Older emergency department (ED) patients have complex medical, social, and physical problems. We established a program at four ED sites to improve case finding of at-risk older adults and provide comprehensive assessment in the ED setting with formal linkage to community agencies. The objectives of the program are to (1) improve case finding of at-risk older ED patients, (2) improve care planning and referral for those returning home, and (3) create a coordinated network of existing medical and community services. The four sites are a 1,000-bed teaching center, a 700-bed county teaching hospital, a 400-bed community hospital, and a health maintenance organization (HMO) ED site. Ten community agencies also participated in the study: four agencies associated with the hospital/HMO sites, two nonprofit private agencies, and four public agencies. Case finding is done using a simple screening assessment completed by the primary or triage nurse. A geriatric clinical nurse specialist (GCNS) further assesses those considered at risk. Patients with unmet medical, social, or health needs are referred to their primary physicians or to outpatient geriatric evaluation and management centers and to community agencies. After 18 months, the program has been successfully implemented at all four sites. Primary nurses screened over 70% (n = 28,437) of all older ED patients, GCNSs conducted 3,757 comprehensive assessments, participating agency referrals increased sixfold, and few patients refused the GCNS assessment or subsequent referral services. Thus, case finding and community linkage programs for at-risk older adults are feasible in the ED setting.

Ethnic and generational variation in elder mistreatment has only recently been explored. This research builds upon pioneer work in the field by examining perceptions of elder mistreatment across four ethnic groups (European-American, African-American, Puerto Rican, and Japanese-American) and two generations (elder and 'baby boom' caregiver). Focus group discussions revealed differences in defining elder mistreatment and responding to it. They also suggested that psychological abuse and neglect may be more important mistreatment forms than previously acknowledged. Policy and practice implications of study results are considered. jg]Key words gw]Elder mistreatment gw]Elder abuse gw]Ethnic groups gw]Generations.

Outcomes of elder mistreatment have not been studied prospectively in a national sample. The NEMS 8-year follow-up findings indicate a strong relationship between elder mistreatment at Wave I and negative emotional and physical health 8 years later. Fortunately, current (Wave II) social support appears to be both consistently and powerfully protective against most negative outcomes.

A comparison group study of abusing and nonabusing caregivers suggested a correlation between alcohol use and abuse and violence against elderly parents. Findings reveal that abusers were more likely than nonabusers to drink, to become intoxicated, and to be identified as having a drinking problem. Policy and practice implications are discussed.