Bruise in the elderly where maltreatment or abuse should be considered

Bruises are common in the general elderly population. In spite of them being the most frequent visitors to the doctor's office, clinicians rarely suspect bruising associated with physical elder abuse (1).

• a 2005 study of accidental elderly bruising revealed that:
  • around 90% accidental bruising in the geriatric population were on extremities
  • around 50% of bruises resolved in less than 6 days (bruise was visible for 4 to 41)
  • colour cannot be used to estimate the age of the bruise
  • multiple bruises were more common in elders who were on anticoagulation medications (1)

The following factors should prompt the clinicians to suspect an abusive aetiology for the bruises:

• an elder who seems to be more withdrawn than usual
• a concerned caretaker who refuses to leave the patient alone
• bruising patterns which cannot be connected to daily activities or routine daily care (2)

Bruises which occur due to physical abuse of the elders are often large (>5 cm) and are present on the face, lateral right arm and posterior torso (1) (3)

Elders with suspected abusive bruises should be inquired about the cause and if the patient fails to mention abuse as the cause question the patient in a more reassuring manner so that the patient feels safe and may reveal a previously unrecognized abusive situation (1) (3).

Reference:

• 1. Wiglesworth A et al. Bruising as a marker of physical elder abuse. J Am Geriatr Soc. 2009;57(7):1191-6.
• 2. Valente MJ, Abramson N.Easy bruisability. South Med J. 2006;99(4):366-70.
• 3. Van Houton M. et al. Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review. European Geriatric Medicine 2022; 13(1): 53–85.