Domestic Violence

Elder Abuse
Domestic elder abuse is the maltreatment of an older person by someone within a domestic relationship. Institutional abuse is committed by individuals in residential facilities against the older person. There are 7 forms of elder abuse:

• Physical abuse
• Sexual abuse
• Emotional or psychological abuse
• Neglect
• Abandonment
• Financial or material exploitation
• Self neglect, in which the older person is allowed to make decisions which clearly and adversely affect their health and well-being.

Elder abuse is common, with over 250,000 new cases reported each year. Reported cases are estimated to comprise about 20% of the actual cases of elder abuse.

Every state has agencies designated to help resolve cases of elder abuse. In many states, the APS (Adult Protective Services) agency will serve this role. Other local agencies may also help.

Child Abuse
It is estimated that over 1.5 million children in the United States will be victims of some form of child abuse each year. Risk factors include:

• Female children are more likely to be sexually abused
• Male children are more likely to be physically and emotionally abused
• Single parent families increase the risk, as does large families and low-income families.

Dating Partner Abuse
About half of women report dating relationships that involve some degree of violence. Among adolescents, the rate is higher with about one in four reporting extreme violence, including rape or the use of weapons.

Screening for Intimate Partner Abuse
There are a number of good ways to screen for this problem. Among them are these questions:

• In the last year, has anyone physically hurt you by slapping, kicking, or hitting?
• In the last year, has anyone made you do something sexual you didn't want to do?
• In the last year, has someone made you worried about the safety of your child?
• Are you afraid of your partner or anyone else?
• Does your partner ever humiliate you in public, keep you from seeing your friends or doing things you want to do?

Victims of intimate partner abuse will sometimes answer these questions "no" even though they should answer them "yes." Reasons for this response include:

• Not wanting to upset domestic relations
• Lack of alternative support services
• Fear of retaliation
• Economic dependency
• Embarrassment or shame

Risk Assessment
If you believe the patient may be a victim of partner abuse, it is important to assess her degree of risk, particularly in these areas:

• Immediate danger to the woman or her children
• Weapons in the home
• Recent escalation of violence
• Is there a plan? (bags packed, extra keys, money, safe haven, emergency phone numbers)

Make sure the patient is aware that help is available and effective. Ultimately, there are resolutions to this problem, including counseling, temporary or permanent separation, and removal of the abuser through judicial proceedings. Provide her with a list of resources, including law enforcement, local shelters, child protective agencies, and telephone hotlines. Some women keep  copies of these phone numbers on a small piece of paper that they wear inside their shoes, hidden from sight but always available.