Radiologists' Training, Experience, and Attitudes About Elder Abuse Detection

Abstract

OBJECTIVE Elder abuse is underrecognized, and identification of subtle cases requires a high index of suspicion among all health care providers. Because many geriatric injury victims undergo radiographic imaging, diagnostic radiologists may be well positioned to identify injury patterns suggestive of abuse. Little is known about radiologists’ experience with elder abuse. Our goal was to describe knowledge, attitudes, training, and practice experience in elder abuse detection among diagnostic radiologists. SUBJECTS AND METHODS We conducted 19 interviews with diagnostic radiologists at a large urban academic medical center using a semistructured format. Data from these sessions were coded and analyzed to identify themes. RESULTS Only two radiologists reported any formal or informal training in elder abuse detection. All subjects believed they had missed cases of elder abuse. Even experienced radiologists reported never having received a request from a referring physician to assess images for evidence suggestive of elder abuse. All subjects reported a desire for additional elder abuse training. Also, subjects identified radiographic findings or patterns potentially suggestive of elder abuse, including high-energy injuries such as upper rib fractures, injuries in multiple stages of healing, and injuries inconsistent with reported mechanism. CONCLUSION Radiologists are uniquely positioned to identify elder abuse. Though training in detection is currently lacking, providers expressed a desire for increased knowledge. In addition, radiologists were able to identify radiographic findings suggestive of elder abuse. On the basis of these findings, we plan to conduct additional studies to define pathognomonic injury patterns and to explore how to empower radiologists to incorporate detection into their practice.

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

“…These low reported rates of elder abuse, both in our study and in the literature, also align with larger epidemiological studies that report significant under-recognition of the problem (Fulmer, 2003;Touza Garma, 2017). In prior, interview-based qualitative studies, both radiologists and EM physicians reported believing that a lack of adequate training had led them to miss cases of elder abuse, and expressed desires for more training on the subject (Rosen, Bloemen, et al, 2016;Rosen, Hargarten, et al, 2016). Our interviews were also consistent with these findings and showed an overwhelming consensus across disciplines that elder abuse was both lacking and desired from training curricula.…”

“…The prevalence of elder abuse has been estimated to be as high as 10% in the US (Burnes et al, 2015;C. Cooper et al, 2009;Rosen, Hargarten, Flomenbaum, & Platts-Mills, The health care system, and the emergency department (ED) in particular, has been proposed as providing an important "window of opportunity" to screen patients for elder abuse (Kahan & Paris BE, 2003;Rosen, Bloemen, et al, 2016). Health care providers in the ED are uniquely positioned to detect and report abuse, as they are often the only contact that victims have outside their families (Touza Garma, 2017).…”

“…Although elders are frequent users of emergency departments, accounting for 12-24% of all ED visits (Samaras, Chevalley, Samaras, & Gold, 2010), and often undergo imaging during their stays (Murphy, Waa, Jaffer, Sauter, & Chan, 2013;Wong et al, 2017), significant gaps in knowledge remain about how to utilize this imaging for the screening and diagnosis of abuse. Evidence-based imaging correlates have not been described (Lachs & Pillemer, 2004), and most radiologists in the US receive neither formal nor informal training in elder abuse identification (Rosen, Bloemen, et al, 2016).…”

Concepção De Profissionais Da Saúde Sobre Violência Contra Idosos: Revisão Integrativa

“…Muitos profissionais da saúde reconhecem não saber como intervir e promover de forma pragmática a discussão no contexto social, além isso desconhecem a quem recorrer quando se deparam com um idoso vítima de violência; ademais, frequentemente existem sentimentos de receio e medo por parte do idoso de mencionar que sofreu agressão, por desconfiar dos serviços de apoio e proteção da pessoa idosa ou por temer que os familiares e/ou o agente agressor acabem por descobrir ( OLIVEIRA et al, 2018). Principalmente porque os idosos tem receio que ao denunciar sofram represália dos familiares e/ou do agente agressor (ROSEN et al, 2016).…”

Recognizing and Managing Elder Abuse in the Emergency Department

“…Emergency radiologists are contributing additional concerning findings indicative of elder abuse, 38,41,42 such as the concomitant presence of old and new fractures, high-energy fractures inconsistent with the purported mechanism, and distal ulnar diaphyseal fractures. 41,42 The ultimate goal is to identify pathognomonic injury patterns similar to those found in child abuse cases, to assist ED providers.…”