Detection and diagnosis of elder abuse is dependent on being open to what is reported by the patient or others. Without such openess, reported abuse may be dismissed as paranoia, dementia, or patient noncompliance. A high index of suspicion is necessary. When it is lacking, signs of abuse and neglect may be erroneously ascribed to frequent falls, accidental medication errors, failure to thrive, or the normal decline with aging.

There is no substitute for direct questioning when inquiring about abuse. In one report, 6 33 percent of abused victims stated on initial presentation to the emergency department that they were involved in an abusive relationship. Another 6 percent of abuse cases were detected by eliciting information from other informants. The remaining cases were elicited by physical examination (43 percent) or by social service evaluation during hospitalization (19 percent).

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