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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 2024:1-17. [PMID: 38602348 DOI: 10.1080/08946566.2024.2339242] [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: 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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2
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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 2023:1-17. [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] [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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3
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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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4
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Baek D, Elman A, Gottesman E, Shaw A, Makaroun LK, Stern ME, Mulcare MR, Sullivan M, Pino C, McAuley J, LoFaso VM, Chang ES, Hancock D, Bloemen EM, Tietz S, Lindberg DM, Sharma R, Clark S, Lachs MS, Pillemer K, Rosen T. Initial steps in addressing the challenges of elder mistreatment evaluation: Protocol for evaluating the Vulnerable Elder Protection Team. BMJ Open 2023; 13:e071694. [PMID: 37832983 PMCID: PMC10583105 DOI: 10.1136/bmjopen-2023-071694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Although many programmes have been developed to address elder mistreatment, high-quality, rigorous evaluations to assess their impact are lacking. This is partly due to challenges in conducting programme evaluation for such a complex phenomenon. We describe here the development of a protocol to mitigate these challenges and rigorously evaluate a first-of-its-kind emergency department/hospital-based elder mistreatment intervention, the Vulnerable Elder Protection Team (VEPT). METHODS AND ANALYSIS We used a multistep process to develop an evaluation protocol for VEPT: (1) creation of a logic model to describe programme activities and relevant short-term and long-term outcomes, (2) operationalisation of these outcome measures, (3) development of a combined outcome and (4) design of a protocol using telephone follow-up at multiple time points to obtain information about older adults served by VEPT. This protocol, which is informing an ongoing evaluation of VEPT, may help researchers and health system leaders design evaluations for similar elder mistreatment programmes. ETHICS AND DISSEMINATION This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #20-02021422. 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)
- Daniel Baek
- 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
| | - Elaine Gottesman
- 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
| | - 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, Pennsylvania, USA
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mary R Mulcare
- 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
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/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
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Elizabeth M Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah Tietz
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel M Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rahul Sharma
- 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
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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5
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Elman A, Gottesman E, Makaroun LK, Chang ES, Baek D, Clark S, Rosen T. Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:1551-1564. [PMID: 37083117 PMCID: PMC10125886 DOI: 10.1177/07334648231166276] [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: 06/29/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 04/22/2023] Open
Abstract
The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six focus groups and seven interviews during March-April 2021 using a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and caseworkers in New York City, a community hard hit by the initial COVID surge. Data from transcripts were analyzed to identify themes. Participants identified challenges faced by APS (e.g., clients less willing to engage with APS, inability to perform necessary job tasks remotely, and low staffing levels) as well as strategies APS used in response (e.g., increasing collaboration with other community-based programs and service providers, enabling remote court hearings through technology and in-person facilitation, and ensuring staff had access to personal protective equipment). These findings may inform APS planning for future large-scale societal disruptions.
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Affiliation(s)
- Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | | | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, USA
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6
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Wyman J, Malloy L. Increasing disclosures of older adult maltreatment: a review of best practices for interviewing older adult eyewitnesses and victims. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:274-292. [PMID: 38628254 PMCID: PMC11018022 DOI: 10.1080/13218719.2023.2192260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2024]
Abstract
The current article provides a contemporary review of the best practices for interviewing older adults about crimes they witnessed or experienced. Specifically, we provide a detailed overview of how investigators can use a range of interviewing adaptations and procedures to acquire detailed and accurate maltreatment disclosures from older adults. In addition to discussing well-established investigative interviewing practices (e.g. rapport building, free-recall, cognitive instructions and prompts), this article also summarizes more recent literature on the benefits of multidisciplinary investigations, use of assistive technology and interview accommodations, along with effective practices for working with minority and marginalized older adults. Lastly, several research, professional and policy recommendations are provided for supporting older adults during investigative interviews.
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Affiliation(s)
- Joshua Wyman
- Department of Psychology, King’s University College at Western University, London, ON, Canada
| | - Lindsay Malloy
- Faculty of Social Sciences and Humanities, Ontario Tech University, Oshawa, ON, Canada
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7
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Sweeny AL, Bourke C, Torpie TM, Sargeant S, Hughes J, Watson J, Conroy S, Carrasco A, Tighe K, Thornton NS, Cumner AS, Baird K. Improving domestic violence screening practices in the emergency department: an Australian perspective. J Accid Emerg Med 2023; 40:114-119. [PMID: 35288455 DOI: 10.1136/emermed-2021-211167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/24/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Domestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular. OBJECTIVE To examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV. METHODS Emergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening. RESULTS In total, 496 emergency clinicians participated. Universal screening was uncommon; less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were 'very or severely limiting' for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen. CONCLUSION This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection.
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Affiliation(s)
- Amy Lynn Sweeny
- Emergency Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia .,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Caitlin Bourke
- Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Thomas Martin Torpie
- Emergency Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Sally Sargeant
- School of Health and Human Services, Southern Cross University - Gold Coast Campus, Coolangatta, Queensland, Australia
| | - James Hughes
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Julie Watson
- Social Work, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Sheree Conroy
- Emergency Department, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Angel Carrasco
- Social Work and Support Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Kym Tighe
- Social Work and Support Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | | | - Amber-Shea Cumner
- Emergency Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Social Work, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Kathleen Baird
- Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia.,School of Nursing and Midwifery, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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8
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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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9
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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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10
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Abstract
Elder abuse is a global call to action. Nurses have a primary role to play in its detection and prevention. Globally, demographic change is creating an increasing number of older adults. Consequently, this increased number of people will be affected by age discrimination and ageism, both of which contribute to elder abuse. Despite the existence of the Universal Declaration of Human Rights, older adults are not recognized explicitly under the international human rights laws that legally oblige governments to address the rights of all people. Drawing initially on global conversations specific to elder abuse and the role of nurses, the current article explores the challenges of recognizing and combating elder abuse. To provide specific gerontological nursing strategies, recognition is given to actions implemented in Canada to address this major health challenge. The desired outcome is an advocacy framework for gerontological nurses to use in working toward the recognition and prevention of elder abuse. [Journal of Gerontological Nursing, 48(4), 21-25.].
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11
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Farhat SMM, Berbiche D, Vasiliadis HM. Family Violence Associated with Self-Rated Health, Satisfaction With Life, and Health Service Use in Primary Care Older Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:2487-2509. [PMID: 32646316 DOI: 10.1177/0886260520938513] [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] [Indexed: 06/11/2023]
Abstract
We aimed to document in primary care older adults the relationship between family violence (FV) and mental and physical health, satisfaction with life, and health service use, by gender. The study sample included data from 1,658 older adults recruited in primary care practices, in one of the largest health regions in the province of Quebec. The presence of FV (partner/spouse, adult child) was assessed with the 21-item Family Violence Scale (FVS) adapted from the conflicts Tactics Scale 2. Self-rated mental health (SRMH) and self-rated physical health (SRPH) were assessed with single-item measures. Satisfaction with life (SWL) was measured using a validated French version of the SWL scale. Health service use over a 2-year period included outpatient consultations (number), emergency department (ED) visits (yes/no), and hospitalizations (yes/no). Multi-level logistic and Poisson's regression models were conducted to assess study outcomes as a function of FV. Analyses were stratified by perpetrator and gender. There was an association between FV and SRMH in women (OR = 0.41, 95% CI = [0.27, 0.62]), and SWL in both men and women (B = -5.74, 95% CI = [-6.71, -4.76]; B = -10.07, 95% CI = [-14.16, -5.98], respectively). Significant associations were found in women between FV and ED visits (OR = 1.45, 95% CI = [1.12, 1.18]), hospitalizations (OR = 1.36, 95% CI = [1.32, 1.43]), and outpatient consultations (RR = 1.25, 95% CI = [1.19, 1.30]). SWL moderated the association between FV and likelihood of hospitalization. Gender differences were observed between FV and SRMH and SWL. FV was associated with increased health service use in women but not men. These gender differences may suggest stigma-related barriers to health service use. Victims of violence with higher SWL had a lower likelihood of being hospitalized. Public health programs aimed at increasing awareness of the different types of FV and interventions aiming to improve resilience in victims are needed.
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Affiliation(s)
| | | | - Helen-Maria Vasiliadis
- University of Sherbrooke, Campus Longueuil, Quebec, Canada
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, Quebec, Canada
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12
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Carney A. The Forensic Nurse's Evolving Role in Addressing Elder Maltreatment in the United States. JOURNAL OF FORENSIC NURSING 2021; 17:194-201. [PMID: 34654033 DOI: 10.1097/jfn.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
U.S. forensic nurses' specialization in elder maltreatment has evolved over the last 30 years. Significant progress in research has led to the ability to define and respond to elder abuse. This article describes the foundation for a specialization in nursing that led to inter vention in abuse and neglect, historical milestones as steps to elder justice, and the evolution of forensic nurse practice with senior victims of abuse.
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Affiliation(s)
- Amy Carney
- Author Affiliation: California State University San Marcos
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13
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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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14
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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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15
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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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16
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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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17
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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: 4] [Impact Index Per Article: 1.0] [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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18
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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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19
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Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review. Ann Emerg Med 2020; 75:181-191. [PMID: 31959308 DOI: 10.1016/j.annemergmed.2019.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/22/2022]
Abstract
This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.
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20
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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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21
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Truong C, Burnes D, Alaggia R, Elman A, Rosen T. Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection. J Elder Abuse Negl 2019; 31:181-190. [PMID: 30880608 DOI: 10.1080/08946566.2019.1588182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elder abuse remains a largely hidden problem in our society and only a small minority of victims are connected to formal support/protective services. Healthcare settings have been identified as a critical milieu to uncover cases of elder abuse; however, under-detection in these settings is a major issue. Victimization disclosure is an important component within the overall detection effort, yet it has received little attention in the elder abuse literature. Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.
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Affiliation(s)
- Carol Truong
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - David Burnes
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Ramona Alaggia
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Alyssa Elman
- b Department of Emergency Medicine , Weill Cornell Medicine College/New York-Presbyterian , New York , NY , USA
| | - Tony Rosen
- b Department of Emergency Medicine , Weill Cornell Medicine College/New York-Presbyterian , New York , NY , USA
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