In Pakistan, elder Abuse Syndrome is managed by geriatricss. Elder abuse syndrome is a clinical pattern of intentional or negligent acts by a caregiver, family member, or trusted other that causes physical injury, emotional harm, financial loss, sexual violation, or unmet basic needs in an adult aged 60 or older. The WHO 2017 meta-analysis estimates roughly 15.7% of older adults living in the community experience at least one form of abuse each year (1 in 6 worldwide), and rates rose substantially during the COVID-19 pandemic.
Elder abuse syndrome (ICD-10: T74.91 for confirmed adult abuse, T76.91 for suspected; Y07.x for perpetrator coding) is the WHO-defined category of intentional acts or failures to act, by a person in a relationship of trust, that result in harm or distress to an older adult. The five recognized subtypes are physical abuse, psychological or emotional abuse, sexual abuse, financial or material exploitation, and neglect (including self-neglect when intervention capacity is lost through cognitive decline). Identification rests on a combination of history (often from caregivers and the patient separately), physical findings inconsistent with the explanation, functional decline disproportionate to chronic disease, and contextual red flags such as caregiver dominance during the visit. The American Geriatrics Society, US Preventive Services Task Force, and World Health Organization all classify elder abuse as a public-health priority requiring systematic clinician inquiry, validated screening instruments (Elder Abuse Suspicion Index, Elder Assessment Instrument), and mandatory or strongly encouraged reporting to Adult Protective Services depending on jurisdiction.
The key symptoms of Elder Abuse Syndrome are: Unexplained bruises in atypical locations (inner arms, neck, ear, trunk, inner thighs), bruises in different stages of healing, or marks reproducing the shape of a hand, belt, or restraint., Weight loss greater than 5% over 6 months, sarcopenia, low pre-albumin, and signs of dehydration (orthostatic hypotension, dry mucous membranes, elevated BUN-to-creatinine ratio) without a medical explanation., Stage 2 to 4 pressure injuries on the sacrum, heels, or ischial tuberosities in a patient with a caregiver who reports turning every two hours., Sudden behavioral change: withdrawal, fearfulness around a specific caregiver, refusing eye contact, rocking, or new mutism in a previously verbal patient., Unexplained or repeated injuries presenting late to medical care, with caregiver explanations that change between encounters or are inconsistent with the injury pattern., Medication non-adherence with empty pill bottles in a patient who is reportedly being managed at home, or sedation out of proportion to prescribed regimens (chemical restraint)., Sudden changes in banking activity, large transfers to a caregiver, new joint accounts, missing valuables, unpaid bills despite adequate income, or a new will favoring a recent acquaintance..
Diagnosis depends on a structured private interview, careful physical examination, and corroborating findings rather than a single laboratory test. The clinician should interview the older adult alone whenever possible. Validated tools such as the Elder Abuse Suspicion Index (EASI, six items, takes two minutes, sensitivity 47-93%) and the Elder Assessment Instrument (EAI, 41 items for inpatient settings) help structure the conversation and document findings. The physical exam should map and photograph every bruise, abrasion, pressure injury, and burn, noting size, location, color, and shape against a standardized body diagram. Patterned injuries (handprints, ligature marks, bilateral upper-arm bruising) and injuries in unusual locations (back of the ear, palm, soles, axillae, inner thighs) raise specific concern. Laboratory workup includes a complete blood count, basic metabolic panel, albumin, pre-albumin, vitamin D, and a urine drug screen when chemical restraint is suspected. Radiographs are obtained for any deformity, and a low threshold for non-contrast head CT applies to any unexplained head injury. Cognitive assessment with the Montreal Cognitive Assessment or Mini-Cog establishes baseline capacity. The clinician also screens caregivers for burden (Zarit Burden Interview), depression, and substance use. Once mistreatment is suspected, the clinician follows mandatory reporting requirements: in the US, all 50 states have Adult Protective Services pathways and 47 states have mandatory clinician reporting. Documentation must distinguish observed facts from inferences and avoid speculative language to support later civil and criminal proceedings.
Outcomes depend on how rapidly and thoroughly the abuse is interrupted. Older adults identified as victims have approximately three times the 13-year mortality of matched non-abused peers in the Lachs JAMA 1998 cohort, with most excess deaths attributable to chronic stress, untreated medical disease, and progression of dementia in unsafe environments. With successful Adult Protective Services intervention, structured caregiver support, and psychiatric care for depression and PTSD, depressive symptoms improve in 50-70% of victims within 6 months and functional decline can be partially reversed. Recurrence is the central prognostic threat: 30-40% of identified victims experience repeat abuse within 1 year without sustained follow-up, falling to under 15% when multidisciplinary teams maintain weekly to monthly contact for the first year. Financial recovery is variable — small amounts can be reversed through bank fraud channels, but large losses, particularly to organized scams or family perpetrators, are rarely recovered. Prosecution rates remain low (under 5% of reported cases lead to criminal charges in most US jurisdictions), but civil remedies (restitution, removal of power of attorney) succeed more often.
Geriatricians, geriatric psychiatrists, forensic nurses, and social workers with elder-abuse training identify subtle patterns that general clinicians may miss, perform formal capacity evaluations, coordinate with Adult Protective Services and law enforcement, and design longitudinal safety plans. Specialist involvement increases the rate of successful protective intervention and prosecution.
Find specialists →Acute injuries (bruises, lacerations, mild dehydration) resolve within 2-4 weeks. Pressure injuries heal over 6-16 weeks with appropriate care. Malnutrition and weight loss reverse over 3-6 months. Depressive and post-traumatic stress symptoms typically improve at 8-12 weeks with combined psychotherapy and SSRI. Long-term safety stabilization and financial restitution often require 6-18 months of multidisciplinary engagement.
Older adults with capacity should aim for 150 minutes per week of moderate aerobic activity (walking, stationary cycling, swimming) plus twice-weekly resistance training and balance work (Otago, Tai Chi). Caregivers benefit from the same recommendations to reduce their own burden, depression, and risk of burnout-driven abusive behavior.
Choose a geriatrician or geriatric psychiatrist affiliated with a hospital that has an established elder-abuse response team, a forensic nurse program, or a memory clinic. Confirm experience with capacity assessments and willingness to participate in court testimony when needed.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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