Physical abuse of the elderly: the medical director's response.

Many people think of physical abuse when the term “elder abuse” is used. Although it ranks behind neglect and emotional abuse as the third most common form of abuse, physical abuse cases are some of the most heinous. It is also the most common form of abuse that comes to medical attention. Physical abuse may include pushing, striking, force feeding, improper use of physical restraints, and infliction of pain or the withholding of pain relief. It is not uncommon for a person to be a victim of multiple types of abuse; thus, physical abuse should alert us to look for other types of abuse as well. Medical directors therefore must become proficient in identifying physical abuse in older adults, know the markers that raise suspicion for abuse, and lead their multidisciplinary team and/or agency in an effective approach to this problem. As the leader of a multidisciplinary team, the medical director is well positioned to prevent and identify possible mistreatment. The medical director can make sure that the issue of abuse is openly discussed in team meetings. For example, if a home health nurse notices that a patient is having unusual and/or unexpected wounds the possibility of abuse may be raised by the medical director during a multidisciplinary team meeting. Other members of the team might then add their observations that serve to either increase or decrease the level of concern. In working toward recognition and prevention of abuse, the medical director has the authority to insist that more training and education on the topic of elder abuse is available for members of the interdisciplinary team. In this article we will emphasize the role of the medical director in the home health care setting and focus on the issue of physical abuse in a board and care. The following discussion will be case-based to highlight the challenges as well as potential solutions when physical abuse is suspected.