Can diagnostic imaging help improve elder abuse detection?

Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings

BACKGROUND

Falls and interpersonal violence pose significant threats to older adults, leading to injuries, hospitalizations, and emergency department (ED) visits. This study investigates the demographics and injury patterns in older adults (aged 60 and above) who sought ED care due to assaults, comparing them with those who experienced falls to gain a deeper understanding of older adult abuse patterns.

METHOD

This study utilizes data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (2005-2019) to examine injuries among older adults aged 60 years and above. Participants were categorized into two groups: older adult abuse and injuries due to falls. The differences between the groups by demographics, injury locations, patterns, and temporal trends were analyzed using statistical methods accounting for the weighted stratified nature of the data. Cosinor analysis and Joinpoint regression were used for temporal analysis.

RESULTS

Over 15 years, there were an estimated 307,237 ED visits for older adult abuse and 39,477,217 for falls. Older adults experiencing abuse were younger and had lower hospital admission rates compared to fall patients. Injuries associated with abuse included contusions/abrasions, penetrating injuries, and fractures to the head/neck, fingers, toes, ribs, and lower extremities. In contrast, fall patients had higher admission rates, with more fractures, including cervical spine and hip fractures. Temporal patterns showed a higher rate of assaults during the summer, whereas abuse demonstrated bimodal peaks in the summer and fall.

CONCLUSIONS

Injuries associated with abuse such as facial, upper trunk, and upper extremity fractures should raise suspicion even in the absence of severe symptoms. These findings emphasize the importance of early identification to connect older adults with support resources, as patients experiencing abuse often get discharged from the ED.

Evaluating the knowledge and training of forensic pathologists and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa

BACKGROUND

Forensic radiography is an important component in forensic sciences. There seems to be a lack of recent studies in the literature on the knowledge and training of forensic pathologists and registrars performing forensic radiography at forensic pathology mortuaries in South Africa.

AIM

To evaluate the knowledge and training of forensic pathologists (consultants) and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa.

SETTING

A prospective study was conducted at a conveniently selected forensic pathology mortuary located in the Free State province of South Africa.

METHOD

Personnel performing forensic radiography at the selected mortuary were invited to participate in the study. An exploratory quantitative study design was used. The research tool was a self-administered questionnaire comprising open- and closed-ended questions. Four registrars and four consultants (n = 8) completed the questionnaire.

RESULTS

Training was only received on computed tomography (n = 1; 12.5%), the C-arm machine (n = 1; 12.5%) and the digital X-ray mobile machine (n = 1; 12.5%) Lodox on corpse positioning (n = 7; 87.5%) and setting of exposure factors (n = 2; 25%).

CONCLUSION

Lack of training of the personnel performing forensic radiography, at the selected mortuary was identified. Training is required in image acquisition protocols, quality control tests of the X-ray machines, setting technical factors and operation of various X-ray machines.

CONTRIBUTION

Training of registered radiation workers who perform forensic radiography in mortuaries is essential to produce high-quality ionising radiation images and ensure their own and other staff members' safety.

Nonaccidental Injury in the Elderly: What Radiologists Need to Know

Elder abuse may result in serious physical injuries and long-term psychological consequences and can be life threatening. Over the past decade, attention to elder abuse has increased owing to its high prevalence, with one in six people aged 60 years and older experiencing some form of abuse worldwide. Despite this, the detection and reporting rates remain relatively low. While diagnostic imaging is considered critical in detection of child abuse, it is relatively underused in elder abuse. The authors discuss barriers to use of imaging for investigation and diagnosis of elder abuse, including lack of training, comorbidities present in this vulnerable population, and lack of communication among the intra- and interdisciplinary care providers. Moreover, imaging features that should raise clinical concern for elder abuse are reviewed, including certain types of fractures (eg, posterior rib), characteristic soft-tissue and organ injuries (eg, shoulder dislocation), and cases in which the reported mechanism of injury is inconsistent with the imaging findings. As most findings suggesting elder abuse are initially discovered at radiography and CT, the authors focus mainly on use of those modalities. This review also compares and contrasts elder abuse with child abuse. Empowered with knowledge of elderly victims' risk factors, classic perpetrator characteristics, and correlative imaging findings, radiologists should be able to identify potential abuse in elderly patients presenting for medical attention. Future recommendations for research studies and clinical workflow to increase radiologists' awareness of and participation in elder abuse detection are also presented. An invited commentary by Jubanyik and Gettel is available online. Online supplemental material is available for this article. ^©RSNA, 2022.

Creating opportunities to improve detection of older adult abuse: a national interRAI study

Despite being recognized as a major global health issue, older adult abuse (OAA) remains largely undetected and under-reported. Most OAA assessment tools fail to capture true prevalence. Follow up of patients where abuse exposure is not easily determined is a necessity. The interRAI-HC (International Resident Assessment Instrument—Home Care) currently underestimates the extent of abuse. We investigated how to improve detection of OAA using the interRAI-HC. Analysis of 7 years of interRAI-HC data from an Aotearoa New Zealand cohort was completed. We identified that through altering the criteria for suspicion of OAA, capture rates of at-risk individuals could be nearly doubled from 2.6% to 4.8%. We propose that via adapting the interRAI-HC criteria to include the "unable to determine" whether abuse occurred (UDA) category, identification of OAA sufferers could be substantially improved. Improved identification will facilitate enhanced protection of this vulnerable population.

Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review : Awareness and recognition of injury patterns

Aim

Identify types, characteristics and anatomic location of physical signs in elder abuse.

Findings

Physical signs in elder abuse are most common bruises and anatomically predominantly located on the head, face/maxillofacial area, neck, upper extremities and torso.

Message

Increase knowledge on physical signs in elder abuse so as to enhance timely detection and intervention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41999-021-00550-z.

Purpose

Elder abuse is a worldwide problem with serious consequences for individuals and society. The recognition of elder abuse is complex due to a lack of awareness and knowledge. In this systematic review, types, characteristics and anatomic location of physical signs in elder abuse were identified.

Methods

Databases of MEDLINE, COCHRANE, EMBASE and CINAHL were searched. The publication dates ranged from March 2005 to July 2020. In addition to the electronic searches, the reference lists and citing of included articles were hand-searched to identify additional relevant studies. The quality of descriptive and mixed-methods studies was assessed.

Results

The most commonly described physical signs in elder abuse were bruises. The characteristics of physical signs can be categorized into size, shape and distribution. Physical signs were anatomically predominantly located on the head, face/maxillofacial area (including eyes, ears and dental area), neck, upper extremities and torso (especially posterior). Physical signs related to sexual elder abuse were mostly located in the genital and perianal area and often accompanied by a significant amount of injury to non-genital parts of the body, especially the area of the head, arms and medial aspect of the thigh.

Conclusions

Most common types, characteristics and anatomic location of physical signs in elder abuse were identified. To enhance (early) detection of physical signs in elder abuse, it is necessary to invest in (more) in-depth education and to include expertise from a forensic physician or forensic nurse in multidisciplinary team consultations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41999-021-00550-z.