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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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Melady D, Schumacher JG. Developing a Geriatric Emergency Department: People, Processes, and Place. Clin Geriatr Med 2023; 39:647-658. [PMID: 37798070 DOI: 10.1016/j.cger.2023.05.008] [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
Older patients' ED visits rose 30% over 5 years and EDs are now examining geriatric emergency department (GED) models of care. The 3 Ps model focuses on the GED's People, Processes, and the Place to provide a framework for GED development. Key resources include the: GED Collaborative, GED Guidelines, and Geriatric Emergency Department Accreditation process. Core to a GED's operation is its care processes including: (1) General approaches; (2) Screening for high-risk conditions; (3) Enhanced assessment; (4) Workflow alterations; and (5) Transitions. This article provides practical guidance to EDs seeking to enhance the ED experience of older people and improve the quality of their outcomes.
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Affiliation(s)
- Don Melady
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7, Canada; Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
| | - John G Schumacher
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County (UMBC), 104 Fairfield Drive, Baltimore, MD 21228, USA; Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore (UMB), Baltimore, MD, 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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Graça H, Frazão SL, Magalhães T, Vieira-Pinto P, Gomes JC, Taveira-Gomes T. Health Conditions in Older Adults Suspected of Being Maltreated: A 20-Year Real-World Study. J Clin Med 2023; 12:5247. [PMID: 37629290 PMCID: PMC10455491 DOI: 10.3390/jcm12165247] [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: 06/26/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Older adult maltreatment (OAM) is a global problem that has attracted increasing attention due to the ageing population and its severe impact on victim health. Thus, this study aims to analyse the prevalence of certain health conditions in people ≥ 60 years old whom physicians from a local healthcare unit suspected to be victims of maltreatment. The specific objectives are to determine the prevalence rates of health-related risk factors, traumatic injuries and intoxications, mental disorders, and physical disorders. We conducted a real-world, retrospective, observational, and cross-sectional study based on secondary data analyses of electronic health records and healthcare registers of patients at the Local Healthcare Unit of Matosinhos (2001-2021). Information was obtained based on codes from the International Classification of Diseases, codes from the International Classification of Primary Care, and clinical notes (according to previously defined keywords). We identified 3092 suspected victims of OAM, representing 4.5% of the total population analysed. This prevalence is lower than the known rates. We also found that some health risk factors, traumatic injuries and intoxications, mental health disorders, and physical disorders presented higher rates in the suspected victims than among the total population. In this age group, we cannot assume that these health problems are only related to a possible current victimisation process; they could also be associated with adverse childhood experiences or intimate partner violence, among other forms of violence, all of which can lead to cumulative effects on the victim's health. This evidence increases healthcare providers' responsibility in detecting and reporting all cases of suspected maltreatment.
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Affiliation(s)
- Hugo Graça
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.G.); (S.L.F.)
| | - Sofia Lalanda Frazão
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.G.); (S.L.F.)
- National Institute of Legal Medicine and Forensic Sciences, Largo da Sé Nova, 3000-231 Coimbra, Portugal
- Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal;
| | - Teresa Magalhães
- MTG Research and Development Lab, 4200-604 Porto, Portugal; (T.M.); (T.T.-G.)
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, 4585-116 Gandra, Portugal
| | - Paulo Vieira-Pinto
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.G.); (S.L.F.)
- FOREN—Forensic Science Experts, 1400-136 Lisboa, Portugal
- Faculty of Human and Social Sciences, University Fernando Pessoa (FCHS-UFP), 4249-004 Porto, Portugal
| | - Joana Costa Gomes
- Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal;
- USF Caravela, Local Healthcare Unit of Matosinhos, Rua da Lagoa, 4460-352 Senhora da Hora, Portugal
| | - Tiago Taveira-Gomes
- MTG Research and Development Lab, 4200-604 Porto, Portugal; (T.M.); (T.T.-G.)
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa (FCS-UFP), 4249-004 Porto, Portugal
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Alpert AB, Sayegh SJ, Strawderman M, Cunliffe S, Griggs JJ, Cerulli C. Methodologic Approaches for Using Electronic Medical Records to Identify Experiences of Violence in Transgender and Cisgender People: Closing the Gap Between Diagnostic Coding and Lived Experiences. Med Care 2023; 61:384-391. [PMID: 37072686 PMCID: PMC10168107 DOI: 10.1097/mlr.0000000000001852] [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] [Indexed: 04/20/2023]
Abstract
BACKGROUND Transgender people experience extreme rates of violence and the electronic medical record (EMR) remains a mostly untapped resource to study the medical sequelae of such experiences. OBJECTIVES To develop and test a method for identifying experiences of violence using EMR data. RESEARCH DESIGN Cross-sectional study utilizing EMR data. PEOPLE Transgender and cisgender people seen at a regional referral center in Upstate New York. MEASURES We tested the utility of keyword searches and structured data queries to identify specific types of violence at various ages and in various contexts among cohorts of transgender and cisgender people. We compared the effectiveness of keyword searches to diagnosis codes and a screening question, "Are you safe at home?" using McNemar's test. We compared the prevalence of various types of violence between transgender and cisgender cohorts using the χ 2 test of independence. RESULTS Of the transgender cohort, 47% had experienced some type of violence versus 14% of the cisgender cohort (χ 2P value <0.001). Keywords were significantly more effective than structured data at identifying violence among both cohorts (McNemar P values all <0.05). CONCLUSIONS Transgender people experience extreme amounts of violence throughout their lives, which is better identified and studied using keyword searches than structured EMR data. Policies are urgently needed to stop violence against transgender people. Interventions are also needed to ensure safe documentation of violence in EMRs to improve care across settings and aid research to develop and implement effective interventions.
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Affiliation(s)
- Ash Blythe Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
- Department of Public Health Sciences, University of Rochester Medical Center
| | | | - Myla Strawderman
- Division of Hematology and Medical Oncology, Department of Medicine, Wilmot Cancer Institute
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Scott Cunliffe
- Division of Hematology and Medical Oncology, Department of Medicine, Wilmot Cancer Institute
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center
- The Susan B. Anthony Center, Rochester, NY
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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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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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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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Garbett H, Carter B, Gregory A, Cramer H, Lewis NV, Morgan K, Thompson J, Feder G, Braude P. Domestic violence and injuries: prevalence and patterns-a pilot database study to identify suspected cases in a UK major trauma centre. Inj Prev 2022; 28:injuryprev-2021-044481. [PMID: 35613902 DOI: 10.1136/injuryprev-2021-044481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Victim-survivors of domestic violence and abuse (DVA) present to secondary care with isolated injuries to the head, limb or face. In the UK, there are no published studies looking at the relationship of significant traumatic injuries in adults and the relationship to DVA.The primary objective was to assess the feasibility of using a tailored search method to identify cases of suspected DVA in the national audit database for trauma. The secondary objective was to assess the association of DVA with clinical characteristics. METHODS We undertook a single-centre retrospective observational cohort pilot study. Data were analysed from the local Trauma and Audit Research Network (TARN) database. The 'Scene Description' field in the database was searched using a tailored search strategy. Feasibility was evaluated with notes review and assessed by the PPV and prevalence. Secondary objectives used a logistic regression in Excel. RESULTS This method of identifying suspected cases of DVA from the TARN database is feasible. The PPV was 100%, and the prevalence of suspected DVA in the study period was 3.6 per 1000 trauma discharges. Of those who had experienced DVA, 52.7% were male, median age 43 (IQR: 33-52) and mortality 5.5%. Subgroup analysis of older people demonstrated longer hospital stay (p=0.17) and greater likelihood of admission to intensive care (OR 2.60, 95% CI 0.48 to 14.24). CONCLUSION We have created a feasible methodology to identify suspected DVA-related injuries within the TARN database. Future work is needed to further understand this relationship on a national level.
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Affiliation(s)
- Hollie Garbett
- Department of Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Ben Carter
- Department of Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Alison Gregory
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Natalia V Lewis
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Karen Morgan
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Julian Thompson
- North Bristol NHS Trust, Severn Major Trauma Network, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Philip Braude
- Department of Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
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Hall Y, Smith J, Turner RM, Greco P, Hau K, Barak Y. Creating opportunities to improve detection of older adult abuse: a national interRAI study. BMC Geriatr 2022; 22:220. [PMID: 35300608 PMCID: PMC8928619 DOI: 10.1186/s12877-022-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Despite being recognized as a major global health issue, older adult abuse (OAA) remains largely undetected and under-reported. Most OAA assessment tools fail to capture true prevalence. Follow up of patients where abuse exposure is not easily determined is a necessity. The interRAI-HC (International Resident Assessment Instrument—Home Care) currently underestimates the extent of abuse. We investigated how to improve detection of OAA using the interRAI-HC. Analysis of 7 years of interRAI-HC data from an Aotearoa New Zealand cohort was completed. We identified that through altering the criteria for suspicion of OAA, capture rates of at-risk individuals could be nearly doubled from 2.6% to 4.8%. We propose that via adapting the interRAI-HC criteria to include the "unable to determine" whether abuse occurred (UDA) category, identification of OAA sufferers could be substantially improved. Improved identification will facilitate enhanced protection of this vulnerable population.
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Affiliation(s)
- Yvette Hall
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Jim Smith
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | | | - Kenny Hau
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
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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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12
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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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