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Bloemen EM, Gottesman E, Furfari K, Glover J, Gabbay E, Cox S, Lindberg D, Tietz S, Rosen T, Baek D, Elman A, Huberman B. Examining ethical issues that arise in providing ED/hospital care for patients experiencing elder mistreatment and approaches to address them. J Elder Abuse Negl 2024; 36:395-412. [PMID: 38867518 PMCID: PMC11333161 DOI: 10.1080/08946566.2024.2365341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Clinicians in the emergency department and hospital who treat patients experiencing elder mistreatment (EM) can expect to encounter challenging ethical dilemmas. Collaboration with ethics and EM consultation services offers teams an important opportunity to improve patient-centered outcomes and address value-based concerns when treating these patients. This article describes the role of a hospital clinical ethics consultation service and best practices for collaboration between ethics and EM consultation services. Illuminated via four case studies, the article presents several core ethical frameworks, including allowing patients the dignity of risk, considerations around a harm reduced discharge, involving abusers in surrogate decision making, and providers' experience of moral distress when dealing with patients experiencing EM. Increasing collaboration with ethics and elder mistreatment services can help teams more effectively respond to EM.
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Affiliation(s)
- Elizabeth M. Bloemen
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Kristin Furfari
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jackie Glover
- Department of Pediatrics and the Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ezra Gabbay
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sarah Cox
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine
| | - Sarah Tietz
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Barrie Huberman
- Division of Medical Ethics, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY USA
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Khurana B, Bayne HN, Prakash J, Loder RT. Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings. J Am Geriatr Soc 2024; 72:1011-1022. [PMID: 38376211 PMCID: PMC11127187 DOI: 10.1111/jgs.18801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/14/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Falls and interpersonal violence pose significant threats to older adults, leading to injuries, hospitalizations, and emergency department (ED) visits. This study investigates the demographics and injury patterns in older adults (aged 60 and above) who sought ED care due to assaults, comparing them with those who experienced falls to gain a deeper understanding of older adult abuse patterns. METHOD This study utilizes data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (2005-2019) to examine injuries among older adults aged 60 years and above. Participants were categorized into two groups: older adult abuse and injuries due to falls. The differences between the groups by demographics, injury locations, patterns, and temporal trends were analyzed using statistical methods accounting for the weighted stratified nature of the data. Cosinor analysis and Joinpoint regression were used for temporal analysis. RESULTS Over 15 years, there were an estimated 307,237 ED visits for older adult abuse and 39,477,217 for falls. Older adults experiencing abuse were younger and had lower hospital admission rates compared to fall patients. Injuries associated with abuse included contusions/abrasions, penetrating injuries, and fractures to the head/neck, fingers, toes, ribs, and lower extremities. In contrast, fall patients had higher admission rates, with more fractures, including cervical spine and hip fractures. Temporal patterns showed a higher rate of assaults during the summer, whereas abuse demonstrated bimodal peaks in the summer and fall. CONCLUSIONS Injuries associated with abuse such as facial, upper trunk, and upper extremity fractures should raise suspicion even in the absence of severe symptoms. These findings emphasize the importance of early identification to connect older adults with support resources, as patients experiencing abuse often get discharged from the ED.
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Affiliation(s)
- Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology and Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Haley N. Bayne
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405
| | - Jaya Prakash
- Trauma Imaging Research and Innovation Center, Department of Radiology and Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis St, Boston MA 02115
| | - Randall T. Loder
- Department of Orthopedic Surgery, Indiana University School of Medicine, Riley Children’s Hospital, 705 Riley Hospital Drive, Indianapolis, IN 46202
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Burnett J, Campetti R, Froberg R, Beauchamp JE, Lees-Haggerty K. Perspectives on elder mistreatment screening and responding in emergency departments: A qualitative study with survivors. Int J Psychiatry Med 2024:912174231225765. [PMID: 38196310 DOI: 10.1177/00912174231225765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Elder Mistreatment (EM) occurs in approximately 10% of older adults and is associated with trauma-related outcomes including depression, anxiety, post-traumatic stress disorder, and early mortality. Low screening and older adult self-reporting rates, especially within Emergency Departments represent missed opportunities for identify and mitigate future EM occurrences and consequences. To date, no studies have obtained EM survivors perspectives of EM screening and response practices in emergency departments. METHODS Semi-structured interviews with 19 EM survivors with Adult Protective Services validated EM were completed in the older adult's home. The Elder Mistreatment Emergency Department Screening and Response Tool (EM-SART) was used to guide the interview questions. All interviews were recorded, transcribed, and analyzed using qualitative thematic analyses. RESULTS The participants were mostly female (63%) and white (58%) with an average age of 74 years. Physical abuse accounted for 67% of the EM incidents. Three themes emerged indicating the survivor preference for (1) building rapport and approaching the older adult with compassion and care, (2) setting the context before asking the EM questions, and (3) allowing mutuality, collaborative work, and shared decision-making during the response. CONCLUSIONS Older adults are agreeable and willing to self-report and actively engage in the EM screening and response practices in the emergency department if trauma-informed care principles are utilized.
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Affiliation(s)
- Jason Burnett
- The University of Texas Health Science Center, Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, Houston, TX, USA
| | | | | | - Jennifer Es Beauchamp
- The University of Texas Health Science Center, Cizik School of Nursing, Houston, TX, USA
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Ross J. Elder Abuse-the Need for Increased Awareness, Assessment, and Reporting in Health Care. J Perianesth Nurs 2023; 38:945-946. [PMID: 38042582 DOI: 10.1016/j.jopan.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Jacqueline Ross
- Department of Patient Safety and Risk Management, The Doctors Company, Chagrin Falls, OH.
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McQuown CM, Tsivitse EK. Nonspecific Complaints in Older Emergency Department Patients. Clin Geriatr Med 2023; 39:491-501. [PMID: 37798061 DOI: 10.1016/j.cger.2023.04.007] [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] [Indexed: 10/07/2023]
Abstract
Nonspecific complaints such as generalized weakness and fatigue are common in older adults presenting to an emergency department. These complaints may be caused by acute or chronic medical problems, or they may be exacerbated or caused by socioeconomic risks factors. Acute causes may be related to serious medical conditions requiring prompt treatment. A thorough history and physical examination in conjunction with an interdisciplinary approach allows emergency departments to identify acute conditions as well as geriatric syndromes and unmet home needs, such as food insecurity and caregiver burden. A whole-health system approach should be used for safe transitions of care.
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Affiliation(s)
- Colleen M McQuown
- Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard. Cleveland, OH 44106, USA.
| | - Emily K Tsivitse
- Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard. Cleveland, OH 44106, USA
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Gottesman E, Elman A, Rosen T. Elder Mistreatment: Emergency Department Recognition and Management. Clin Geriatr Med 2023; 39:553-573. [PMID: 37798065 DOI: 10.1016/j.cger.2023.05.007] [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] [Indexed: 10/07/2023]
Abstract
Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.
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Affiliation(s)
- Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA.
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Zobdeh A, Bandari R, Heravi-Karimooi M, Mashayekh M, Hazrati M, Montazeri A. Development and validation of the short form domestic elder abuse assessment questionnaire (SF-DEAQ). BMC Geriatr 2023; 23:654. [PMID: 37828448 PMCID: PMC10571479 DOI: 10.1186/s12877-023-04388-x] [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: 11/14/2022] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The present study aimed to design and determine the psychometric properties of a short-form questionnaire to investigate the domestic elder abuse. METHODS This study consisted of two phases: in phase 1 we employed a modified Delphi approach with 18 participants. Consequently, content and face validity, and item analysis were applied. In Phase 2 we evaluated structural validity and convergent validity. Reliability was assessed by looking at internal consistency, stability, and absolute reliability. RESULTS The findings led to the development of a 27-items short form of domestic elder abuse in four domains that jointly accounted for 74.14% of the variance observed. The short form showed high internal consistency (Cronbach's alpha = 0.93) and significantly correlated (r = 0.91; p < 0.001 for both scales) with the comprehensive (49-item) domestic elder abuse. CONCLUSION The short form of domestic elder abuse was found to be reliable and valid as the longer version. The short form of domestic elder abuse could lessen the burden on respondents.
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Affiliation(s)
- Amirreza Zobdeh
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Razieh Bandari
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Majideh Heravi-Karimooi
- Elderly Care Research Center, Faculty of Nursing & Midwifery, Shahed University, Tehran, Iran
| | - Maryam Mashayekh
- Amir-Almomenin Hospital, Busher University of Medical Sciences, Genaveh, Iran
| | - Maryam Hazrati
- Iranian Research Center on Aging, University of Social and Rehabilitation Sciences, Tehran, Iran
- Shiraz Transplant Center, Abu-Al Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metric Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
- Faculty of Humanity Sciences , University of Sciences & Culture, Tehran, Iran.
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Choksomngam Y, Petrungjarern T, Ketkit P, Boontak P, Panya R, Wongpakaran T, Wongpakaran N, Lerttrakarnnon P. The Prevalence of Elder Abuse and its Association with Frailty in Elderly Patients at the Outpatient Department of a Super-Tertiary Care Hospital in Northern Thailand. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1644. [PMID: 37763763 PMCID: PMC10537392 DOI: 10.3390/medicina59091644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The global population is undergoing rapid aging, resulting in an increase in geriatric syndromes and hidden health issues such as elder abuse. However, the prevalence of elder abuse varies across different settings. The objective of this study is to determine the prevalence and factors associated with elder abuse at the outpatient department of a super-tertiary care hospital in northern Thailand. Materials and Methods: This cross-sectional study involved 210 elderly patients who visited Maharaj Nakorn Chiang Mai Hospital between May and August 2022. The participants completed several assessments, including the Mini-Cog, Thai Geriatric Depression Scale-6, Core Symptom Index-15, FRAIL scale, Barthel Activities of Daily Living, Interview Guideline for Screening for Elder Abuse, and Diagnostic Criteria for Elder Abuse. Fisher's exact test was used to examine the association between the factors and elder abuse. Results: The Screening for Elder Abuse yielded noteworthy results, with 15.7% of the elderly patients having experienced psychological abuse. However, only a smaller subset of study participants, comprising five individuals or 2.38%, met the diagnostic criteria for elder abuse. Furthermore, statistical analysis revealed no significant correlation between elder abuse and the other factors examined in the study. Conclusions: As a result, it is crucial for hospitals to consider preventive measures and implement routine screening protocols.
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Affiliation(s)
- Yanee Choksomngam
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Terdsak Petrungjarern
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.P.); (P.K.); (R.P.)
| | - Perapoln Ketkit
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.P.); (P.K.); (R.P.)
| | - Pakpoom Boontak
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.P.); (P.K.); (R.P.)
| | - Ratchanon Panya
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.P.); (P.K.); (R.P.)
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.W.); (N.W.)
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.W.); (N.W.)
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
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Adjei MD, Diji AKA, Oduro E, Bam VB, Dzomeku VM, Budu IH, Lomotey AY, Sakyi R, Kyerew AA. Experiences of patient advocacy among nurses working in a resource constrained emergency department in Ghana. Int Emerg Nurs 2023; 67:101252. [PMID: 36801654 DOI: 10.1016/j.ienj.2022.101252] [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: 03/02/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Patient advocacy at the emergency department is stressful and cumbersome as a result of the increasing patient-to-nurse ratio and high patient turnovers. It is also unclear what patient advocacy entails and the experiences of patient advocacy in a resource-constrained emergency department. This is significant because advocacy underpins the care provided in the emergency department. AIM The primary aim of this study is to explore the experiences and underpinning factors that influence patient advocacy among nurses working in a resource constrained emergency department. METHODS A descriptive qualitative study was conducted among 15 purposively sampled ED nurses working at a resource-constrained secondary-level hospital facility. Study participants were individually interviewed via a recorded telephone conversation, after which the interviews were transcribed verbatim and inductively analyzed using the content analysis approach. The study participants described patient advocacy, situations in which they advocated for patients, the factors that motivated them and the challenges they encountered practicing patient advocacy. RESULTS Three major themes generated from the study included: "stories of advocacy", "motivating" factors and "challenging" factors. ED nurses understood patient advocacy and also advocated for patients in various instances. There were factors such as personal upbringing, professional training and religious training that motivated them and they were challenged by negative inter-professional experiences, patient and relatives' attitudes and healthcare system factors. CONCLUSION Participants understood patient advocacy and incorporated it into daily nursing care. Unsuccessful advocacy causes disappointment and frustrations. There were no documented guidelines on patient advocacy.
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Affiliation(s)
- Mabel Dorothy Adjei
- Nursing And Midwifery Training College, P.M.B 4, Sunyani Bono Region, Ghana; Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana.
| | | | - Evans Oduro
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Victoria Bubunyo Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana.
| | | | - Isaac Hayford Budu
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Richard Sakyi
- Nursing And Midwifery Training College, P.M.B 4, Sunyani Bono Region, Ghana; Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
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Optimal Management of the Geriatric Trauma Patient. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Rosen T, Zhang H, Wen K, Clark S, Elman A, Jeng P, Baek D, Zhang Y, Gassoumis Z, Fettig N, Pillemer K, Lachs MS, Bao Y. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. JAMA Netw Open 2023; 6:e2255853. [PMID: 36787139 PMCID: PMC9929702 DOI: 10.1001/jamanetworkopen.2022.55853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/15/2023] Open
Abstract
Importance Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment. Objective To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults. Design, Setting, and Participants This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022. Main Outcomes and Measures We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses. Results This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001). Conclusions and Relevance In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | | | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Marsigit J, Khasanah FT, Nainggolan L, Wahyudi ER. Depression as a Consequence of Elder Mistreatment: A Case Report. Gerontol Geriatr Med 2022; 8:23337214221146072. [PMID: 36579135 PMCID: PMC9791278 DOI: 10.1177/23337214221146072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
A 61-year-old elderly woman came to the emergency room in tertiary hospital in Jakarta, Indonesia due to epigastric pain for the past 7 months which was worsened in the past 4 days. Due to her illness, her daughters prevent her to do daily chores and her hobbies, such as singing and gardening. On admission, she had hypertension with moderate dependency, frail, cognitive impairment, malnutrition, risk of sarcopenia, and risk of depression. She was later diagnosed with poorly differentiated colon adenocarcinoma and adjustment disorders with anxiety and depressive reaction due to emotional elder mistreatment. There are a variety of forms of elder abuse, not only physical, but also emotional, sexual, financial, and neglect. The prevalence of elder mistreatment is projected between 5% and 10% all over the world and it is thought to be underdiagnosed. Among the consequences of mistreatment or abuse include social alongside, economic, physical, and mental (e.g., isolation, constrained relationships, and broken social networks). This is a case report of depression because of elder mistreatment.
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Affiliation(s)
- Jessica Marsigit
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia,Jessica Marsigit, Department of Internal Medicine, Faculty of Medicine Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
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Toya M, Minegishi S, Utsuno H, Ohta J, Namiki S, Unuma K, Uemura K, Sakurada K. Forensic Characteristics of Physical Elder Abuse and Current Status and Issues of Collaboration between Forensic Medicine Departments and Related Institutions in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15382. [PMID: 36430103 PMCID: PMC9692923 DOI: 10.3390/ijerph192215382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
This study sought to clarify the characteristics and trends of physical elder abuse and the status of collaboration between forensic medicine departments and related institutions in Japan. Questionnaires were sent to 82 forensic medicine departments and 2857 institutions randomly selected from hospitals, municipalities and public community general support centers. The survey period was February to June 2021, including an extension period for collection. Responses from 675 facilities were analyzed. The most common finding in cases of physical elder abuse at forensic medicine departments was subcutaneous hemorrhage on the head (85.7%), with mixed old and new injuries most commonly observed in the lower limbs (70%). There were few cases in which there was collaboration between forensic medicine departments and other institutions. Among the issues identified, there is a need to provide related institutions with information obtained in forensic medicine departments. A new collaboration system is needed to achieve this.
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Affiliation(s)
- Maiko Toya
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Saki Minegishi
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Hajime Utsuno
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Jun Ohta
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Shuuji Namiki
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koichi Sakurada
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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14
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Mosqueda LA. Expanding the role of interdisciplinary teams in the emergency department: Using a consultative model to serve older adults who are abused. J Am Geriatr Soc 2022; 70:3061-3063. [PMID: 36062464 PMCID: PMC9669142 DOI: 10.1111/jgs.18018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
This Editorial comments on the article by Rosen et al. in this issue.
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Affiliation(s)
- Laura A Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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15
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Rosen T, Elman A, Clark S, Gogia K, Stern ME, Mulcare MR, Makaroun LK, Gottesman E, Baek D, Pearman M, Sullivan M, Brissenden K, Shaw A, Bloemen EM, LoFaso VM, Breckman R, Pillemer K, Sharma R, Lachs MS. Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program. J Am Geriatr Soc 2022; 70:3260-3272. [PMID: 35860986 PMCID: PMC9669128 DOI: 10.1111/jgs.17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED-based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. METHODS We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. RESULTS During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty-two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy-five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety-four percent reported believing that there is merit in establishing a VEPT Program in other EDs. CONCLUSION VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer-term outcomes.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine / Boston Medical Center, Boston, MA, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mary R. Mulcare
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Lena K. Makaroun
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Morgan Pearman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kelly Brissenden
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elizabeth M. Bloemen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
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16
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Alqadiri S, MacLeod H, Huang SCC, Molnar F, Frank C. Indices et stratégies clés pour reconnaître la maltraitance des personnes âgées. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:749-750. [PMID: 36241408 PMCID: PMC9833138 DOI: 10.46747/cfp.6810749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Sultan Alqadiri
- Médecin à la Division de médecine gériatrique de L'Hôpital d'Ottawa (Ontario)
| | - Heather MacLeod
- Spécialiste de la transposition des connaissances en gériatrie au Programme gériatrique régional de l'Est de l'Ontario à Ottawa
| | | | - Frank Molnar
- Spécialiste en médecine gériatrique; il pratique au Département de médecine de l'Université d'Ottawa et à l'Institut de recherche de l'Hôpital d'Ottawa
| | - Chris Frank
- Médecin de famille; il se concentre sur les soins aux personnes âgées et les soins palliatifs à l'Université Queen's à Kingston (Ontario)
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17
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Alqadiri S, MacLeod H, Huang SCC, Molnar F, Frank C. Key signs and strategies for recognizing elder abuse. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:746-747. [PMID: 36241391 PMCID: PMC9833147 DOI: 10.46747/cfp.6810746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sultan Alqadiri
- Physician in the Division of Geriatric Medicine at the Ottawa Hospital in Ontario
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18
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Garland J, Irvine R. A Guide to the Postmortem Investigation of Starvation in Adults. Am J Forensic Med Pathol 2022; 43:205-214. [PMID: 35588207 DOI: 10.1097/paf.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Starvation is a rare cause of death in developed countries and is a complex multifaceted pathological process. To complicate the forensic investigation of starvation further, many medical conditions independent of starvation may cause wasting. This article provides one of the first comprehensive guides to the postmortem investigation of starvation in adults, with reference tables on organ-specific macroscopic and microscopic features, as well as features for excluding alternative causes of wasting. The eclectic literature on this complex topic is summarized in an accessible and easily referenced format, including mechanisms of death and ancillary postmortem investigations.
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Affiliation(s)
- Jack Garland
- From the Forensic and Analytical Science Service, NSW Health Pathology, New South Wales, Lidcombe, Australia
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19
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Firdaus MAM, Mohd Yunus R, Hairi NN, Choo WY, Hairi F, Suddin LS, Sooryanarayana R, Ismail N, Peramalah D, Ali ZM, Ahmad SN, Razak IA, Othman S, Bulgiba A. Elder abuse and hospitalization in rural Malaysia. PLoS One 2022; 17:e0270163. [PMID: 35749384 PMCID: PMC9231721 DOI: 10.1371/journal.pone.0270163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9–9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.
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Affiliation(s)
| | - Raudah Mohd Yunus
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
- Health and Well-being Research Cluster, Institute of Research Management and Monitoring, Research Management and Innovation Complex, University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | - Wan Yuen Choo
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Leny Suzana Suddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Rajini Sooryanarayana
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Norliana Ismail
- Disease Control Division, Tobacco Control Unit, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Devi Peramalah
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zainudin M. Ali
- Negeri Sembilan Health State Department, Seremban, Negeri Sembilan, Malaysia
| | - Sharifah N. Ahmad
- Negeri Sembilan Health State Department, Seremban, Negeri Sembilan, Malaysia
| | - Inayah A. Razak
- Negeri Sembilan Health State Department, Seremban, Negeri Sembilan, Malaysia
| | | | - Awang Bulgiba
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
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20
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Ellis B, Brousseau AA, Eagles D, Sinclair D, Melady D. Canadian Association of Emergency Physicians position statement on care of older people in Canadian Emergency Departments: executive summary. CAN J EMERG MED 2022; 24:376-381. [PMID: 35532853 DOI: 10.1007/s43678-022-00315-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Brittany Ellis
- Department of Emergency Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - Audrey-Anne Brousseau
- Département de médecine familiale et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Debra Eagles
- Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Douglas Sinclair
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Don Melady
- Faculty of Medicine, Schwartz/Reisman Emergency Medicine Institute, University of Toronto, Toronto, ON, Canada
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21
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Newton A, Awuviry‐Newton K, Oppong Nkansah J, Abekah‐Carter K. Understanding older adults' functioning and health-seeking behaviour during the COVID-19 pandemic in Ghana: A descriptive qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e823-e831. [PMID: 34032345 PMCID: PMC8239829 DOI: 10.1111/hsc.13452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/04/2021] [Accepted: 05/04/2021] [Indexed: 05/06/2023]
Abstract
Little research has been conducted to explore the functional status of community-dwelling older adults in sub-Saharan Africa, including Ghana, especially during the COVID-19 pandemic. This study investigated the functional status and the health-seeking behaviour of older adults during the COVID-19 pandemic in Ghana. Utilising a descriptive qualitative approach, semi-structured interviews were used to collect data from 12 eligible older adults from southern Ghana. With the use of NVivo (v12), descriptive and focused coding techniques were employed to analyse the data. The following five themes were identified after the data analysis: (a) older adults' health status during COVID-19 pandemic, (b) feeling limited, (c) feeling of unhappiness for being inactive, (d) striving to be active and (e) seeking healthcare during COVID-19 pandemic. This study revealed the unique health and social-related needs of Ghanaian older adults during the COVID-19 pandemic. This study's findings draw attention to the urgent need for the state to devise practical health and social-related initiatives to support older adults during and after the COVID-19 pandemic.
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Affiliation(s)
- Abraham Newton
- Department of Social StudiesUniversity of EducationWinnebaGhana
| | - Kofi Awuviry‐Newton
- African Health and Ageing Research Centre (AHARC)WinnebaGhana
- Priority Research Centre for Generational Health and AgeingDepartment of Public Health and MedicineThe University of NewcastleCallaghanNSWAustralia
| | | | - Kwamina Abekah‐Carter
- African Health and Ageing Research Centre (AHARC)WinnebaGhana
- Department of Social WorkUniversity of GhanaLegonGhana
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22
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Schuessler Z. Nurses' Role in Identifying Elder Financial Abuse. J Contin Educ Nurs 2022; 53:30-34. [PMID: 34978479 DOI: 10.3928/00220124-20211210-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One of the current worldwide public health problems is elderly financial abuse (EFA). Although EFA remains a hidden social phenomenon, it has been recognized as a serious concern in the United States, and currently, one in 18 cognitively intact older adults is affected by EFA. Detecting EFA is difficult because the perpetrators are often family members, trusted friends, or guardians. Thus, EFA is frequently unrecognized and grossly under-reported. In the coming decades, EFA will increase as the elderly population continues to grow rapidly worldwide. This article highlights the magnitude of the problem and the role of nurses and other health care providers in identifying, intervening in, and reporting EFA. [J Contin Educ Nurs. 2022;53(1):30-34.].
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23
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Elder Abuse. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Dash K, Breckman R, Lees-Haggerty K, Elman A, Lachs M, Stoeckle RJ, Fulmer T, Rosen T. Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments. J Elder Abuse Negl 2021; 33:311-326. [PMID: 34496716 DOI: 10.1080/08946566.2021.1965930] [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: 10/20/2022]
Abstract
Hospital emergency departments (EDs) lack the tools and processes required to facilitate consistent screening and intervention in cases of elder abuse and neglect. To address this need, the National Collaboratory to Address Elder Mistreatment has developed a clinical care model that ED's can implement to improve screening, referral, and linkage to coordinated care and support services for older adults who are at risk of mistreatment. To gauge ED readiness to change and facilitate adoption of the care model, we developed an organizational assessment tool, the Elder Mistreatment Emergency Department Assessment Profile (EM-EDAP). Development included a phased approach in which we reviewed evidence on best practice; consulted with multidisciplinary experts; and sought input from ED staff. Based on this formative research, we developed a tool that can be used to guide EDs in focusing on practice improvements for addressing elder mistreatment that are most responsive to local needs and opportunities.
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Affiliation(s)
- Kim Dash
- Health Promotion, Practice, and Innovation, US Division, Education Development Center, Waltham, MA, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine/Ne York Presbyterian Hospital, New York, NY, USA
| | - Kristin Lees-Haggerty
- Health Promotion, Practice, and Innovation, US Division, Education Development Center, Waltham, MA, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Mark Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine/Ne York Presbyterian Hospital, New York, NY, USA
| | - Rebecca Jackson Stoeckle
- Health Promotion, Practice, and Innovation, US Division, Education Development Center, Waltham, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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25
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Rosen T, Wen K, Makaroun LK, Elman A, Zhang Y, Jeng PJ, LoFaso VM, Lachs MS, Clark S, Bao Y. Diagnostic Coding of Elder Mistreatment: Results From a National Database of Medicare Advantage and Private Insurance Patients, 2011-2017. J Appl Gerontol 2021; 41:918-927. [PMID: 34075830 PMCID: PMC8636549 DOI: 10.1177/07334648211018530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health care providers may play an important role in detection of elder mistreatment, which is common but underrecognized. We used the Health Care Cost Institute insurance claims database to describe elder mistreatment diagnosis among Medicare Advantage (MA) and private insurance patients in the United States from 2011 to 2017. We used International Classification of Diseases (ICD) coding to identify cases, examining the impact of transition from ICD-9 (Ninth Revision) to ICD-10 (Tenth Revision), which occurred in October 2015 and added 14 new codes for "suspected" mistreatment. 8,127 patients (0.051% of all aged ≥ 65), including 6,304 with MA (0.058%) and 1,823 with private insurance (0.026%) received elder mistreatment diagnosis. Transition from ICD-9 to ICD-10 was associated with a small increase in diagnosis rate, with "suspected" codes used in 45.3% of ICD-10 versus 9.7% of ICD-9 cases. Overall rates remained low. Rates, settings, and types of diagnosis differed between MA and private insurance patients.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, 2301 Martha Van Rensselaer Hall, Ithaca, NY 14853
| | - Lena K. Makaroun
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medicine, 402 East 67 Street New York, NY 10065
| | - Philip J. Jeng
- Department of Health Policy & Research, Weill Cornell Medicine, 402 East 67 Street New York, NY 10065
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medicine, 402 East 67 Street New York, NY 10065
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26
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Kayser J, Morrow-Howell N, Rosen TE, Skees S, Doering M, Clark S, Hurka-Richardson K, Bin Shams R, Ringer T, Hwang U, Platts-Mills TF, Network TG. Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement. J Elder Abuse Negl 2021; 33:123-144. [PMID: 33797344 PMCID: PMC8204570 DOI: 10.1080/08946566.2021.1904313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research - two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.
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Affiliation(s)
- Jay Kayser
- School of Social Work, University of Michigan - Ann Arbor, Ann Arbor, Michigan, USA.,Department of Developmental Psychology, University of Michigan - Ann Arbor, Ann Arbor, Michigan, USA
| | - Nancy Morrow-Howell
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Tony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York - Presbyterian Hospital, New York, USA
| | - Stephanie Skees
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Michelle Doering
- Becker Medical Library, Washington University, St Louis, Missouri, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rayad Bin Shams
- Quantworks, Inc, Healthcare and Life Sciences, Carrboro, North Carolina, USA
| | - Thom Ringer
- Department of Emergency Medicine, Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Emergency Medicine, Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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27
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Cimino-Fiallos N, Rosen T. Elder Abuse-A Guide to Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am 2021; 39:405-417. [PMID: 33863468 DOI: 10.1016/j.emc.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Elder abuse affects many older adults and can be life threatening. Older adults both in the community and long-term care facilities are at risk. An emergency department visit is an opportunity for an abuse victim to seek help. Emergency clinicians should be able to recognize the signs of abuse, including patterns of injury consistent with mistreatment. Screening tools can assist clinicians in the diagnosis of abuse. Physicians can help victims of mistreatment by reporting the abuse to the appropriate investigative agency and by developing a treatment plan with a multidisciplinary team to include a safe discharge plan and close follow-up.
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Affiliation(s)
- Nicole Cimino-Fiallos
- Department of Emergency Medicine, Meritus Medical Center, 11116 Medical Campus Road, Hagerstown, MD 21742, USA.
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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Abujarad F, Ulrich D, Edwards C, Choo E, Pantalon MV, Jubanyik K, Dziura J, D'Onofrio G, Gill TM. Development and usability evaluation of VOICES: A digital health tool to identify elder mistreatment. J Am Geriatr Soc 2021; 69:1469-1478. [PMID: 33615433 DOI: 10.1111/jgs.17068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES A major barrier for society in overcoming elder mistreatment is an inability to accurately identify victims. There are several barriers to self-reporting elder mistreatment, including fear of nursing home placement or losing autonomy or a caregiver. Existing strategies to identify elder mistreatment neglect to empower those who experience it with tools for self-reporting. In this project, we developed and evaluated the usability of VOICES, a self-administrated digital health tool that screens, educates, and motivates older adults to self-report elder mistreatment. DESIGN Cross-sectional study with User-Centered Design (UCD) approach. SETTING Yale School of Medicine and the Agency on Aging of South-Central Connecticut. PARTICIPANTS Thirty eight community-dwelling and cognitively intact older adults aged 60 years and older, caregivers, clinicians, and social workers. INTERVENTION A tablet-based self-administrated digital health tool that screens, educates, and motivates older adults to self-report elder mistreatment. MEASUREMENTS Qualitative and quantitative data were obtained from: (1) focus groups participants including: feedback from open-ended discussion, demographics, and a post-session survey; (2) usability evaluation including: demographics, usability measures, comfortability with technology, emotional state, and open-ended feedback. RESULTS Focus group participants (n = 24) generally favored using a tablet-based tool to screen for elder mistreatment and expressed comfort answering questions on elder mistreatment using tablets. Usability evaluation participants (n = 14) overall scored VOICES a mean System Usability Scale (SUS) score of 86.6 (median = 88.8), higher than the benchmark SUS score of 68, indicating excellent ease of use. In addition, 93% stated that they would recommend the VOICES tool to others and 100% indicated understanding of VOICES' information and content. CONCLUSION Our findings show that older adults are capable, willing, and comfortable with using the innovative and self-administrated digital tool for elder mistreatment screening. Our future plan is to conduct a feasibility study to evaluate the use of VOICES in identifying suspicion of mistreatment.
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Affiliation(s)
- Fuad Abujarad
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Davis Ulrich
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chelsea Edwards
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Esther Choo
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karen Jubanyik
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas M Gill
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Rosen T, Bao Y, Zhang Y, Clark S, Wen K, Elman A, Jeng P, Bloemen E, Lindberg D, Krugman R, Campbell J, Bachman R, Fulmer T, Pillemer K, Lachs M. Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case-control study using data linkage and machine learning. BMJ Open 2021; 11:e044768. [PMID: 33550264 PMCID: PMC7925867 DOI: 10.1136/bmjopen-2020-044768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims. METHODS AND ANALYSIS We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims' healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation. ETHICS AND DISSEMINATION This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip Jeng
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard Krugman
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jacquelyn Campbell
- John Hopkins University School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Ronet Bachman
- Department of Criminology, University of Delaware, Newark, Delaware, USA
| | - Terry Fulmer
- John A Hartford Foundation, New York, New York, USA
| | - Karl Pillemer
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Mark Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Rosen T, Platts-Mills TF, Fulmer T. Screening for elder mistreatment in emergency departments: current progress and recommendations for next steps. J Elder Abuse Negl 2021; 32:295-315. [PMID: 32508284 DOI: 10.1080/08946566.2020.1768997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emergency Department (ED) visits provide an important but seldom realized opportunity to identify elder mistreatment. Many screening tools exist, including several that are brief and may be effective, but few have been specifically designed for or tested in EDs. In addition to the absence of validated tools, other challenges with implementing ED elder mistreatment screening include difficulty integrating anything longer than a few questions into a busy clinical encounter and resources required to respond to positive screens. The Electronic Health Record (EHR) offers a critical tool to facilitate elder mistreatment screening through required data entry and real-time monitoring of compliance and results. We describe current work in the field and recommend next steps including design and testing of a two-step screening process, implementation research to accelerate adoption, development of ED-based interventions and referral protocols for positive cases, and consideration of the important role of pre-hospital providers in case identification.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital , New York, NY, USA
| | - Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina School of Medicine , Chapel Hill, North Carolina, USA
| | - Terry Fulmer
- The John A. Hartford Foundation , New York, NY, USA
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Rathke CADFE, Costa GMC, Souto RQ. Competências dos médicos no atendimento a idosos em situação de violência: revisão de escopo. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562020024.210037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo descrever, por meio das evidências da literatura, as competências dos médicos de serviços hospitalares diante de situações de violência contra a pessoa idosa (VCPI). Método revisão de escopo com busca em bases de dados/plataformas/buscadores e literatura cinzenta abrangendo Medline; BVS; Embase; CINAHL; Web of Science; BDTD, OpenGrey, OpenThesis, RCAAP, Portal de Teses e Dissertações da CAPES, DART-Europe E-theses Portal e Theses Canada Portal (catálogos Aurora e Voilà). Os descritores e palavras-chave utilizados, combinados com os operadores booleanos OR, AND e NOT, foram: “Physicians”, “Médicos”, “Atitude”, “Attitude”, “Conhecimento”, “Knowledge”, “Behavior”, “Atendimento Médico”, “Cuidados Médicos”, “Medical Care”, “Serviços Hospitalares”, “Hospital Services”, “Hospital”, “Hospitalists”, “Médicos Hospitalares”, “Maus-Tratos ao Idoso”, “Elder Abuse”, “Physical Abuse”, “Elder Neglect”, “Aged Abuse”, “Elder Mistreatment”. Resultados seis trabalhos foram selecionados. Evidenciou-se falta de conhecimento sobre o tema e a abordagem, e de treinamento específico. Quanto às habilidades, os achados que mais levaram os médicos a suspeitarem de abuso foram achados físicos ligados à aparência, higiene e lesões - problemas de comunicação e relacionamento foram pouco apontados. Na atitude houve pesquisa de abusos em apenas 44% das suspeitas e percentuais baixos ou nulos de denúncia de casos. Apenas um estudo explorou a atitude frente às negligências, onde 24,8% relataram aos serviços sociais e 21,3% informaram à polícia. Conclusão a maioria dos casos de VCPI continua não percebida e, consequentemente, não reportada ou manejada. Há múltiplos problemas quanto às competências dos médicos hospitalares ao abordarem tais situações, cenário que expõe a demanda por medidas de sensibilização, capacitação e incentivo ao adequado enfrentamento da VCPI.
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Interpersonal Violence: a Review of Elder Abuse. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rohringer TJ, Rosen TE, Lee MR, Sagar P, Murphy KJ. Can diagnostic imaging help improve elder abuse detection? Br J Radiol 2020; 93:20190632. [PMID: 32108517 PMCID: PMC10993220 DOI: 10.1259/bjr.20190632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/05/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022] Open
Abstract
Elder abuse is an underdetected, under-reported issue with severe consequences. Its detection presents unique challenges based on characteristics of this vulnerable population, including cognitive impairment, age-related deconditioning, and an increased number of co-morbidities, all of which predispose to increase vulnerability to injury. While radiologists play a critical role in detection of child abuse, this role is currently not paralleled in detection of elder abuse. We conducted a thorough review of the literature using MEDLINE to describe the current knowledge on injury patterns and injury findings seen in elder abuse, as well as barriers to and recommendations for an increased role of diagnostic imaging in elder abuse detection. Barriers limiting the role of radiologists include lack of training and paucity of rigorous systematic research delineating distinctive imaging findings for physical elder abuse. We outline the current ways in which imaging can help raise clinical suspicion for elder abuse, including inconsistencies between purported mechanism of injury and imaging findings, injury location, multiple injuries at differing stages of healing, and particular patterns of injury likely to be intentionally inflicted. We additionally outline the mechanism by which medical education and clinical workflow may be modified to increase the role for imaging and radiologist participation in detecting abuse in older adult patients, and identify potential future directions for further systematic research.
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Affiliation(s)
- Taryn J Rohringer
- University of Toronto, 1 King’s College
Circle, Toronto, ON M5S 1A8,
Canada
| | - Tony E Rosen
- Assistant Professor of Emergency Medicine, Weill Cornell
Medical Center, 525 E 68 Street, New York, NY,
10065, USA
| | - Mihan R Lee
- Diagnostic Radiologist at Weill Cornell Medical Center, 525 E
68 street, New York, NY, 10065,
USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114,
USA
| | - Kieran J Murphy
- Professor of Medical Imaging, University of Toronto, University
Health Network, 399 Bathurst Street, Toronto,
ON M5T 2S8, Canada
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Elman A, Rosselli S, Burnes D, Clark S, Stern ME, LoFaso VM, Mulcare MR, Breckman R, Rosen T. Developing the Emergency Department Elder Mistreatment Assessment Tool for Social Workers Using a Modified Delphi Technique. HEALTH & SOCIAL WORK 2020; 45:110-121. [PMID: 31984415 PMCID: PMC8454199 DOI: 10.1093/hsw/hlz040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 05/12/2023]
Abstract
Elder mistreatment is common and has serious consequences. The emergency department (ED) may provide a unique opportunity to detect this mistreatment, with social workers often asked to take the lead in assessment and intervention. Despite this, social workers may feel ill-equipped to conduct assessments for potential mistreatment, due in part to a lack of education and training. As a result, the authors created the Emergency Department Elder Mistreatment Assessment Tool for Social Workers (ED-EMATS) using a multiphase, modified Delphi technique with a national group of experts. This tool consists of both an initial and comprehensive component, with 11 and 17 items, respectively. To our knowledge, this represents the first elder abuse assessment tool for social workers designed specifically for use in the ED. The hope is that the ED-EMATS will increase the confidence of ED social workers in assessing for elder mistreatment and help ensure standardization between professionals.
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Dion S, Gogia K, Elman A, Clark S, Ulrey P, Connolly MT, Lewis S, LoFaso VM, Lachs MS, Wartell J, Rosen T. Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data. J Elder Abuse Negl 2020; 32:27-45. [PMID: 32151210 DOI: 10.1080/08946566.2020.1733725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response.
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Affiliation(s)
- Sarah Dion
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Page Ulrey
- Economic Crimes Unit, King County Prosecuting Attorney's Office, Seattle, Washington, USA
| | - Marie-Therese Connolly
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Stuart Lewis
- School of Medicine, New York University, New York, New York, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Julie Wartell
- Department of Urban Studies and Planning, University of California, San Diego, California, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Alhalaseh L, Abu-Zanat A, Alsmairat M. Elder Abuse. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosen T, Zhang Y, Bao Y, Clark S, Elman A, Wen K, Jeng P, Lachs MS. Can artificial intelligence help identify elder abuse and neglect? J Elder Abuse Negl 2019; 32:97-103. [PMID: 31713474 PMCID: PMC7069787 DOI: 10.1080/08946566.2019.1682099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A health care encounter is a potentially critical opportunity to detect elder abuse and initiate intervention. Unfortunately, health care providers currently very seldom identify elder abuse. Through development of advanced data analytics techniques such as machine learning, artificial intelligence has the potential to dramatically improve elder abuse identification in health care settings.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medical College
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medical College
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Philip Jeng
- Department of Health Policy & Research, Weill Cornell Medical College
| | - Mark S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College/NewYork-Presbyterian
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Forero Borda LM, Hoyos Porto SDJ, Buitrago Martínez V, Heredia Ramírez RA. Maltrato a las personas mayores: una revisión narrativa. UNIVERSITAS MÉDICA 2019. [DOI: 10.11144/javeriana.umed60-4.malt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
El maltrato a las personas mayores es un tema de interés creciente, tanto así que se considera un problema de salud pública. Hay particularidades que hacen del entorno colombiano un ambiente propicio para generar situaciones de maltrato: la exposición a la “violencia a gran escala”, la diferencia de género y el cambio de la pirámide poblacional. Según el estudio SABE Colombia, el 12,9 % de las personas mayores informó haber sufrido maltrato, del cual el más común es el psicológico, seguido por el físico, el financiero y el sexual. A pesar de que el Estado reconoce al adulto mayor como “sujeto de especial protección”, aún hay desconocimiento por parte de los profesionales de la salud a la hora de enfrentar estos casos. Este debería ser un tema de obligatoriedad moral, por lo que se debe abordar a profundidad para así identificarlo oportunamente y proponer estrategias de prevención de una manera contextualizada. Esta revisión de la literatura tiene por objetivos sintetizar la información epidemiológica disponible, los factores de riesgo y las estrategias de evaluación y plantear las rutas de atención idóneas asentadas en los aspectos legales alrededor del maltrato hacia los ancianos en Colombia.
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Logan JE, Haileyesus T, Ertl A, Rostad WL, Herbst JH. Nonfatal Assaults and Homicides Among Adults Aged ≥60 Years - United States, 2002-2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:297-302. [PMID: 30946734 PMCID: PMC6611471 DOI: 10.15585/mmwr.mm6813a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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