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Am Fam Physician. 2009;80(11):1301-1302

Background: About 4 percent of older adults are physically abused annually, with higher rates among those requiring caregivers. High rates of facial injuries are well documented among domestic partners and children who have been abused, and abused children are more likely to have centrally located bruises (i.e., torso, abdomen, back, buttocks, and neck) than those injured accidentally. However, no systematic research on abuse-related bruising in older persons is available.

The Study: Wiglesworth and colleagues interviewed patients who had been referred to Adult Protective Services because physical abuse was suspected. Participants were 65 years and older, with the alleged perpetrator being known and in a position of trust to the older adult. Participants were examined for the extent and location of bruising and were asked about other abuse indicators, medical conditions, recent falls, medication use, and use of assistive devices. A unanimous decision of four board-certified geriatricians was used to determine whether physical abuse had occurred. Data were compared against results from a 2005 study of accidental bruising in older adults.

Results: It was determined that 67 of the participants had been abused. All participants were evaluated within 30 days of physical abuse (mean = 10.3 ± 6.5 days). Forty-eight participants (72 percent) had related bruising, with slightly more than one half (54 percent) having three or more bruises. No correlation was found between bruising and sex, the use of prescription or over-the-counter medications, the need for assistance with activities of daily living, recent falls, or Mini-Mental State Examination score, although participants using assistive devices were more likely to have bruising.

All abused adults with bruises had at least one bruise more than 1 cm wide. Bruises 5 cm or wider were significantly associated with abuse (56 percent of the abuse group versus 7 percent of the comparison group). Those in the abused group were significantly more likely to recall the source of at least one bruise (91 percent) versus those in the comparison group (29 percent), and were more likely to have bruises on the head, neck, or torso (40 versus 13 percent, respectively), posterior torso (15 versus 3 percent), and lateral right arm (25 versus 7 percent). Head bruises on abused patients were almost exclusively limited to the face, except for one bruise on the ear.

Conclusion: Bruises on the head, neck, lateral right arm, or posterior torso should raise concern for physical abuse in older persons. Bruises 5 cm or wider are a common sign of abuse, and all older persons with bruising who had been abused had at least one bruise wider than 1 cm. Older adults with relevant bruising should be asked about possible causes.

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