Older people who have a wrist or hip fracture often get such injuries after taking a fall. But researchers say there's a distinct pattern of broken bones and bruises that suggests something more sinister – elder abuse.
After reviewing international medical literature and Ontario coroners' reports, Dr. Kieran Murphy and colleagues saw the same pattern of fractures and soft-tissue injuries over and over again.
"There is indeed a typical distribution of injuries that are seen radiologically in the elderly who are beaten," said Murphy, a radiologist at the University Health Network in Toronto. "So they have injuries around their eyes, they have injuries to their teeth.
"They may have shaking injuries, which cause bleeds (inside) the head called subdurals, they may have soft-tissue injuries and upper-extremities injuries," he added.
Murphy and his team reviewed more than 1,100 cases of abuse in people over age 60. Their findings will be presented Tuesday at the annual meeting of the Radiological Society of North America in Chicago.
Their analysis also showed that these elderly abuse victims were most often in a home setting being cared for by non-professionals, such as a family member or other untrained caregiver.
Often the offender is financially dependent on the older person and may have an alcohol or drug addiction, he said. The person being assaulted is often debilitated in some way, by dementia or the effects of a stroke, for example.
"If you factor in these different issues, you can come up with a fairly accurate likelihood that somebody's injuries are non-accidental," Murphy said.
"Older people fall and they fall on an outstretched hand and they break their wrist or they break their hip. Those are normal elderly fractures.
"They don't usually break their scapula (shoulder blade). But if somebody hits them in the back, they might break that. Or they don't normally break their orbit (bony eye socket). But if somebody punches them in the face, they'll break that."
Murphy said he hopes the study will help radiologists and other physicians recognize what could be signs of elder abuse, which is significantly under-reported.
"Radiologists need to be aware of the pattern of injuries frequently seen in the abused elderly," he said. "More importantly, we need to integrate the physical and radiological findings with the social context of the patient to help identify those at risk."
Irmajean Bajnok of the Registered Nurses' Association of Ontario calls elder abuse a "silent epidemic" because it appears only a small percentage of cases are ever reported.
"The older persons are in vulnerable situations; they're not likely to report this," said Bajnok, the RNAO's director of international affairs and best practice guidelines.
Bajnok said elderly patients need to be assessed by health providers that are aware of the signs of elder abuse and can ask directly: "Has anyone ever hurt you?"
Nurses are among those ideally placed to look for elder abuse, she said, but pointed out the issue is complex.
Caregivers, both in the home and in long-term-care facilities, can experience tremendous frustration in trying to look after elderly patients with complicated medical conditions that can include dementia.
But instead of pointing fingers of blame, it's more constructive to look for what triggers incidents of abuse and to figure out ways to train caregivers to de-escalate situations that could lead to physical maltreatment.