A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers

Abstract

Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists' contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients' injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists' role in elder abuse detection.

Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review

“…Radiologists were the focus of three articles (Lee et al, 2019; Rosen, Bloemen, et al, 2016; Wong et al, 2017. The study authors discussed the importance of radiologists receiving training on elder abuse because older adults who are physically abused are likely to receive radiographic imaging if they come into the emergency room (Lee et al, 2019; Rosen, Bloemen, et al, 2016).…”

“…Radiologists were the focus of three articles (Lee et al, 2019; Rosen, Bloemen, et al, 2016; Wong et al, 2017. The study authors discussed the importance of radiologists receiving training on elder abuse because older adults who are physically abused are likely to receive radiographic imaging if they come into the emergency room (Lee et al, 2019; Rosen, Bloemen, et al, 2016). They also discussed the importance of radiologists having the ability to utilize their training to recognize relevant injury patterns in elder abuse cases as a point of detection and then intervention for cases of elder abuse (Wong et al, 2017).…”

Can diagnostic imaging help improve elder abuse detection?

“…Injury patterns with high sensitivity and specificity for child abuse have been well-characterized, such as posterior rib fractures, metaphyseal corner fractures and depressed skull fractures. 19 Age-related changes and increased co-morbidities in older adults have rendered delineating similarly pathognomonic injury patterns more challenging in the geriatric population, e.g. osteoporosis and use of medications such as anticoagulants.…”

“…osteoporosis and use of medications such as anticoagulants. 19 Radiologists play a critical and central role in detection of child abuse, and may be able to play a similarly crucial role in detection of elder abuse. Lack of clear characterization taken with poor disclosure by victims and poor recognition by physicians elucidates the significant need for more objective and systematic detection of physical elder abuse, particularly at present as our population ages and the number of cases continue to increase.…”

“…With elderly patients accounting for up to 24% of emergency department visits, and most patients undergoing imaging studies during these visits, the potential for diagnostic imaging to provide needed objectivity and support in detecting physical elder abuse is great. 19 The goal of the current study was to conduct a rigorous review of the literature to describe the current knowledge on injury patterns and injury findings seen in elder abuse, as well as barriers to and recommendations for an increased role of diagnostic imaging in elder abuse detection.…”