Eli's Hospice Insider

It's a sad truth that elder abuse comes in many forms. And the signs of elder mistreatment depend on type of abuse, says Solomon Liao, MD, FAAHPM, director of palliative care services and associate clinical professor with the University of California, Irvine.

Watch for the following signs of abuse that may occur in a hospice setting, Liao suggests:

Physical abuse can present as bruises and in fewer instances as fractures or burns. Signs of physical abuse to be mindful of include:

• Suspicious bruises. Bruises on the face and neck, as well as any bruise bigger than 5cm elsewhere on the body are suspicious.

• Injuries in the skin folds (arm pits, backs of knees, inside elbows, under the breasts, etc.). These areas are usually protected from spontaneous injury, so wounds in these spots should trigger concern

• Circumferential injuries. When you see injuries such as burns that reach all the way around the foot or bruises all the way around the upper arm, it's unlikely that they are the result of a natural accident.

• Linear demarcation or central clearing. These types of wounds are most likely man made.

Neglect can be harder to detect. Some signs to watch for are multiple pressure ulcers, overdoses or underdoses of medications, or a patient who is crying out in pain and has not been given their pain medication. While malnutrition and dehydration might be signs of elder abuse in other settings, they aren't reliable signs in the hospice population because they can be signs of disease progression.

Financial abuse is more likely to be reported by the patient or her caregivers. Be sensitive to the things patients tell you or say related to their finances. Not many studies have been done on financial abuse in the hospice population. But studies that focus on elder financial abuse in the general population suggest watching for sudden changes in spending or statements such as "I can't afford my medication."

Tip: Watch for financial abuse during the bereavement period. Elderly widows or widowers can be especially vulnerable at this time. Listen when family expresses concern over a sudden change in spending habits.