Articlegreen2016

Diagnosis of Elder Abuse in U.S. Emergency Departments

Christopher S. Evans · Katherine M. Hunold · Tony Rosen · Timothy F. Platts‐Mills

88 citations0/0 files storedJournal of the American Geriatrics Society

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

Abstract

OBJECTIVES: To estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets. DESIGN: Retrospective cross-sectional analysis. SETTING: U.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). PARTICIPANTS: All ED visits of individuals aged 60 and older. MEASUREMENTS: The primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse. RESULTS: In 2012, NEDS contained information on 6,723,667 ED visits of 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 greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68-2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36-3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84-2.65), and septicemia (OR = 1.92, 95% CI = 1.44-2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits. CONCLUSION: The proportion of U.S. ED visits by older adults 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.

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References

1993Elder Abuse 2013Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America 1998The Mortality of Elder Mistreatment 2015Elder Abuse: Systematic Review and Implications for Practice 2008Elder Mistreatment in the United States: Prevalence Estimates From a Nationally Representative Study 2015Elder Abuse 2009Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population 2013Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: U.S. Preventive Services Task Force Recommendation Statement

Cited by

2020Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review 2019Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed 2018Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool 2018Improving Quality of Care in Hospitals for Victims of Elder Mistreatment: Development of the Vulnerable Elder Protection Team 2018Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team

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