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Riedel HB, Espejo T, Dreher-Hummel T, Bingisser R, Nickel CH. Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study. Swiss Med Wkly 2024; 154:3775. [PMID: 38875501 DOI: 10.57187/s.3775] [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: 06/16/2024] Open
Abstract
AIM OF THE STUDY The mistreatment of older adults is a global and complex problem with varying prevalence. As there are no data on the prevalence of elder mistreatment in European emergency department populations, we aimed to translate and culturally adapt the Emergency Department Senior Abuse Identification (ED Senior AID) tool for German use, assess the positive screen rate for elder mistreatment with the German version, and compare characteristics of patients who screened positive and negative. METHODS To assess the prevalence of elder mistreatment, we created a German version of the ED Senior AID tool. This tool identifies intentional or negligent actions by a caregiver or trusted person that cause harm or risk to an older adult. Then, the German ED Senior AID tool was applied to all consecutively presenting patients aged ≥65 years at our academic emergency department in the Northwest of Switzerland from 25 April to 30 May 2022. Usability was defined as the percentage of patients with completed assessments using the German ED Senior AID tool. RESULTS We included 1010 patients aged ≥65 years, of whom 29 (2.9%) screened positive with the ED Senior AID tool. The patients who screened positive were older, more severely cognitively impaired, hospitalised more frequently, and presented with higher frailty scores than those who screened negative. Mortality up to 100 days after presentation was comparable in all patients (p = 0.861), regardless of their screening result. The tool showed good usability, with 73% of assessments completed. CONCLUSION This is the first prospective investigation on the prevalence of elder mistreatment in a European emergency department setting. Overall, 2.9% of patients screened positive using a validated screening tool translated into German. TRIAL REGISTRATION This study was registered with the National Institute of Health on ClinicalTrials.gov with the registration number NCT05400707.
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Affiliation(s)
- Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Dreher-Hummel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Nilaweera D, Gurvich C, Freak-Poli R, Woods RL, Owen A, McNeil J, Nelson M, Stocks N, Ryan J. The association between adverse events in later life and mortality in older individuals. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 16:100210. [PMID: 37753199 PMCID: PMC10518669 DOI: 10.1016/j.cpnec.2023.100210] [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: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Background Stress can have adverse impacts on health, particularly when it is chronic or resulting from major adverse events. Our study investigated whether relatively common adverse events in older individuals were associated with an increased risk of death, as well as cause-specific death and potential gender differences. Methods Participants were 12896 community-dwelling Australians aged ≥70 years at enrolment into the ASPREE (ASPirin in Reducing Events in the Elderly) study and without known life-limiting disease. A questionnaire administered in the year after enrolment, collected information on ten adverse events experienced in the past year. Mortality status was verified by multiple sources including health records and the National Death Index across a maximum of 10 years. Underlying causes of death were determined using clinical information by two adjudicators. Cox-proportional hazards regression models were used to estimate mortality risk. Results Two of the ten adverse events were associated with an increased risk of mortality in fully adjusted models. A 69% increased risk of mortality was observed in participants who reported their spouse/partner had recently died (95% CI: 1.19-2.39, P < 0.01). Cancer-related but not cardiovascular deaths also increased. Participants with a seriously ill spouse/partner also had a 23% increased risk of mortality (HR: 1.23, 95% CI: 1.02-1.48, P = 0.03). There was a tendency for these associations to be stronger among men than women. Limitations Perceived stress and cortisol were not measured, thus limiting our understanding of the psychological and physiological impacts of adverse events. Conclusions Experiencing adverse events in later-life, especially the death of a spouse/partner, may be a risk factor for earlier mortality. These findings may increase public health awareness and better inform initiatives for particular groups, including bereaved men.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Yılmaz S, Gunay E, Lee DH, Whiting K, Silver K, Koyuturk M, Karakurt G. Adverse health correlates of intimate partner violence against older women: Mining electronic health records. PLoS One 2023; 18:e0281863. [PMID: 36888574 PMCID: PMC9994723 DOI: 10.1371/journal.pone.0281863] [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: 06/30/2021] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Intimate partner violence (IPV) is often studied as a problem that predominantly affects younger women. However, studies show that older women are also frequently victims of abuse even though the physical effects of abuse are harder to detect. In this study, we mined the electronic health records (EHR) available through IBM Explorys to identify health correlates of IPV that are specific to older women. Our analyses suggested that diagnostic terms that are co-morbid with IPV in older women are dominated by substance abuse and associated toxicities. When we considered differential co-morbidity, i.e., terms that are significantly more associated with IPV in older women compared to younger women, we identified terms spanning mental health issues, musculoskeletal issues, neoplasms, and disorders of various organ systems including skin, ears, nose and throat. Our findings provide pointers for further investigation in understanding the health effects of IPV among older women, as well as potential markers that can be used for screening IPV.
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Affiliation(s)
- Serhan Yılmaz
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Erkan Gunay
- Emergency Department, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Da Hee Lee
- Osteopathic Medicine and Public Health, Des Moines University, Des Moines, IA, United States of America
| | - Kathleen Whiting
- Neuroscience Program, Uniformed Services University, Washington, DC, United States of America
| | - Kristin Silver
- Behavioral Health, Center of Outpatient Education, VA Northeast Ohio Healthcare System, Cleveland, OH, United States of America
| | - Mehmet Koyuturk
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH, United States of America
- Center for Proteomics & Bioinformatics, Case Western Reserve University, Cleveland, OH, United States of America
| | - Gunnur Karakurt
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, United States of America
- * E-mail:
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Ockner SA, Fieg EL. Geriatric Emergency Medicine: Providing Older Missourians with the Care They Need and Deserve. MISSOURI MEDICINE 2022; 119:444-451. [PMID: 36337997 PMCID: PMC9616449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Emergency care of older adults evolved in an effort to meet the needs of our aging population. The pace of improving the quality and cost-effectiveness of emergency department (ED) care for older adults is accelerating with the development of Geriatric Emergency Department Accreditation (GEDA) and research initiatives forged by the Center for Leading Innovation and Collaboration (CLIC) and Geriatric Emergency care Applied Research (GEAR). The innovations of two Missouri EDs are highlighted, including how each approached fall risk and quality improvement efforts for aging populations with multimorbidity. Additional work is needed to accommodate this growing population and implement sustainable solutions.
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Affiliation(s)
- Samuel A Ockner
- Instructor of Emergency Medicine at Washington University School of Medicine, St. Louis, Missouri
| | - Edward L Fieg
- Director, Emergency Department at John Cochran Veterans Hospital, and is affiliated with St. Louis University Hospital, St. Louis, Missouri
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Still under our radar: elder mistreatment. Eur J Emerg Med 2022; 29:97-98. [PMID: 35210376 DOI: 10.1097/mej.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect. Healthcare (Basel) 2021; 9:healthcare9020226. [PMID: 33670706 PMCID: PMC7922918 DOI: 10.3390/healthcare9020226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.
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Jackman C, Laging R, Laging B, Honan B, Arendts G, Walker K. Older person with vague symptoms in the emergency department: Where should I begin? Emerg Med Australas 2019; 32:141-147. [PMID: 31854096 DOI: 10.1111/1742-6723.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Christine Jackman
- Emergency Department, Cabrini, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Melbourne, Victoria, Australia.,School of Medicine, Deakin University Medical School, Geelong, Victoria, Australia
| | - Rohan Laging
- Emergency Department, Cabrini, Melbourne, Victoria, Australia.,Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Bridget Laging
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Glenn Arendts
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Katie Walker
- Emergency Department, Cabrini, Melbourne, Victoria, Australia.,Health Services, Monash University, Melbourne, Victoria, Australia
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Rosen T, Stern ME, Mulcare MR, Elman A, McCarthy TJ, LoFaso VM, Bloemen E, Clark S, Sharma R, Breckman R, Lachs MS. Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team. Emerg Med J 2018; 35:600-607. [PMID: 30093378 PMCID: PMC6589031 DOI: 10.1136/emermed-2017-207303] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND An ED visit provides a unique opportunity to identify elder abuse, which is common and has serious medical consequences. Despite this, emergency providers rarely recognise or report it. We have begun the design of an ED-based multidisciplinary consultation service to improve identification and provide comprehensive medical and forensic assessment and treatment for potential victims. METHODS We qualitatively explored provider perspectives to inform intervention development. We conducted 15 semistructured focus groups with 101 providers, including emergency physicians, social workers, nurses, technologists, security, radiologists and psychiatrists at a large, urban academic medical centre. Focus groups were transcribed, and data were analysed to identify themes. RESULTS Providers reported not routinely assessing for elder mistreatment and believed that they commonly missed it. They reported 10 reasons for this, including lack of knowledge or training, no time to conduct an evaluation, concern that identifying elder abuse would lead to additional work, and absence of a standardised response. Providers believed an ED-based consultation service would be frequently used and would increase identification, improve care and help ensure safety. They made 21 recommendations for a multidisciplinary team, including the importance of 24/7 availability, the value of a positive attitude in a consulting service and the importance of feedback to referring ED providers. Participants also highlighted that geriatric nurse practitioners may have ideal clinical and personal care training to contribute to the team. CONCLUSIONS An ED-based multidisciplinary consultation service has potential to impact care for elder abuse victims. Insights from providers will inform intervention development.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Michael E. Stern
- Division of Emergency Medicine, Weill Cornell Medical College, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Mary R. Mulcare
- Division of Emergency Medicine, Weill Cornell Medical College, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Alyssa Elman
- Division of Emergency Medicine, Weill Cornell Medical College, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Thomas J. McCarthy
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, 525 E. 68 St., Box 39, New York, NY 10065, USA
| | - Elizabeth Bloemen
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, New York, NY 10065, USA
| | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Rahul Sharma
- Division of Emergency Medicine, Weill Cornell Medical College, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, 525 E. 68 St., Box 39, New York, NY 10065, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, 525 E. 68 St., Box 39, New York, NY 10065, USA
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