Éric Mercier, Alexandra Nadeau, Audrey-Anne Brousseau, Marcel Émond, Judy Lowthian, Simon Berthelot, Andrew P Costa, Fabrice Mowbray, Don Melady, Krishan Yadav, Christian Nickel, Peter A Cameron
Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review.
Ann Emerg Med. 2020 Feb;75(2):181-191. doi: 10.1016/j.annemergmed.2019.12.011.
Abstract/Text
This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.
Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
XinQi Dong
Medical implications of elder abuse and neglect.
Clin Geriatr Med. 2005 May;21(2):293-313. doi: 10.1016/j.cger.2004.10.006.
Abstract/Text
Recognition of elder abuse and neglect among health care professionals has been a relatively recent phenomenon. Each year, millions of elderly persons suffer as the result of abuse and neglect. Their quality of life is severely jeopardized in the form of worsened functional status and progressive dependency, poorly rated self-health, feelings of helplessness, and from the vicious cycle of social isolation, stress and further psychologic decline. Other medical implications of abuse and neglect include higher health systems use in the form of frequent ER visits, higher hospitalization, and higher nursing home placement; most importantly, it is an independent predictor for higher mortality. Physicians are well situated in detecting and reporting suspected cases and taking care of the frail elders who are victims of abuse and neglect, but there are barriers on the individual level, and there is a broader need for system change. Through education, training, and reinforcement, there are strategies to get health care professionals more involved and provide effective management protocols and guidelines for us to advocate for our patients in the current epidemic of elder abuse and neglect.
Detecting elder abuse and neglect: assessment and intervention
2014 Mar 15;89(6):453-60.
Abstract/Text
Tony Rosen, Veronica M LoFaso, Elizabeth M Bloemen, Sunday Clark, Thomas J McCarthy, Christopher Reisig, Kriti Gogia, Alyssa Elman, Arlene Markarian, Neal E Flomenbaum, Rahul Sharma, Mark S Lachs
Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases.
Ann Emerg Med. 2020 Sep;76(3):266-276. doi: 10.1016/j.annemergmed.2020.03.020. Epub 2020 Jun 10.
Abstract/Text
STUDY OBJECTIVE: Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls.
METHODS: We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014.
RESULTS: We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%).
CONCLUSION: Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.
Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Tony Rosen, Michael E Stern, Mary R Mulcare, Alyssa Elman, Thomas J McCarthy, Veronica M LoFaso, Elizabeth M Bloemen, Sunday Clark, Rahul Sharma, Risa Breckman, Mark S Lachs
Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team.
Emerg Med J. 2018 Oct;35(10):600-607. doi: 10.1136/emermed-2017-207303. Epub 2018 Aug 9.
Abstract/Text
BACKGROUND: An ED visit provides a unique opportunity to identify elder abuse, which is common and has serious medical consequences. Despite this, emergency providers rarely recognise or report it. We have begun the design of an ED-based multidisciplinary consultation service to improve identification and provide comprehensive medical and forensic assessment and treatment for potential victims.
METHODS: We qualitatively explored provider perspectives to inform intervention development. We conducted 15 semistructured focus groups with 101 providers, including emergency physicians, social workers, nurses, technologists, security, radiologists and psychiatrists at a large, urban academic medical centre. Focus groups were transcribed, and data were analysed to identify themes.
RESULTS: Providers reported not routinely assessing for elder mistreatment and believed that they commonly missed it. They reported 10 reasons for this, including lack of knowledge or training, no time to conduct an evaluation, concern that identifying elder abuse would lead to additional work, and absence of a standardised response. Providers believed an ED-based consultation service would be frequently used and would increase identification, improve care and help ensure safety. They made 21 recommendations for a multidisciplinary team, including the importance of 24/7 availability, the value of a positive attitude in a consulting service and the importance of feedback to referring ED providers. Participants also highlighted that geriatric nurse practitioners may have ideal clinical and personal care training to contribute to the team.
CONCLUSIONS: An ED-based multidisciplinary consultation service has potential to impact care for elder abuse victims. Insights from providers will inform intervention development.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Natalie L Richmond, Sheryl Zimmerman, Bryce B Reeve, Joseph A Dayaa, Mackenzie E Davis, Samantha B Bowen, John A Iasiello, Rachel Stemerman, Rayad B Shams, Jason S Haukoos, Philip D Sloane, Debbie Travers, Laura A Mosqueda, Samuel A McLean, Timothy F Platts-Mills
Ability of Older Adults to Report Elder Abuse: An Emergency Department-Based Cross-Sectional Study.
J Am Geriatr Soc. 2020 Jan;68(1):170-175. doi: 10.1111/jgs.16211.
Abstract/Text
OBJECTIVES: To characterize assessments of a patient's ability to report elder abuse within the context of an emergency department (ED)-based screen for elder abuse.
DESIGN: Cross-sectional study in which participants were screened for elder abuse and neglect.
SETTING: Academic ED in the United States.
PARTICIPANTS: Patients, aged 65 years and older, presenting to an ED for acute care were assessed by trained research assistants or nurses.
MEASUREMENTS: All patients completed the four-item Abbreviated Mental Test 4 (AMT4), then completed a safety interview (using the Emergency Department Senior Abuse Identification tool) designed to detect multiple domains of elder abuse and received a physical examination. Based on the cognitive assessment and safety interview, assessors ranked their confidence in the patient's ability to report abuse as absolutely confident, confident, somewhat confident, or not confident. To assess interrater reliability, two assessors independently rated confidence for a subset of patients.
RESULTS: Assessors suspected elder abuse in 18 of 276 patients (6.5%). Assessors were absolutely confident in the patient's ability to report abuse for 95.7% of patients, confident for 2.5%, somewhat confident for 1.5%, and not confident for 0.3%. Among patients with an AMT4 of 4 (n = 249), assessors were confident or absolutely confident in 100% of patients. Among patients with an AMT4 of less than 4 (n = 27), they were confident or absolutely confident in the patient's ability to report abuse for 81% of patients, including 11 of 12 patients with mild cognitive impairment and 7 of 11 patients with severe cognitive impairment. For patients receiving paired evaluations (n = 131), agreement between assessors regarding patient ability to report abuse was 97% (κ = 0.5).
CONCLUSIONS: In this sample of older adults receiving care in an ED, research assistants and nurses felt that the vast majority were able to report elder abuse, including many patients with cognitive impairment. J Am Geriatr Soc 68:170-175, 2019.
© 2020 The American Geriatrics Society.
Timothy F Platts-Mills, Karen Hurka-Richardson, Rayad B Shams, Aileen Aylward, Joseph A Dayaa, Melinda Manning, Laura Mosqueda, Jason S Haukoos, Mark A Weaver, Philip D Sloane, Debbie Travers, Phyllis L Hendry, Ashley Norse, Christopher W Jones, Samuel A McLean, Bryce B Reeve, Sheryl Zimmerman, Investigators for the ED Senior AID Research Group, Katie Davenport, Debra Bynum, Emilia Frederick, Kim Lassiter-Fisher, Amy Stuckey, Racquel Daley-Placide, Mark Hoppens, Judy Betterton, Samantha Owusu, Cynthia Flemming, Andrew Colligan
Multicenter Validation of an Emergency Department-Based Screening Tool to Identify Elder Abuse.
Ann Emerg Med. 2020 Sep;76(3):280-290. doi: 10.1016/j.annemergmed.2020.07.005.
Abstract/Text
STUDY OBJECTIVE: Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse.
METHODS: We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool.
RESULTS: Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%).
CONCLUSION: This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.
Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Mark J Yaffe, Christina Wolfson, Maxine Lithwick, Deborah Weiss
Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI).
J Elder Abuse Negl. 2008;20(3):276-300. doi: 10.1080/08946560801973168.
Abstract/Text
This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.
Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement
2013 Mar 19;158(6):478-86.
Abstract/Text
