How To Detect The Presence of Abuse and Neglect

Abuse may be physical, psychological, sexual, or financial. Victims of abuse typically live with the abuser. Neglect involves witholding food or other necessities. Red flags for abuse and neglect include a family history of alcoholism, drug abuse, or violence; economic stress; cognitive impairment; caregiver experience; and blaming personalities.

DO's for Screening:

• Suspect abuse when the patient has injuries in various stages of healing or that aren't readily explained. A caregiver who's unwilling to leave her side is another red flag.
• Assess the patient's general appearance, posture and mental status. Is she clean and appropriately dressed? Does she appear withdrawn, anxious, depressed, cognitively impaired or delirious? Poor eye contact with her caregiver and reluctance to return to her living situation are also signs of abuse.
• Assess for signs of malnourishment, such as a low serum albumin level and electrolyte imbalances, and for signs of dehydration, such as weight loss and poor skin turgor. Look for skin abnormalities such as bruises, scars and abrasions. Does she have pressure ulcers? Look for restraint marks on her wrists and ankles and cigarette burns anywhere on her body. Assess her for orbital ecchymosis, subconjunctival hemorrhage, and signs of ruptured tympanic membrane. Forced feeding may cause lip bruises and lacerations. Also assess for whiplash injuries (neck stiffness, shoulder pain, headache, paresthesia, hoarseness, difficulty of swallowing or chewing).
• Suspect rib fractures if she has chest pain or assymetrical chest movement. crepitations during arm or leg range of motion may indicate a fracture.
• Very gently palpate her abdomen. Extreme tenderness may signal an underlying injury.
• Check her rectum and genitalia for bruising, bleeding, or discharge. Torn, stained, or bloody underclothes and difficulty walking or sitting due to genital discomfort are signs of sexual abuse.
• If you suspect abuse, ask the caregiver to leave so you can interview the patient alone. Ask her, "Does anyone ever hurt you?"
• Say to the suspected abuser, "Caring for your loved one must be difficult. Do you ever feel as if you're going to lose control?"
• If you suspect abuse, follow agency policies and state laws for reporting and documenting your findings and subsequent interventions. Notify adult or child protective services.

DONT's for Screening:

• Don't interview a possible victim in the presence of the possible abuser.
• Don' be judgemental with either the victim or the abuser.