Emergency room visits are often the first place abused elderly adults go, which is why identification of abuse is critical in these settings.
But elder abuse may be vastly under-identified in emergency room visits, according to a new study published last week in the Journal of the American Geriatrics Society.
The study’s authors were from University of North Carolina at Chapel Hill, University of California San Diego, and Weil Cornell Medicine.
The researchers found that elder abuse was only diagnosed in 1 out of every 7,700 emergency room visits, a rate which is two orders of magnitude lower than the estimated prevalence of elder abuse in the population.
The paper’s technical results:
In 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012–0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68–2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36–3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84–2.65), and septicemia (OR = 1.92, 95% CI = 1.44–2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits.
Which, in layman’s terms, translates to:
The proportion of U.S. ED visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population. Efforts to improve the identification of elder abuse in EDs may be warranted.
The researcher’s are now testing a screening process that could lead to better diagnosis of abuse situations. From a UNC press release:
Emergency departments are seeing increasing numbers of older adults, and trying to meet the complex needs of these patients with increased physician training and access to social workers who can identify and address unmet care needs. Platts-Mills and his research team plan to improve the identification of elder abuse in the emergency department by developing and validating a screening tool designed for this setting.
Current practice in most emergency departments is to ask a single question about safety at home at the time of triage. The new tool will use several questions to inquire about different aspects of elder abuse including psychological abuse and neglect, and it will include a physical exam for patients with significant cognitive impairment.
Following development, the tool will be tested in emergency departments in North Carolina, Michigan, and Alabama. The work is funded by the National Institute of Justice.
More coverage of the research can be viewed here.
