This is the first clinical case-control study detailing clinical outcomes and evaluating risk factors of persons suffering severe physical abuse. Of elderly trauma victims, those who are physically abused have more-severe injuries than their nonabused counterparts. More research is needed to better evaluate risk factors of physical abuse and effective interventions.

Better screening that connects victims of abuse with community services, police action, and alternative residential options is important in reducing the risk of revictimization and connecting individuals with resources that can improve their safety at home, regardless of whether it is in the community or a residential facility.

Background: Studies have demonstrated that measures of lower quality of care and associated adverse health effects are more prevalent in for-profit nursing homes compared to not-for-profit facilities. However, these studies omit persons who receive care in the community setting, and exclusively focus on isolated clinical signs that may obscure the true effect size, since these clinical signs rarely occur in isolation. Objective: In this study, we use the Clinical Signs of Neglect Scale (CSNS), which is an aggregate measure of clinical signs of neglect and substandard care, to evaluate the association of residence type on health outcomes among individuals living in both private community residences and for-profit and not-for-profit long-term care facilities. Methods: In a multicenter, retrospective data analysis of 1,149 patients identified from an inpatient hospital registry, we assessed the relationship between residence type (community dwelling, not-for-profit, and for-profit facilities) and clinical signs of neglect. Adjusted parameter estimates and 95% CIs were estimated with linear regression in 3 models using different reference groups. Results: The most serious clinical signs were consistently more prevalent among residents of for-profit facilities, as were measures of poor institutional quality. Relative to low-functioning community-dwelling patients, the mean difference in CSNS scores was higher among patients residing in not-for-profit facilities by 1.99 (p = 0.012) and 3.55 (p ≤ 0.001) among patients in for-profit facilities. In a separate model, the mean difference in CSNS scores among patients living in for-profit facilities compared to not-for-profit facilities was 1.90 (p = 0.035). Conclusions: Using an aggregate measure, our findings support prior studies demonstrating an association between residence type and adverse health outcomes for disabled elderly.

We conducted a case-control study to evaluate severe physical abuse of the elderly treated in two Chicago area Level I trauma centers. This report details whether physicians are adequately reporting cases of abuse to Adult Protective Services (APS), and assesses 1 year. The failure to report two-thirds of the cases and the substantially higher risk of death during the first year after hospitalization indicates the need for improved identification, reporting, and intervention. It is important that clinicians understand the complexity of elder abuse in order to better identify suspected victims and report these cases to professionals in APS.

Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual's residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.

Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations.

The PC-PTSD was an easy to administer screening tool. Patients reported PTSD symptoms at higher rates than previous studies. Patients with gunshot wounds and those injured greater than 30 days from the time of the screen were more likely to report PTSD symptoms. Although males represented 82% of positive screens, there was no statistical difference in PTSD symptoms between male and female participants because of the small number of females represented. Families also reported significant levels of PTSD. Both patients and families may benefit from additional screening and intervention in the early posttrauma period.

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. Our goal was to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages. We conducted interviews and a focus group of MIs regarding their attitudes toward foreign-born workers, knowledge of occupational health, and perceived roles. They were familiar with occupational injuries and sympathetic toward foreign-born workers, and they described their roles as conduits, cultural brokers, and advocates for hospitals, providers, and patients. More detailed and representative data would require a larger investigation. However, the time-sensitive nature of policy-making at this point mandates that occupational health stakeholders participate in the national dialogue on standards, training, and licensure for MIs to promote improved access and quality of health care for LEP patients who have been injured at work.