Dementia and Memory Disorders in Abuse in the Elderly

Abstract Abuse of the elderly is common, rarely recognized, and often the cause of death. Knowledge of aging and disease processes related to memory and cognitive impairment is necessary to evaluate maltreatment of the older person, whether through creation of stress related to financial abuse, neglect, self-neglect, and physical or sexual assaults. Other intersections include determination of medical capacity and legal competency, as well as the local and state laws protecting the older person throughout their life, especially when there is decline in function. When surviving maltreatment, the older persons’ memory of events following a specific incidence of maltreatment is compromised by dementia or memory disorders. Discovery of what happened to the older person remains challenging and requires a multidisciplinary approach to discovery with the possible involvement of family or neighbors, home-care providers, elder advocates, law enforcement, judges, prosecutors, social services, and advanced health-care providers. Because memory loss occurs gradually in the majority of older persons, determining if verbal and behavioral cues imply abuse starts with a skilled advanced health-care provider, who is familiar with the patient, their comorbidities, and the functional extent of cognitive decline. Likely, the older person has records with a primary or specialty care provider, who first determines if memory loss or cognitive impairment exist and to what extent. This chapter is directed toward helping the reader review and incorporate current science about the aging disorders of memory loss and brain disease in the application of new knowledge to maltreatment case exemplars. The exemplars are designed to challenge the advanced health-care provider and other multidisciplinary team members in decisions about the accuracy of the report of maltreatment and the subsequent care of an older person with dementia and memory disorders affected by maltreatment.