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Scott S, Brameier DT, Tryggedsson I, Suneja N, Stenquist DS, Weaver MJ, von Keudell A. Elder Abuse in the Orthopaedic Patient: An Updated Review of Prevalence, Identification, and Screening Tools for Orthopaedic Surgeons. Geriatr Orthop Surg Rehabil 2024; 15:21514593241266486. [PMID: 39156482 PMCID: PMC11329899 DOI: 10.1177/21514593241266486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Elder abuse is a prevalent, though often overlooked and underreported, cause of musculoskeletal injury in the elderly population. The purpose of this review is to provide an updated overview of the prevalence of elder abuse, its association with musculoskeletal injuries, and the available resources to aid orthopaedic surgeons in early detection and intervention. Significance Improved training on this topic is needed throughout the medical education of orthopaedic surgeons to effectively recognize and address elder abuse. Our findings reveal an urgent need for increased awareness, education, and collaboration among healthcare professionals to address this significant public health concern. As the aging population continues to grow, understanding the connection between elder abuse and musculoskeletal injuries is essential for providing comprehensive care to older adults. Results This review offers practical recommendations for identifying individuals at risk of elder abuse and outlines strategies for intervention. Indicators of abuse range from obvious signs like dirty clothes, neglect, and unattended injuries from falls, to more subtle cues requiring careful observation and questioning, such as mental health symptoms and family histories of abuse. Conclusion By shedding light on this often-overlooked issue, this review advocates for a proactive approach to identifying and addressing elder abuse to safeguard the well-being and quality of life of older individuals.
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Affiliation(s)
- Sophia Scott
- Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Nishant Suneja
- Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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El-Qawaqzeh K, Hosseinpour H, Gries L, Magnotti LJ, Bhogadi SK, Anand T, Ditillo M, Stewart C, Cooper Z, Joseph B. Dealing with the elder abuse epidemic: Disparities in interventions against elder abuse in trauma centers. J Am Geriatr Soc 2023; 71:1735-1748. [PMID: 36876983 DOI: 10.1111/jgs.18286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults. METHODS Analysis of the 2017-2018 ACS TQIP. All trauma patients ≥60 years with an abuse report for suspected physical abuse were included. Patients with missing information on abuse interventions were excluded. Outcomes were rates of abuse investigation initiation following an abuse report and change of caregiver at discharge among survivors with an abuse investigation initiated. Multivariable regression analyses were performed. RESULTS Of 727,975 patients, 1405 (0.2%) had an abuse report. Patients with an abuse report were younger (mean, 72 vs 75, p < 0.001), and more likely to be females (57% vs 53%, p = 0.007), Hispanic (11% vs 6%, p < 0.001), Black (15% vs 7%, p < 0.001), suffer from dementia (18% vs 11%, p < 0.001), functional disability (19% vs 15%, p < 0.001), have a positive admission drug screen (9% vs 5%, p < 0.001) and had a higher ISS (median [IQR], 9 [4-16] vs 6 [3-10], p < 0.001). Perpetrators were members of the immediate/step/extended family in 91% of cases. Among patients with an abuse report, 1060 (75%) had abuse investigations initiated. Of these, 227 (23%) resulted in a change of caregiver at discharge. On multivariate analysis for abuse investigation initiation, male gender, private insurance, and management at non-level I trauma centers were associated with lower adjusted odds (p < 0.05), while Hispanic ethnicity, positive admission drug screen, and penetrating injury were associated with higher adjusted odds (p < 0.05). On multivariate analysis for change of caregiver, male gender, and private insurance were associated with lower adjusted odds (p < 0.05), while functional disability and dementia were associated with higher adjusted odds (p < 0.05). CONCLUSIONS Significant gender, ethnic, and socioeconomic disparities exist in the management of physical abuse of older adults. Further studies are warranted to expand on and address the contributing factors underlying these disparities. LEVEL OF EVIDENCE III. STUDY TYPE Therapeutic/Care Management.
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Affiliation(s)
- Khaled El-Qawaqzeh
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lynn Gries
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Collin Stewart
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Zara Cooper
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
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Knowledge, attitudes, detection, and reporting practices of elder abuse among orthopedists. Eur Geriatr Med 2022; 13:1425-1431. [PMID: 36040647 DOI: 10.1007/s41999-022-00685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/27/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of the present study is to explore orthopedists' level of knowledge regarding laws and directives related to the detection and reporting of elder abuse, their attitudes towards the detection and reporting of elder abuse, detection and reporting practices, and the associations between these variables. METHODS In this cross-sectional study, 145 orthopedists employed in various Israeli hospitals-senior orthopedists, orthopedic residents, and orthopedic interns-completed a questionnaire. RESULTS The orthopedists had a medium level of knowledge and held positive attitudes on the detection and reporting of elder abuse, but the actual number of cases they detected and reported was low. Senior orthopedists had the highest level of knowledge and also the most positive attitudes, followed by orthopedic residents, and then orthopedic interns. Common reasons for unwillingness to report cases of elder abuse differed between levels of training. A minority of the orthopedists had received training on the detection and management of elder abuse. Higher knowledge and more positive attitudes were found associated with a higher number of detected and reported cases of elder abuse. CONCLUSIONS The importance of training orthopedists on the detection and management of elder abuse cannot be overemphasized. It seems that orthopedists should receive such training early in their career. LEVEL OF EVIDENCE IV.
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Zhang LP, Du YG, Dou HY, Liu J. The prevalence of elder abuse and neglect in rural areas: a systematic review and meta-analysis. Eur Geriatr Med 2022; 13:585-596. [PMID: 35224680 DOI: 10.1007/s41999-022-00628-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Many epidemiological studies have reported that elder abuse and neglect were prevalent in rural areas. However, none of them has synthesized the literature in this field. Therefore, we aimed to estimate the overall prevalence of elder abuse and neglect in rural areas through a systematic review and meta-analysis. METHODS PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched to identify eligible articles, with no language restrictions. Statistical analyses were conducted using Review Manager software (version 5.3). Meta-analyses and sensitivity analysis were performed using a random-effects model. All results were reported as the pooled prevalence of elder and neglect with their 95% confidence intervals (CIs). The quality of the included studies was evaluated by strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Potential publication bias was assessed by the funnel plot. RESULTS 13 cross-sectional studies involving 10,313 participants were eligible. The prevalence of elder abuse and neglect ranged from 4.5 to 61.7% across the rural areas, and pooled prevalence estimate was 33% (95% CI 23-43). The prevalence of physical abuse was estimated at 7% (95% CI 5-9), financial abuse at 5% (95% CI 4-7), psychological/emotional abuse at 17% (95% CI 11-23), and neglect at 26% (95% CI 17-35). There was significant heterogeneity among the included studies. Stratified analyses revealed that sampling design was part of the heterogeneity source. WHO regions, gender, countries' income classification, and study quality could not explain the potential reasons for heterogeneity. CONCLUSIONS The pooled prevalence of elder abuse and neglect was relatively high in rural areas. Early and targeted screening and prevention are needed. There is an urgent need for high quality studies using agreed definition of elder abuse and neglect to protect the potential high risk populations.
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Affiliation(s)
- Li-Ping Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, No. 10 Poyang Lake Road, West Area of Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Ya-Ge Du
- School of Nursing, Peking University, 38 College Road, Haidian District, Beijing, 100191, China
| | - Hao-Ying Dou
- School of Nursing, Tianjin University of Traditional Chinese Medicine, No. 10 Poyang Lake Road, West Area of Tuanbo New Town, Jinghai District, Tianjin, 301617, China.
| | - Jie Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, No. 10 Poyang Lake Road, West Area of Tuanbo New Town, Jinghai District, Tianjin, 301617, China
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Ben Natan M, Steinfeld Y, Yonai Y, Berkovich Y. Retrospective study of older patient characteristics that increase the likelihood that a fracture was associated with abuse. J Elder Abuse Negl 2021; 33:221-229. [PMID: 34096472 DOI: 10.1080/08946566.2021.1934769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Searching for clinical manifestations of elder abuse may help healthcare professionals identify cases of elder abuse. The aim of the present study was to explore characteristics of older patients with fractures that increase the likelihood that the fracture was associated with abuse. This is a retrospective chart review study of 1,000 patients aged 65 and older who presented to an emergency department in northern-central Israel with a fracture during 2019. The chart review included participant characteristics - sociodemographic data, medical data, data regarding the fracture, and data on the presence of forensic markers of elder abuse in individual patients. Descriptive statistics and regression models were used for the analyses. Older age, presence of dementia, and hand and facial fractures were associated with the presence of forensic markers, and were also found to predict having at least one forensic factor. This study provides further support for the creation of clinical guidelines for identification of elder abuse.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Steinfeld
- The Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Yonai
- The Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaron Berkovich
- The Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel Hillel Yaffe Medical Center, Hadera, Israel
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