A geriatric patient may have one or more injuries or problems that may be misidentified as abuse. It is important to exclude other causes before concluding that abuse has occurred.


Conditions which may be confused with abuse:

(1) bruises or lacerations

(2) fractures or blunt trauma

(3) burns or scalds

(4) anogenital lesions

(5) malnutrition or dehydration

(6) chronic wounds

(7) sedation (which may be confused with chemical restraint)


Differential diagnosis of bruises and lacerations:

(1) senile purpura

(2) steroid purpura

(3) senile skin laxity

(4) contact dermatitis

(5) coagulopathy secondary to medications or disease

(6) drug eruption


Differential diagnosis of fracture or blunt trauma:

(1) fracture secondary to osteoporosis

(2) fall injury

(3) intoxication

(4) hematoma associated with excessive anticoagulation

(5) impaired vision


Differential diagnosis of burns or scalds:

(1) toxic epidermal necrolysis

(2) fixed drug eruption

(3) contact dermatitis


Differential diagnosis of anogenital lesions:

(1) lichen sclerosis et atrophicus

(2) anal lesions associated with inflammatory bowel disease

(3) vaginitis or vaginal bleeding

(4) cystocele or rectocele

(5) fecal or urinary incontinence


Differential diagnosis of malnutrition or dehydration:

(1) gastrointestinal disorder (diarrhea, malabsorption)

(2) anorexia

(3) diabetes mellitus

(4) drug-induced diuresis


Differential diagnosis of chronic wounds:

(1) poor wound healing

(2) decubitus

(3) vascular ischemia


Differential diagnosis of sedation:

(1) adverse drug reaction

(2) decreased drug metabolism or excretion


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