Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases

Rosen, Tony; LoFaso, Veronica M.; Bloemen, Elizabeth M.; Clark, Sunday; McCarthy, Tom; Reisig, Christopher; Gogia, Kriti; Elman, Alyssa; Markarian, Arlene; Flomenbaum, Neal; Sharma, Rahul; Lachs, Mark S.

doi:10.1016/j.annemergmed.2020.03.020

Cited by 24 publications

(27 citation statements)

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“…The design of the included studies concerned eight descriptive studies [13,[21][22][23][24][25][26][27], three case studies [28][29][30], five narrative reviews [11,[31][32][33][34], six mixed methods studies [12,[35][36][37][38][39] and two books [40,41]. See Tables 1, 2, 3 and 4 for characteristics studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Most of the descriptive studies (n = 8) showed moderate to good quality [13,21,24,26,27]. Most of the mixed methods studies (n = 6) showed low quality [12,[35][36][37].…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Furthermore studies described that the distribution of physical signs in a stocking or glove distribution (e.g., due to immersion of the extremities in hot water), the presence of a cutaneous casal necklace (dermatitis around the neck due to vitamin B3 deficiency in case of neglect), and injuries in multiple stages of healing or multifocal fractures to be caused by elder abuse [30,36]. No description of characteristics of physical signs were given in six out of eight descriptive studies [21,[23][24][25][26][27], two out of nine case report studies (primary case report studies) [28,29], and two out of six mixed methods studies [38,39].…”

Section: Characteristics Of Physical Signsmentioning

confidence: 99%

“…Other anatomic locations mentioned to be associated with elder abuse included the lower extremities, abdomen, lumbar area and gluteal/genital/rectal area, the latter location often mentioned as being associated with the presence of sexual elder abuse or neglect (e.g., decubitus ulcers) [12, 13, 21-27, 29, 30, 35-39]. Some studies described physical signs due to elder abuse to be specifically located on the left respectively right side of the body [13,24,26,27,30,38,39]. Furthermore Rosen et al [26] described that physical abuse victims were more likely to have visible injuries in the maxillofacial, dental or neck area without the presence of injuries to the upper or lower extremities.…”

Section: Anatomic Location Of Physical Signsmentioning

confidence: 99%

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Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review

et al. 2021

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Purpose Elder abuse is a worldwide problem with serious consequences for individuals and society. The recognition of elder abuse is complex due to a lack of awareness and knowledge. In this systematic review, types, characteristics and anatomic location of physical signs in elder abuse were identified. Methods Databases of MEDLINE, COCHRANE, EMBASE and CINAHL were searched. The publication dates ranged from March 2005 to July 2020. In addition to the electronic searches, the reference lists and citing of included articles were hand-searched to identify additional relevant studies. The quality of descriptive and mixed-methods studies was assessed. Results The most commonly described physical signs in elder abuse were bruises. The characteristics of physical signs can be categorized into size, shape and distribution. Physical signs were anatomically predominantly located on the head, face/maxillofacial area (including eyes, ears and dental area), neck, upper extremities and torso (especially posterior). Physical signs related to sexual elder abuse were mostly located in the genital and perianal area and often accompanied by a significant amount of injury to non-genital parts of the body, especially the area of the head, arms and medial aspect of the thigh. Conclusions Most common types, characteristics and anatomic location of physical signs in elder abuse were identified. To enhance (early) detection of physical signs in elder abuse, it is necessary to invest in (more) in-depth education and to include expertise from a forensic physician or forensic nurse in multidisciplinary team consultations.

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Section: Study Characteristicsmentioning

confidence: 99%

“…Most of the descriptive studies (n = 8) showed moderate to good quality [13,21,24,26,27]. Most of the mixed methods studies (n = 6) showed low quality [12,[35][36][37].…”

Section: Quality Assessmentmentioning

confidence: 99%

Section: Characteristics Of Physical Signsmentioning

confidence: 99%

Section: Anatomic Location Of Physical Signsmentioning

confidence: 99%

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Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review

et al. 2021

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“…In this issue of Annals, Rosen et al 21 present the results of a carefully conducted study to identify physical patterns associated with elder abuse. The authors examined the records of successfully prosecuted cases and compared the patterns of physical injury in those cases with those of older adults who presented to the ED after an unintentional fall.…”

mentioning

confidence: 99%

Strengthening Our Intuition About Elder Abuse

Platts‐Mills

Hurka-Richardson

2020

Annals of Emergency Medicine

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Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

et al. 2023

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ImportanceElder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment.ObjectiveTo examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults.Design, Setting, and ParticipantsThis retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022.Main Outcomes and MeasuresWe used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses.ResultsThis study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P &lt; .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P &lt; .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P &lt; .001).Conclusions and RelevanceIn this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.

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Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases

Cited by 24 publications

References 71 publications

Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review

Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review

Strengthening Our Intuition About Elder Abuse

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

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