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Bloemen EM, Tietz S, Lindberg DM, Hayes J, Lum H, Gottesman E, Elman A, Sullivan M, Pino C, McAuley J, Shaw A, Hancock D, Chang ES, Yasui R, LoFaso VM, Stern ME, Rosen T. Elder abuse geriatrics: describing an important new medical specialist. J Elder Abuse Negl 2024; 36:367-383. [PMID: 38602348 DOI: 10.1080/08946566.2024.2339242] [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: 04/12/2024]
Abstract
Elder mistreatment, including elder abuse and neglect, is a difficult diagnosis to make and manage for most providers. To address this, two elder abuse consultation teams were developed for patients in the hospital and emergency department settings. As these teams have developed, the providers involved have obtained specialized training and experience that we believe contributes to a new field of elder abuse geriatrics, a corollary to the well-established field of child abuse pediatrics. Providers working in this field require specialized training and have a specialized scope of practice that includes forensic evaluation, evaluation of cognition and capacity, care coordination and advocacy for victims of abuse, and collaboration with protective services and law enforcement. Here we describe the training, scope of practice, ethical role, and best practices for elder mistreatment medical consultation. We hope this will serve as a starting point for this new and important medical specialty.
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Affiliation(s)
- Elizabeth M Bloemen
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah Tietz
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel M Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason Hayes
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hillary Lum
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elaine Gottesman
- 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
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Robin Yasui
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Bloemen E, Elman A, Baek D, Gottesman E, Shaw A, Sullivan M, Pino C, McAuley J, Tietz S, Herman S, Rachmuth L, Chang ES, Hancock D, LoFaso VM, Stern ME, Lindberg D, Clark S, Rosen T. Strategies for dissemination of ED/hospital elder mistreatment response team model. J Elder Abuse Negl 2024; 36:350-366. [PMID: 38117212 PMCID: PMC11186973 DOI: 10.1080/08946566.2023.2297232] [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: 12/21/2023]
Abstract
Interdisciplinary Emergency Department/hospital-based teams represent a promising care model to improve identification of and intervention for elder mistreatment. Two institutions, Weill Cornell Medicine/NewYork-Presbyterian Hospital and the University of Colorado Anschutz Medical Campus have launched such programs and are exploring multiple strategies for effective dissemination. These strategies include: (1) program evaluation research, (2) framing as a new model of geriatric care, (3) understanding the existing incentives of health systems, EDs, and hospitals to align with them, (4) connecting to ongoing ED/hospital initiatives, (5) identifying and collaborating with communities with strong elder mistreatment response that want to integrate the ED/hospital, (6) developing and making easily accessible high-quality, comprehensive protocols and training materials, (7) offering technical assistance and support, (8) communications outreach to raise awareness, and (9) using an existing framework to inform implementation in new hospitals and health systems.
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Affiliation(s)
- Elizabeth Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alyssa Elman
- 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
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Sarah Tietz
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Seth Herman
- Department of Social Work, NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Lisa Rachmuth
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Dan Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY 10065, USA
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Peter A S, Prabhu MM, Tolson D, Nayak BS, Bhandary RP, V B, Devi ES. Effectiveness of interventions to prevent abuse in people living with dementia in community settings: A systematic review. DEMENTIA 2024:14713012241260476. [PMID: 38901056 DOI: 10.1177/14713012241260476] [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: 06/22/2024]
Abstract
OBJECTIVES This review examined the evidence for interventions to prevent the abuse of people living with dementia in the community. METHODS The articles were retrieved from 2000 to 2023 from six databases, including MEDLINE via PubMed, CINAHL Plus via EBSCO, EMBASE, ProQuest Medical Library, Web of Science, and Scopus. The research articles that focused on finding the effectiveness of interventions for preventing abuse of people living with dementia in community settings were included in this review. The review included randomized controlled trials and pre-test post-test trials only. The quality appraisal of the eligible studies was done using ROB 2 and ROBINS II. The findings were tabulated and narratively synthesised. RESULTS Out of 1831 articles, only three were included in this review. Only two RCTs were included in this efficacy review. Both the studies showed that the interventions were not effective in reducing abuse. The studies utilised family caregiver interventions like psychological interventions and online supportive education. The review identified psychological interventions with some evidence. Another study was a quasi-experimental study that used dialectical behaviour therapy as an intervention to reduce abuse occurrence. The study showed low evidence and focused only on reporting of elder abuse as an outcome. CONCLUSION This review found very few studies and was not able to draw a conclusion on the effectiveness of interventions for abuse in people living with dementia. Given the paucity of research, there is a clear need to identify how to overcome the challenges faced in elder abuse research and further refine the development of approaches to reduce elder abuse among people living with dementia in community settings.
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Affiliation(s)
- Seelia Peter A
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka,India 576104
| | - M Mukhyaprana Prabhu
- Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
| | - Debbie Tolson
- Alzheimer's Scotland Centre for Policy and Practice, University of West of Scotland, UK; School of Health and Life Sciences, University of West of Scotland, UK
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
| | - Rajeshkrishna P Bhandary
- Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
| | - Binil V
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
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Giorgetti A, Pelletti G, Fiorentini C, Mazzotti MC, Fais P, Pelotti S. On tackling abuse of older people: The forensic challenges in fatal cases investigation. Leg Med (Tokyo) 2024; 67:102398. [PMID: 38237384 DOI: 10.1016/j.legalmed.2024.102398] [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: 03/08/2023] [Revised: 09/11/2023] [Accepted: 01/07/2024] [Indexed: 03/01/2024]
Abstract
The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.
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Affiliation(s)
- Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Clara Fiorentini
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | | | - Paolo Fais
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
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Shi LL, Pudney J, Brangman S, Parham K, Nuara M. Head & Neck Trauma in the Geriatric Population. Otolaryngol Clin North Am 2023; 56:1183-1201. [PMID: 37385861 DOI: 10.1016/j.otc.2023.05.005] [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: 07/01/2023]
Abstract
Craniofacial trauma in the geriatric population is increasing as our population ages. Due to loss of bone quality and medical comorbidities, injuries for minor trauma can be severe. A more extensive medical evaluation is usually warranted in this population before proceeding with surgery. In addition, unique surgical considerations exist in the repair of atrophic and edentulous bony fractures. Some quality improvement measures have already been undertaken but more is needed to help standardize care in this vulnerable population.
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Affiliation(s)
- Lucy L Shi
- Division of Facial Plastic & Reconstructive Surgery, Virginia Mason Franciscan Health, 1201 Terry Avenue 9th Floor, Seattle, WA 98101, USA
| | - Jacey Pudney
- Department of Geriatrics, SUNY Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Sharon Brangman
- Department of Geriatrics, SUNY Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Kourosh Parham
- Department of Otolaryngology-Head & Neck Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Michael Nuara
- Division of Facial Plastic & Reconstructive Surgery, Virginia Mason Franciscan Health, 1201 Terry Avenue 9th Floor, Seattle, WA 98101, USA.
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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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Lindberg DM, Bloemen EM. First steps in family-centered care for family violence. Acad Emerg Med 2023; 30:68-69. [PMID: 36250959 DOI: 10.1111/acem.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Daniel M Lindberg
- Department of Emergency Medicine and the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado Anschutz Medical Campus, Colorado, Aurora, USA
| | - Elizabeth M Bloemen
- Department of Medicine, Division of Geriatrics, University of Colorado Anschutz Medical Campus, Colorado, Aurora, USA
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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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