Clinical and Forensic Markers Indicating Abuse or Neglect

Victims of sexual abuse may present oral venereal lesions. Bruising of the uvula (Marshall et al., 2000) and bruising of the palate and the junction of the hard palate may indicate forced oral copulation (Fenton et al., 2000). Bleeding and bruising of the anogenital area as well as difficulty in sitting and walking may indicate sexual abuse in elderly women (Fulmer et al., 1984).

A retrospective descriptive study of reported cases of sexual assault from New Zealand looked at women and children, including some elderly women ranging in age from 60 to 83 years. One-third of women were assaulted in their homes, and one-third were intoxicated at the time of the assault. Fifty percent were restrained, and 75 percent had evidence of trauma. The most common site of bruising, inflammation, tenderness, abrasions, or trauma was the anogenital area (41 percent of cases). The remainder of the cases involved other parts of the body, with no particular site injured more frequently than another (Goodyear-Smith, 1989). Other types of bruising, for example, on the abdomen, might be suggestive of sexual abuse (Burgess, 2000). New diagnoses of sexually transmitted disease in nursing home residents or other elders may indicate abuse. Urinary tract infections in nursing home residents may indicate sexual abuse if several cases occur in a cluster. Behavioral signs indicating potential sexual abuse may include withdrawal, fear, depression, anger, insomnia, increased interest in sexual matters, or increased sexual or aggressive behavior.

Financial Fraud and Exploitation

Financial exploitation is the inappropriate use of an elderly person’s resources for personal gain (American Medical Association, 1996). Financial fraud and abuse make up 12.3 percent of reports to protective service agencies (National Center on Elder Abuse, 1996).

Age-Related Changes

There is never a situation in which financial exploitation is considered normal, regardless of the age or functional status of the individual.

Clinical and Forensic Markers Indicating Abuse or Neglect

Paveza and his colleagues (1997) have studied the types of financial exploitation and the associated variables. They have determined that risk factors vary with the type of financial abuse; however, in general the vic-

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