The signs and symptoms of abuse and neglect may mimic the signs and symptoms of many common chronic medical conditions in either children or elderly persons. A complete assessment for child or elder abuse and neglect is time consuming and is best performed as a regimented evaluation that includes separate histories from the patient(s) and suspected party and a clinical assessment that emphasizes function, cognition, and specific aspects of the physical examination. The management of abuse and neglect should be multidisciplinary with several key personnel participating. An child or elderly person in immediate danger should be removed from his or her environment.
For less acute cases, a variety of interventions aimed at decreasing the stress of caregiving or ameliorating other family stressors may be appropriate. Most states require clinicians who suspect abuse and neglect report their concerns to a designated authority.
There are many gaps in our knowledge about abuse and neglect. It is hoped that with the future application of rigorous epidemiologic methodology as has been employed in the study of child abuse, this social ill can be better understood and prevented. Until then, clinicians must integrate their clinical experience and social skills to recognize the problem and provide thoughtful and compassionate intervention.
