Medical Signs

If you or someone you know is experiencing abuse or neglect, there are several important steps to take and services to contact.

Please note that if you or another person are in imminent danger, call 911.

When monitoring changes in an individual’s health, behavior, or appearance, it’s essential to consider the multiple variables that could influence these differences. While specific health changes may indicate abuse or neglect, others might be indicative of natural decline or other underlying conditions. If any concerns arise, it is always advisable to seek the advice of a physician or other appropriate professionals.

 

The following information is acquired from a consensus study report through The National Academies Press. This is a non-exhaustive list offering insight into the common clinical and medical indicators of elder mistreatment, along with age-related changes. This information is intended as an educational supplement and should not be considered direct advice. An excerpt providing more detail on this report can be found here, along with a full citation supplied on this website’s references page.

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Clicking the “+” and “-” to the far left of each section will expand and collapse the information within.

 

Skin abrasions or lacerations

Skin injuries may manifest as identifiable lacerations (characterized by tears or cuts resulting from force), and abrasions (scrape-like injuries occurring on the skin surface due to movement against another surface). The skin of elderly individuals is more vulnerable to both abrasions and lacerations, due to skin thinning and lost elasticity. Skin tears are a common skin injury that is often not indicative of abuse or neglect.

Common signs of age or natural decline

 

  1.  Skin tears less than an inch in length
  2.  Skin tears in the arms or legs
  3.  No more than two skin tears at once
  4.  Lack of scarring from injury 
  5.  Unknown or accidental source of skin tears
  6.  Laceration on arm from a fall 
  7.  Unknown cause of small laceration

Common signs of abuse or neglect

 

Abrasions and lacerations are frequent markers of abuse or neglect. If your observations are more consistent with abuse or neglect, it is important to document when you noticed these changes and take photos, as well as seek the examination and documentation by a trusted healthcare professional.

 

  1. Skin tears in places other than the arms or legs
  2. More than two skin tears, abrasions or lacerations
  3. Scarring from lacerations

Bruises may appear immediately after an incident, but can also appear hours or days following the trauma. Bruises can also appear in different than where the trauma actually occurred (notably the eyelid or neck).

 

Red, blue and purple bruises are more recent than blue, green, yellow or brown bruises.

Common signs of age or natural decline

 

Bruises tend to heal more slowly and are more prevalent in elderly individuals due to the combined effects of skin thinning and a reduction in the fat layer that protects vessels. 

 

Common signs of abuse or neglect

 

  1. Bruising that mimics knuckle, finger or hand shapes
  2. Bruises that look like lines or are parallel in pattern
  3. Bruising on the face, neck, abdomen, chest, or butt
  4. Bruises on the head
  5. Bruising on the palms and soles of hands and feet
  6. A noticeable quantity of bruises, especially if they are in different healing stages (colors)

 

A loss in bone density is common in the elderly population, coupled with conditions like osteoporosis that render bones more susceptible to fractures. Vertebral and hip fractures, in particular, carry an elevated risk to occur spontaneously. 

 

Common signs of age or natural decline

  1. Conditions that increase fracture risk are osteoporosis, vitamin D deficiency, steroid use or Paget’s disease
  2. Cancer increases the chances of bone fracture
  3. Hip fractures
  4. Vertebral fractures
  5. Wrist fracture from fall
  6. Spontaneous fracture after bed rest, paralysis or limb limitation
  7. Limb fractures from a fall
  8. Sprains, strains, and muscle injuries

Common signs of abuse or neglect

 

  1. Dental fractures
  2. Fractures around the eyes
  3. Jaw fractures
  4. Head fractures
  5. Spine fractures
  6. Fractures in the torso
  7. Spiral or rotational fractures in large bones (femur)
  8. Indicators of abuse or neglect prior to fracture

 

The use of restraints is not uncommon in situations where a patient is uncontrollable and puts themselves or others at risk of substantial harm or injury. Patients in these conditions need close monitoring and attention. Outside of these situations, restraints are not legally permitted.

 

Common signs of abuse or neglect

 

  1. Restraints are applied for unjustified reasons
  2. Restraints are too tight and cause skin tearing or serious irritation
  3. Bedsores from improper bedding or lack of attentive care
  4. Scars from restraints
  5. Wrist wounds

 

Bedsores are commonly referred to as pressure ulcers and decubiti. These are formed from skin breakdown that occurs when there is prolonged pressure in one area. This is often from lack of movement or change in position in patients with extended time sitting or lying in bed. 

 

Common signs of age or natural decline

 

Cognitive impairment, malnutrition, vascular disease, incontinence and other conditions can increase the chances of elderly patients developing decubiti (bedsores).

 

Common signs of abuse or neglect

 

  1. The occurrence of multiple bedsores 
  2. Lack of movement or positional changes of the patient in care provided
  3. Ulcers with oder that are not addressed by physicians
  4. Necrotic ulcers that have not received treatment
  5. Severe or deep bedsores

 

Malnutrition occurs when individuals are not being fed, not eating, their body is unable to absorb nutrients, or they are receiving food of low nutritional value. This can result in nutritional deficiencies or a decline in health. A weight loss of greater than 40% of the body can be fatal.

 

Common signs of age or natural decline

 

  1. Decrease in ability to smell or taste
  2. Decrease in appetite
  3. Conditions like cancer, depression, and dementia
  4. Malabsorption syndromes
  5. Strokes, Parkinson’s, and other disorders

Common signs of abuse or neglect

 

  1. Medications that suppress the appetite and are given without clinical indication
  2. Poor oral hygiene maintenance
  3. Lack of staff assistance when individuals are unable to  feeding themselves
  4. Force feeding by staff
  5. Lack of available food to meet nutritional need

 

 

Dehydration most commonly occurs in long-term care residents that have a reduction in fluid intake. It can also occur through sweating, leading to water loss. 

 

Common signs of age or natural decline

 

Elderly individuals typically have a reduction in thirst sensation and have lower water reserves, which can contribute greatly to dehydration. Certain medications and conditions like dementia can also contribute to dehydration.

 

Common signs of abuse or neglect

 

  1. Unavailable fluids provided by carers
  2. Dehydration is severe and has gone undetected until severe symptoms
  3. Clinical indications of dehydration were previously ignored like vital sign changes or weight loss
  4. When refusal of fluids is given as the cause by the facility

 

 

Inability to provide proper prescribed medication, as well as over-medication, can cause consequences serious to health.

 

Common signs of age or natural decline

 

Elderly individuals are more likely to have adverse side effects to medications. The use of multiple prescriptions increases the chance of misuse by patients. Additionally, some patients may not take prescriptions, because of the fear of side effects. Dementia increases the likelihood of a patient refusing or not taking medication.

 

Common signs of abuse or neglect

 

  1. Too much of a medication is given
  2. Patient is not given medication or treatment
  3. Wrong medication is given
  4. Sudden adverse side effects 
  5. Medications are used for sedation when not clinically indicated

 

Burns occur on the skin when it comes in contact with temperature that exceeds 122°F (50°C). Severe burns are especially concerning for the elderly population. Individuals over 75 are three times more likely to not survive recovery. 

 

Common signs of abuse or neglect

 

Burns that occur in facilities are a cause for concern and 40-70% of these cases indicate abuse, negligence or neglect.

 

 

Dementia, depression, psychosis and alcoholism are some of the most common conditions of mental health in the elderly population. Self-neglect can be a noticeable characteristic of these conditions. The occurrence of these conditions are often independent of abuse or neglect.

 

Common signs of abuse or neglect

 

  1. Dementia increases the chances of abuse or neglect by 51%
  2. Depression is observed in 62% of patients in cases of abuse or neglect

 

 

Cleanliness like clean clothes or bedding, bathing, and dental hygiene should be maintained in facilities. Facilities should maintain the hygiene of patients and assistance should be provided if patients are unable to care for themselves. Psychosis, physical limitations, and dementia can impair one’s ability to maintain personal hygiene. 

 

Common signs of abuse or neglect

 

  1. Poor hygiene or noticeable decline in hygiene
  2. Dirty clothes or bedding
  3. Odor
  4. Excessive amount of insect bites

Sexual contact or exposure without consent is considered sexual abuse. This should never occur in facilities between staff and patients, even if consent is given. Limited cognition occurs in 75% of elder sexual abuse case victims, but cognitive impairment is not a cause of this abuse.

Common signs of abuse or neglect

 

  1. Sexually transmitted diseases diagnosed in the mouth
  2. Uvula bruising or inner mouth and throat
  3. Bleeding or bruising around the anus or genitals 
  4. New sexually transmitted disease diagnosis
  5. Urinary tract infections in women
  6. Behavioral changes like fear, insomnia, aggression or increased sexual behavior

 

When elderly individuals are taken advantage of for another person’s monetary gain. Telemarketers, theft, lending, and extortion. Patients with cognitive impairments or dementia may develop paranoia or suspicion of theft, and this can be a symptom of their condition. These conditions can also put them at an increased risk of exploitation.

 

Common signs of abuse or neglect

 

  1. Widows and widowers are more frequent victims
  2. Increased age is consistent with most victims
  3. Sudden decrease in funds or sudden inability to pay for previously covered needs
  4. Changes in wills and deeds
  5. Missing belongings or transfer of goods without approval

This website serves solely as a supplementary and educational resource. It does not offer direct advice or recommendations for individual situations. Additional research should be conducted, and official and professional guidance sought. Federal, state, and local services should always be consulted for appropriate assistance and guidance. Additionally, professional health, legal, and government services should always be consulted, as this website does not serve as a substitute for them. While efforts are made to provide accurate and up-to-date information, this website cannot guarantee the accuracy or currency of the content. It is encouraged that users verify information with relevant authorities or professionals. Please note that if you or someone you know is in imminent danger, call 911.