11/17/2011 - Articles

Elder Abuse and the Importance of Bruising

By: John Russo, Jr., PharmD


Physical abuse isn't an accident. It's an intentional action that creates a serious risk of physical harm to a vulnerable elder. It violates an older person’s basic need for protection from harm.

Why it occurs is not the issue. The purpose here is to defend the defenseless. It starts by recognizing when suspicion should be raised, and the first steps to take to protect a physically abused senior.

When is a bruise likely to be more than accidental?
It’s commonly stated that as we age, weakening of blood vessels and thinning of the skin increase our risk to bruise. The fact is that fewer than 10% of seniors who are not abused show bruising. This compares to bruising in three out of four abused elders, according to the U.S. Department of Justice. There’s likely to be at least one bruise less than an inch in diameter. In fact, most abused elders have one large bruise — at least 2 inches across.

But don't expect to see multiple bruises. The number of bruises isn’t helpful in determining the likelihood of physical abuse. They are just as likely to have one or two bruises as three to nine bruises.

Bruising is most likely to appear on their head (almost always on the face), neck, and middle of the back. One in four abused elders show a bruise on the outside of their right arm. By comparison, fewer than 10% of elders who are not being abused will have bruising in that area.

The bottom line.
By itself, bruising is not proof of abuse. For example, it might be due to certain medicines (see article below) or illness. And this is the key. Once suspicions of abuse are raised, the responsible approach is to seek medical assistance. This will rule out medical explanations. Most importantly, it’s an opportunity to bring your concerns to the attention of a healthcare professional who is better qualified to make a full evaluation and determine the need for additional inquiries.

Many elders in an abusive situation endure it for years before having it discovered. Some die before help arrives. By understanding the significance of bruising, we have an opportunity to raise suspicions of abuse at an earlier stage and initiate appropriate actions.

Supplements That Increase the Risk of Bruising and Bleeding with Coumadin®
John Russo, Jr. PharmD

Dr. Jennifer Strohecker at the Intermountain Medical Center in Salt Lake City, Utah, tells us that the safety of warfarin (Coumadin) may be compromised by many popular herbal and nonherbal supplements. In fact, eight of the 10 most widely used supplements interacted with warfarin.

Here’s what we know.
Cranberry, garlic, ginkgo, and saw palmetto are associated with increased rates of bleeding.

Other supplements alter prothrombin times (a blood test that measures how long it takes blood to clot), which might require a change in the warfarin dose. For example, glucosamine, essential fatty acids, multiherb products, and primrose oil may increase prothrombin times. Coenzyme Q10, soy, melatonin, ginseng, and St. John's wort may decrease prothrombin times.

The bottom line.
People who take supplements need to be aware of the safety risks of supplements, especially when taken with prescription drugs.

If you take warfarin and one of these supplements, tell you doctor.

If you notice bruising, tell you doctor.

Make sure that the side effect of one does not offset the benefit of the other.

Created on: 11/17/2011
Reviewed on: 11/17/2011

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