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Current Geriatrics Reports

Published in:

28-02-2024 | REVIEW

Elder Abuse in the Emergency Department

Authors: Nicole Cimino-Fiallos, Natalie Flanagan

Published in: Current Geriatrics Reports | Issue 2/2024

Abstract

Purpose of Review

This review focuses on the demographics of elder victims of maltreatment frequently seen in the Emergency Department and differentiates the types of abuse and neglect. It teaches emergency clinicians how to recognize and screen for this life-threatening diagnosis through the use of validated screening tools and summarizes technological advances, patterns of abuse and approaches to treatment to guide physicians through the management of these challenging cases.

Recent findings

Elder abuse and neglect (EAN) is under-recognized and under-reported in the Emergency Department (ED). Failure to diagnose this life-threatening condition can lead to worse physical and mental health outcomes for victims and increased ED utilization and hospitalizations. In the United States, an aging population is leading to an increased prevalence of elder maltreatment. The Covid-19 pandemic added an accelerant to the already growing problem. Clinicians must familiarize themselves with this morbid and pervasive diagnosis in order to treat their most vulnerable patients. Physicians can activate community resources and investigative agencies to protect victims of abuse.

Summary

Technological advances, such as tools in the electronic medical record (EMR) and artificial intelligence (AI), combined with the validation of abuse patterns based on aggregate data of known cases of abuse can assist providers in diagnosing and documenting abuse and neglect in older adults that present to the ED. While Emergency physicians should independently strive to diagnose maltreatment, partnering with Emergency Medical Services (EMS), nursing, case management and primary care physicians may be the most realistic approach to identifying and treating this insidious problem. If abuse is recognized, evidence-based treatments, relying heavily on interdisciplinary teams and community support, have the potential to improve health outcomes for the victims.

• Chang ES, Levy BR. High prevalence of elder abuse during the COVID-19 pandemic: risk and resilience factors. The American Journal of Geriatric Psychiatry. 2021;29(11):1152–9. https://doi.org/10.1016/j.jagp.2021.01.007. In this study, a survey was conducted of 897 elderly people during the COVID-19 pandemic and one in five of the surveyed reported abuse which is 83.6% higher than pre pandemic estimates.CrossRefPubMedPubMedCentral

Rosen T, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Reisig C, Gogia K, Elman A, Markarian A, Flomenbaum NE, Sharma R. Identifying injury patterns associated with physical elder abuse: analysis of legally adjudicated cases. Annals of emergency medicine. 2020;76(3):266–76. https://doi.org/10.1016/j.annemergmed.2020.03.020.CrossRefPubMedPubMedCentral

Yon Y. Elder abuse prevalence in community settings: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(2):e147–56. https://doi.org/10.1016/S2214-109X(17)30006-2.CrossRefPubMed

Lachs MS, Pillemer KA. Elder abuse. N Engl J Med. 2015;373:1947–56. https://doi.org/10.1056/NEJMra1404688.CrossRefPubMed

Mouton CP, Haas A, Karmarkar A, Kuo YF, Ottenbacher K. Elder abuse and mistreatment: results from Medicare claims data. J Elder Abuse Negl. 2019 Aug-Dec;31(4-5):263-280. https://doi.org/10.1080/08946566.2019.1678544.

Pillemer K, Burnes D, Riffin C, Lachs MS. Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. Gerontologist. 2016 Apr;56(Suppl_2):S194-S205. https://doi.org/10.1093/geront/gnw004.

Beach SR, Schulz R, Castle NG, Rosen J. Financial exploitation and psychological mistreatment among older adults: differences between African Americans and non-African Americans in a population-based survey. Gerontol. 2010. https://doi.org/10.1093/geront/gnq053.CrossRef

Dong XQ. Elder abuse: Systematic review and implications for practice. Journal of the American Geriatrics Society. 2015;63(6):1214–38. https://doi.org/10.1111/jgs.13454.CrossRefPubMedPubMedCentral

AARP. Home and Community Preferences Survey. AARP. https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html. Published 2021. Accessed December 7, 2023.

10.

Aging in Place. Aging in Place vs. Assisted Living. Aging in Place. https://aginginplace.org/aging-in-place-vs-assisted-living/. Accessed December 7, 2023

11.

Rosay AB, Mulford CF. Prevalence estimates and correlates of elder abuse in the United States: The national intimate partner and sexual violence survey. J Elder Abuse Negl. 2017;29(1):1–14. https://doi.org/10.1080/08946566.2016.1249817.CrossRefPubMed

12.

Weissberger GH, Han SD. Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line. J Appl Gerontol. 2020;39(10):1078–87. https://doi.org/10.1177/0733464819865685.CrossRefPubMed

13.

Wallace RB, Crabb VL. Toward Definitions of Elder Mistreatment. In: Dong X, editor. Elder Abuse. Springer, Cham; 2017. p. 1. https://doi.org/10.1007/978-3-319-47504-2_1.

14.

Rosen T, et al. Identifying and initiating intervention for elder abuse and neglect in the emergency department. Clin Geriatr Med. 2018;34(3):435–51. https://doi.org/10.1016/j.cger.2018.04.007.CrossRefPubMedPubMedCentral

15.

Peterson JC, Burnes DP, Caccamise PL, et al. Financial exploitation of older adults: a population-based prevalence study. J Gen Intern Med. 2014;29:1615–23. https://doi.org/10.1007/s11606-014-2946-2.CrossRefPubMedPubMedCentral

16.

Lachs MS, Pillemer K. Elder abuse. Lancet. 2004;364(9441):1263–72. https://doi.org/10.1016/S0140-6736(04)17144-4.CrossRefPubMed

17.

Evans CS, et al. Diagnosis of elder abuse in US emergency departments. J Am Geriatr Soc. 2017;65(1):91–7. https://doi.org/10.1111/jgs.14480.CrossRefPubMed

18.

Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Grossman DC, Kemper AR, Kubik M. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. Jama. 2018;320(16):1678–87.CrossRefPubMed

19.

• Khurana B, Loder RT. Injury patterns and associated demographics of intimate partner violence in older adults presenting to U.S. emergency departments. J Interpers Violence. 2022 Jun;37(17-18):NP16107-NP16129. https://doi.org/10.1177/08862605211022060. This is a retrospective study looking at interpartner violence injury pattern demographics of elders using the National Electronic Injury Surveillance System (NEISS) and compared them with those of younger people.

20.

Lee M, et al. A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers. J Elder Abuse Negl. 2019;31(2):163–80. https://doi.org/10.1080/08946566.2019.1573160.CrossRefPubMedPubMedCentral

21.

Beach SR, Carpenter CR, Rosen T, et al. Screening and detection of elder abuse: Research opportunities and lessons learned from emergency geriatric care, intimate partner violence, and child abuse. J Elder Abuse Negl. 2016 Aug-Dec;28:185-216. https://doi.org/10.1080/08946566.2016.1229241.

22.

Moore C, Browne C. Emerging innovations, best practices, and evidence-based practices in elder abuse and neglect: A review of recent developments in the field. J Fam Viol. 2017;32:383–97. https://doi.org/10.1007/s10896-016-9812-4.CrossRef

23.

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. 2020;32(3):295–315. https://doi.org/10.1080/08946566.2020.1768997.CrossRefPubMedPubMedCentral

24.

Platts-Mills TF, et al. Development of the emergency department senior abuse identification (ED Senior AID) tool. J Elder Abuse Negl. 2018;30(4):247–70. https://doi.org/10.1080/08946566.2018.1460285.CrossRefPubMedPubMedCentral

25.

Wong NZ, Rosen T, Sanchez AM, Bloemen EM, Mennitt KW, Hentel K, Nicola R, Murphy KJ, LoFaso VM, Flomenbaum NE, Lachs MS. Imaging findings in elder abuse: a role for radiologists in detection. Canadian Association of Radiologists Journal. 2017;68(1):16–20. https://doi.org/10.1016/j.carj.2016.06.001.CrossRefPubMed

26.

Kogan AC, Rosen T, Navarro A, Homeier D, Chennapan K, Mosqueda L. Developing the Geriatric Injury Documentation Tool (Geri-IDT) to improve documentation of physical findings in injured older adults. Journal of general internal medicine. 2019;15(34):567–74. https://doi.org/10.1007/s11606-019-04844-8.CrossRef

27.

Bloemen EM, Rosen T, Cline Schiroo JA, Clark S, Mulcare MR, Stern ME, Mysliwiec R, Flomenbaum NE, Lachs MS, Hargarten S. Photographing injuries in the acute care setting: development and evaluation of a standardized protocol for research, forensics, and clinical practice. Academic Emergency Medicine. 2016;23(5):653–9. https://doi.org/10.1111/acem.12955.CrossRefPubMedPubMedCentral

28.

Makaroun LK, Bachrach RL, Rosland AM. Elder abuse in the time of COVID-19—Increased risks for older adults and their caregivers. The American Journal of Geriatric Psychiatry. 2020;28(8):876–80. https://doi.org/10.1016/j.jagp.2020.05.017.CrossRefPubMedPubMedCentral

29.

Boserup B, McKenney M, Elkbuli A. Alarming trends in US domestic violence during the COVID-19 pandemic. The American journal of emergency medicine. 2020;38(12):2753. https://doi.org/10.1016/j.ajem.2020.04.077.CrossRefPubMedPubMedCentral

30.

Makaroun, Lena K., et al. "Changes in elder abuse risk factors reported by caregivers of older adults during the COVID-19 pandemic." Journal of the American Geriatrics Society 69.3 (2021): 602. https://doi.org/10.1111/jgs.17009.

31.

Banerjee, Debanjan, Migita Michael D'Cruz, and TS Sathyanarayana Rao. "Coronavirus disease 2019 and the elderly: Focus on psychosocial well-being, agism, and abuse prevention–An advocacy review." Journal of geriatric mental health 7.1 (2020): 4-10. https://doi.org/10.4103/jgmh.jgmh_16_20.

32.

Yunus RM, Hairi NN, Choo WY. Consequences of elder abuse and neglect: A systematic review of observational studies. Trauma, Violence, & Abuse. 2019;20(2):197–213. https://doi.org/10.1177/1524838017692798.CrossRef

33.

Mercier É, Nadeau A, Brousseau AA, Émond M, Lowthian J, Berthelot S, Costa AP, Mowbray F, Melady D, Yadav K, Nickel C. Elder abuse in the out-of-hospital and emergency department settings: a scoping review. Annals of emergency medicine. 2020;75(2):181–91. https://doi.org/10.1016/j.annemergmed.2019.12.011.CrossRefPubMed

34.

Acierno R, Hernandez-Tejada MA, Anetzberger GJ, Loew D, Muzzy W. The national elder mistreatment study: An 8-year longitudinal study of outcomes. Journal of elder abuse & neglect. 2017;29(4):254–69. https://doi.org/10.1080/08946566.2017.1365031.CrossRef

35.

Rosen, Tony, et al. "Recognizing and managing elder abuse in the emergency department." Emergency Medicine 49.5 (2017): 200-207. https://doi.org/10.12788/emed.2017.0028

36.

• Rosen T, Elman A, Clark S, Gogia K, Stern ME, Mulcare MR, Makaroun LK, Gottesman E, Baek D, Pearman M, Sullivan M. Vulnerable Elder Protection Team: Initial experience of an emergency department‐based interdisciplinary elder abuse program. Journal of the American Geriatrics Society. 2022; 70(11):3260-72. https://doi.org/10.1111/jgs.17967. A Vulnerable Elder Protection Team (VEPT) was developed to study the effects when managing cases of elder abuse and 94% of ED providers reported benefit to these programs for the care of these victims.

37.

Banerjee D, D’Cruz MM, Rao TS. Coronavirus disease 2019 and the elderly: Focus on psychosocial well-being, ageism, and abuse prevention–An advocacy review. Journal of geriatric mental health. 2020;7(1):4–10. https://doi.org/10.4103/jgmh.jgmh_16_20.CrossRef

Title: Elder Abuse in the Emergency Department
Authors: Nicole Cimino-Fiallos
Natalie Flanagan
Publication date: 28-02-2024
Publisher: Springer US
Published in: Current Geriatrics Reports / Issue 2/2024
Electronic ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-024-00407-w

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Abstract

Purpose of Review

Recent findings

Summary

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