Diagnosis of Elder Abuse in U.S. Emergency Departments

Abstract

OBJECTIVE To estimate the proportion of visits to United States emergency departments (EDs) receiving a diagnosis of elder abuse using two nationally representative datasets. DESIGN Retrospective cross-sectional analysis. SETTING U.S. ED visits recorded in either the 2012 Nationwide Emergency Department Sample (NEDS), or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). PARTICIPANTS All ED visits by patients aged 60 years and older. MEASUREMENTS The primary outcome was elder abuse as defined by ICD-9-CM diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (OR) were calculated to identify patient demographics and common ED diagnoses associated with elder abuse. RESULTS In 2012, NEDS contained 6,723,667 ED visits by 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 increased weighted odds of elder abuse diagnosis in females (OR 1.95, 95% CI 1.68–2.26), and patients with contusion (OR 2.91, 95% CI 2.36–3.57), urinary tract infection (OR 2.21, 95% CI 1.84–2.65), or septicemia (OR 1.92, 95% CI 1.44–2.55). In the 2011 NHAMCS dataset, zero cases of elder abuse were recorded among the 5,965 older adult ED visits. CONCLUSION Among US ED visits by older adults, the proportion of visits 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.

Prevalence and Correlates of Elder Abuse in São Paulo and Rio de Janeiro

“…When older people use the healthcare system, through regular outpatient care, emergency medical care, or directly because of the medical or psychiatric impact of mistreatment, health professionals should be alert in detecting potential abuse to provide proper prevention and increase the safety of older adults . Up‐to‐date curricula, proper training, and screening tools are feasible mechanisms to improve awareness and recognition of abuse in this vulnerable population.…”

Ability of Older Adults to Report Elder Abuse: An Emergency Department–Based Cross‐Sectional Study

“…The emergency department (ED) visit provides a valuable opportunity to screen for elder abuse, as people who experience elder abuse are twice as likely to visit the ED compared to nonabused older adults . Unfortunately, elder abuse is rarely identified in the ED . Further, despite the magnitude of this problem, no screening protocols designed for the ED have been described.…”

“…Although many EDs screen for domestic violence, most do so using only a single question about safety at home, which has been found inadequate for elder abuse . Although the geriatric ED guidelines provide elder abuse screening recommendations, the percentage of US EDs that are consistently screening for elder abuse using a tool designed for elder abuse screening is likely close to 0% …”

“…3,4 Unfortunately, elder abuse is rarely identified in the ED. 5,6 Further, despite the magnitude of this problem, no screening protocols designed for the ED have been described. Although many EDs screen for domestic violence, most do so using only a single question about safety at home, which has been found inadequate for elder abuse.…”

“…5,7 Although the geriatric ED guidelines provide elder abuse screening recommendations, 8 the percentage of US EDs that are consistently screening for elder abuse using a tool designed for elder abuse screening is likely close to 0%. 6 One important component of an ED-based elder abuse screening tool is an efficient method of determining whether the patient can accurately report abuse. This challenge is particularly salient in the ED, where an estimated 31% of older adult patients have some degree of cognitive impairment.…”