Category: Special Populations

Topic: Geriatrics

Level: Paramedic

8 minute read

Elder abuse, neglect (including self-neglect), and exploitation are common and are associated with depression, mental impairment, loss of function, and mortality. Approximately 10% what of elderly adults have been abused in some way.

► As an EMS responder, you have the legal and moral obligation to identify victims and intervene when maltreatment is suspected just as you would with children.

All states and territories of the United States, including the District of Columbia, have enacted legislation providing for the protection of elders found to be abused, neglected, and financially exploited.

Elders in institutional settings in all states and territories are protected by state Long-Term Care Ombudsman Programs (LTCOP) that receive complaints and advocate on behalf of long-term care residents.



ELDER: depending on the jurisdiction, anyone aged  > 60 to > 65.

VULNERABLE ELDER: any elderly person with an impairment, usually cognitive, that renders him or her unable to arrange for adequate self-care and protection; a vulnerable elder is one who has a diminished capacity for self-care and protection.

ABUSE: behavior by someone toward the elder with an ongoing relationship to an elder and a duty towards that elder, that is:

  • willful infliction of pain, injury, or restraint;
  • nonconsensual sexual contact; or
  • emotional harm (psychological abuse).

NEGLECT: failure to provide for the needs and protection of a vulnerable elder.

ABANDONMENT: desertion by a caregiver or caretaker.

SELF-NEGLECT: failure by a vulnerable elder to provide for his or her own care and protection.

Capable elders who willingly choose to self-neglect themselves are excluded.

FINANCIAL EXPLOITATION: non-consensual appropriation of an elderly person's resources for the benefit of another, by someone with an ongoing relationship and duty toward that elderly person.


Risk Factors

At high risk are:

  • Advanced age: increase in vulnerability the older the victim is.
  • Gender: women are the majority.

(Men were more likely to have self-neglect.)

  • Ethnicity: African-Americans were more likely to suffer abuse, and whites self-neglect.
  • Disability: 48% of elder abuse is from self-neglect.
  • Dementia: increases risk for abuse, financial exploitation, and self-neglect.
  • Social isolation: engenders loneliness, contributing to psychological suffering.


  • history of stroke; 
  • hip fracture and serious illness;
  • external family stressors (financial, marital discord, illness);
  • unqualified caretakers;
  • institutional staffing shortages.

Medication issues may involve inappropriate dosing, inconsistency, and unprescribed medications.


Warning Signs

  • Bruising.
  • Burns.
  • Fractures.
  • Worsening of a chronic illness (from inappropriate medication or lack of followup with one's doctors).
  • Malnutrition.
  • Dehydration.
  • Pressure ulcers.
  • Evidence of sexual abuse:

--pain in the anal-genital area; 
--sexually transmitted diseases in the oral or anogenital regions; 
--vaginal or rectal bleeding; 
--bruises/lacerations of the vulva, abdomen, or breasts.

Skin tears are common without mistreatment on the back of the hands or arms.



Although it is not your obligation to offer a full screening questionnaire to all elderly persons you see, it has been found that just 3 questions can offer a sweeping initial assessment:

  1. Do you feel safe here?
  2. Who prepares your meals?
  3. Who handles your checkbook?


In the Field

Besides any transport-worthy medical issues, if you suspect elder abuse, you should transport so that a full evaluation can be initiated.