The metaphor of domestic violence as chronic disease is a useful one for clinicians. Studies of domestic violence over the life span suggest that, like many ongoing illnesses that are typified by periods of quiescence and exacerbation, abuse is more often episodic and recurrent than an isolated event.1-3 This metaphor may also help to remind physicians that elderly patients are at risk; a report from the House Select Committee on Aging has suggested that between 1 million and 2 million older Americans experience mistreatment each year.4
Given the scope of this clinical and public health problem, what has been the response of physicians who care for older adults? Authorities suggest that their response has been disappointing,5 and previous studies have found physicians to be unfamiliar with mandatory-reporting laws and less effective than other professional groups in identifying cases of abuse of elderly persons.6,7 A five-year literature search limited to core journals in the Index Medicus under the subject “elder abuse” yielded 26 articles, only 4 of which contained primary data. For the same period, there were 248 reports concerned with child abuse.
In this article we review what is known about the clinical epidemiology of abuse and neglect of the elderly and outline strategies for evaluation and management that should be of interest to physicians caring for older patients