
psychological reward. The American Medical Association
and the American Academy of Neurology specifically advise
screening individuals age 65 years and older for abuse.
One approach is to utilize the Abbreviated Screening
Method which recommends asking your elderly patients
three questions:
1.) Do you feel safe where you live?
2.) Who prepares your meals?
3.) Who handles your checkbook?
It is critical that elderly patients be screened alone
to eliminate possible intimidation. If any of the above
questions raise suspicion for elder abuse, one of the more
detailed questionnaires should be performed such as The
Brief Abuse Screen for the Elderly (BASE) or The Elder
Assessment Instrument (EAI).
14,15
Elder abuse or suspected
abuse should be reported to the physician’s local elder
abuse hotline.
II. Adult Victims
Anyone is a potential victim; however, victims of IPV
are predominantly women less than 35 years of age, with
many having had prior exposure to IPV.
16
Additional risk
factors for IPV can be found in Table 1.
17-22
Certain groups have a higher prevalence of IPV includ-
ing trauma victims, emergency room patients, patients
with chronic abdominal pain, patients with chronic
headaches, pregnant patients with injuries, patients with
sexually transmitted diseases, and elderly individuals with
injuries.
23
Women living in non-industrialized countries
have higher incidence of IPV than those living in indus-
trialized countries.
24
III. The Littlest Victims – The Children
Nationwide, more than three million children are liv-
ing in homes where IPV occurs. Among these children,
studies estimate that the prevalence of child abuse may
be as high as 60 percent.
25,26
The U.S. Department of
Health & Human Services reported that in 2013 alone
678,932 children were victims of child abuse and neglect,
signifying that 9.1 in 1,000 children are affected.
27
The long term effects of a child witnessing or being a
victim of domestic violence are numerous and include
increased risk for perpetuation of domestic violence in their
future relationships along with many psychological effects
such as depression and vague somatic complaints.
28,29
These
children may also display increased rebellious behavior
with an increased tendency for truancy, dropping out of
school, drug and alcohol use and episodes of running away.
Table 1:
Risk Factors for Domestic Violence
Risk Factors for Domestic Violence
17-22
• Prior exposure to intimate partner violence
• History of heavy alcohol or drug use
• Female sex
• Young age (< 24 years of age)
• History of depression or chronic mental illness
• Lower level of education
• Residence in lower socioeconomic neighborhood