Neglect Assessment in Urban Emergency Departments and Confirmation by an Expert Clinical Team

Terry T. Fulmer · Gregory J. Paveza · Carla L. VandeWeerd · S. Fairchild · Ivo L Abraham · M. Bolton-Blatt

54 citations0/0 files storedThe Journals of Gerontology Series A

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Elder Abuse and Neglect Child Abuse and Trauma Child Abuse and Related Trauma

Abstract

BACKGROUND: Elder neglect accounts for over 70% of all adult protective services reports in the nation annually, and it has been estimated that there are over 70,000 new cases each year. The purpose of this study was to conduct elder neglect research in the emergency department (ED), using a dyadic vulnerability/risk-profiling framework for elder neglect. METHODS: Patients were recruited through four EDs in New York and Tampa from the beginning of February 2001 through the end of September 2003. Demographics, a Mini-Mental Status Examination score, and an initial elder assessment screen were collected. The diagnosis of neglect was then made by a Neglect Assessment Team (NAT) comprising a nurse, physician, and social worker, with extensive clinical experience in elder neglect. RESULTS: Of the 3664 ED screens of adults 70 years and older, 405 (11%) met the inclusion criteria and agreed to participate. Neglect was diagnosed by the NAT in 86 of the 405 cases reviewed. Demographic differences between neglect versus no neglect cases were examined using Fisher's exact test, and differences emerged between the 2 groups. CONCLUSION: This study documents the underreporting of cases of neglect as evidenced by differences in diagnoses by screeners versus experts. The research assistants screened positive for neglect in 5% (N=22) of the 405 cases. The NAT made the diagnosis of neglect in 22% (86/389) of the cases. This markedly different rate of neglect may mean that ED screens are important but may underestimate the true number of cases. Conversely, an NAT may make the diagnosis of neglect in an older adult more often given a higher sensitivity and a more robust knowledge base of the problem.

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1988The Prevalence of Elder Abuse: A Random Sample Survey 2013Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America 1997Risk Factors for Reported Elder Abuse and Neglect: A Nine-Year Observational Cohort Study 1998Violence in families: assessing prevention and treatment programs.2000Elder neglect assessment in the emergency department 2003Domestic Elder Abuse and the Law 1996Older adults. An 11-year longitudinal study of adult protective service use 2003Family Violence and Nursing Practice

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2012Older people in residential care settings: results of a national survey of staff-resident interactions and conflicts 2009Assessing Elder Mistreatment: Instrument Development and Implications for Adult Protective Services 2011Elder Abuse and Neglect: Assessment Tools, Interventions, and Recommendations for Effective Service Provision 2009Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses 2020Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases

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