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Bloemen EM, Tietz S, Lindberg DM, Hayes J, Lum H, Gottesman E, Elman A, Sullivan M, Pino C, McAuley J, Shaw A, Hancock D, Chang ES, Yasui R, LoFaso VM, Stern ME, Rosen T. Elder abuse geriatrics: describing an important new medical specialist. J Elder Abuse Negl 2024:1-17. [PMID: 38602348 DOI: 10.1080/08946566.2024.2339242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Elder mistreatment, including elder abuse and neglect, is a difficult diagnosis to make and manage for most providers. To address this, two elder abuse consultation teams were developed for patients in the hospital and emergency department settings. As these teams have developed, the providers involved have obtained specialized training and experience that we believe contributes to a new field of elder abuse geriatrics, a corollary to the well-established field of child abuse pediatrics. Providers working in this field require specialized training and have a specialized scope of practice that includes forensic evaluation, evaluation of cognition and capacity, care coordination and advocacy for victims of abuse, and collaboration with protective services and law enforcement. Here we describe the training, scope of practice, ethical role, and best practices for elder mistreatment medical consultation. We hope this will serve as a starting point for this new and important medical specialty.
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Affiliation(s)
- Elizabeth M Bloemen
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah Tietz
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel M Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason Hayes
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hillary Lum
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Robin Yasui
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Atkinson E, Roberto KA. Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:150-165. [PMID: 36636948 DOI: 10.1177/15248380221145735] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse.
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Gottesman E, Elman A, Rosen T. Elder Mistreatment: Emergency Department Recognition and Management. Clin Geriatr Med 2023; 39:553-573. [PMID: 37798065 DOI: 10.1016/j.cger.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.
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Affiliation(s)
- Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA.
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Rosen T, Rippon B, Elman A, Gogia K, Chansakul A, Chang ES, Hancock DW, Bloemen EM, Clark S, LoFaso VM. Mechanisms and weapons in physical elder abuse injuries: Findings from legally adjudicated cases. Injury 2023; 54:110845. [PMID: 37296012 PMCID: PMC10527085 DOI: 10.1016/j.injury.2023.110845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Elder abuse is common, but many characteristics have not been well-described, including injury mechanisms and weapons in physical abuse. Better understanding of these may improve identification of elder abuse among purportedly unintentional injuries. Our goal was to describe mechanisms of injury and weapons used and their relation to injury patterns. METHODS We partnered with District Attorney's offices in 3 counties and systematically examined medical, police, and legal records from 164 successfully prosecuted physical abuse cases of victims aged ≥60 from 2001 to 2014. RESULTS Victims sustained 680 injuries (mean 4.1, median 2.0, range 1-35). Most common mechanisms were: blunt assault with hand/fist (44.5%), push/shove, fall during altercation (27.4%), and blunt assault with object (15.2%). Perpetrators more commonly used body parts as weapons (72.6%) than objects (23.8%). Most commonly used body parts were: open hands (55.5% of victims sustaining injuries from body parts), closed fists (53.8%), and feet (16.0%). Most commonly used objects were: knives (35.9% of victims sustaining injuries from objects) and telephones (10.3%). The most frequent mechanism/injury location pair was maxillofacial/dental/neck injury by blunt assault with hand/fist (20.0% of all injuries). The most frequent mechanism/injury type pair was bruising by blunt assault with hand/fist (15.1% of all injuries). Blunt assault with hand/fist injury was positively associated with victim female sex (OR: 2.27, CI: [1.08 - 4.95]; p = 0.031), while blunt assault with object mechanisms was inversely associated with victim female sex (OR: 0.32, CI: [0.12 - 0.81]; p = 0.017). CONCLUSION Physical elder abuse victims are more commonly assaulted with an abuser's body part than an object, and the mechanisms and weapons used impact patterns of injury.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA.
| | - Brady Rippon
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th Street, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Aisara Chansakul
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, 525 East 68th Street, Baker 14, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - David W Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Elizabeth M Bloemen
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Medicine, 525 East 68th Street, Baker 14, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
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Lee M, Chansakul A, Rotman JA, Rosen A. Elder Abuse. Radiol Clin North Am 2023; 61:65-70. [DOI: 10.1016/j.rcl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alqadiri S, MacLeod H, Huang SCC, Molnar F, Frank C. Indices et stratégies clés pour reconnaître la maltraitance des personnes âgées. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:749-750. [PMID: 36241408 PMCID: PMC9833138 DOI: 10.46747/cfp.6810749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Sultan Alqadiri
- Médecin à la Division de médecine gériatrique de L'Hôpital d'Ottawa (Ontario)
| | - Heather MacLeod
- Spécialiste de la transposition des connaissances en gériatrie au Programme gériatrique régional de l'Est de l'Ontario à Ottawa
| | | | - Frank Molnar
- Spécialiste en médecine gériatrique; il pratique au Département de médecine de l'Université d'Ottawa et à l'Institut de recherche de l'Hôpital d'Ottawa
| | - Chris Frank
- Médecin de famille; il se concentre sur les soins aux personnes âgées et les soins palliatifs à l'Université Queen's à Kingston (Ontario)
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Alqadiri S, MacLeod H, Huang SCC, Molnar F, Frank C. Key signs and strategies for recognizing elder abuse. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:746-747. [PMID: 36241391 PMCID: PMC9833147 DOI: 10.46747/cfp.6810746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sultan Alqadiri
- Physician in the Division of Geriatric Medicine at the Ottawa Hospital in Ontario
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Badawy M, Solomon N, Elsayes KM, Soliman M, Diaz-Marchan P, Succi MD, Pourvaziri A, Lev MH, Mellnick VM, Gomez-Cintron A, Revzin MV. Nonaccidental Injury in the Elderly: What Radiologists Need to Know. Radiographics 2022; 42:1358-1376. [PMID: 35802501 DOI: 10.1148/rg.220017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elder abuse may result in serious physical injuries and long-term psychological consequences and can be life threatening. Over the past decade, attention to elder abuse has increased owing to its high prevalence, with one in six people aged 60 years and older experiencing some form of abuse worldwide. Despite this, the detection and reporting rates remain relatively low. While diagnostic imaging is considered critical in detection of child abuse, it is relatively underused in elder abuse. The authors discuss barriers to use of imaging for investigation and diagnosis of elder abuse, including lack of training, comorbidities present in this vulnerable population, and lack of communication among the intra- and interdisciplinary care providers. Moreover, imaging features that should raise clinical concern for elder abuse are reviewed, including certain types of fractures (eg, posterior rib), characteristic soft-tissue and organ injuries (eg, shoulder dislocation), and cases in which the reported mechanism of injury is inconsistent with the imaging findings. As most findings suggesting elder abuse are initially discovered at radiography and CT, the authors focus mainly on use of those modalities. This review also compares and contrasts elder abuse with child abuse. Empowered with knowledge of elderly victims' risk factors, classic perpetrator characteristics, and correlative imaging findings, radiologists should be able to identify potential abuse in elderly patients presenting for medical attention. Future recommendations for research studies and clinical workflow to increase radiologists' awareness of and participation in elder abuse detection are also presented. An invited commentary by Jubanyik and Gettel is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Mohamed Badawy
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Nadia Solomon
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Moataz Soliman
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Pedro Diaz-Marchan
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Marc D Succi
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Ali Pourvaziri
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Michael H Lev
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Vincent M Mellnick
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Angel Gomez-Cintron
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Margarita V Revzin
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
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Kavak N, Pelin Kavak R, Özdemir M, Sever M, Ertan N, Suner A. A 10-year retrospective analysis of intimate partner violence patients in the emergency department. ULUS TRAVMA ACIL CER 2022; 28:796-804. [PMID: 35652880 PMCID: PMC10443018 DOI: 10.14744/tjtes.2021.90453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is an important human rights problem faced by one in three women worldwide. The aim of this study is to evaluate the demographic, trauma, and radiological characteristics of patients admitted to a tertiary emer-gency department due to IPV. METHODS Sociodemographic characteristics (age, gender, education level, and marital status), trauma characteristics (severity, type, and location), radiological imaging findings (radiography, computed tomography, and magnetic resonance imaging) of patients diagnosed with IPV were evaluated. RESULTS In the study, 1225 patients were evaluated, and 98.7% of them were women (mean age 35 [IQR: 17] years). Of the pa-tients, 63.1% were high school and university graduates. The rate of married women was 74.6%. No relationship was found between gender, age, educational status, and marital status (p>0.05). Most of the traumas were minor (85.4%) and blunt (81.9%) trauma, and the most common types of trauma were kicking (49.9%) and punching (47.3%). It was found that the most frequently affected areas of the patients were the head and neck (76.7%), and the frequency of pelvic trauma was high in male patients (p<0.05). The most com-mon bone fracture was nasal (40.5%) followed by ulna fractures (14.5%). The left-sided diaphyseal fractures were the most common in patients exposed to IPV. In our study, the frequency of mortality was 12.9%, and it was found to be significantly higher in males (p<0.05). CONCLUSION Female patients are more frequently exposed to IPV. Specific injury characteristics can be detected in patients diagnosed with IPV and old fractures detected in these patients should alert the clinician about IPV.
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Affiliation(s)
- Nezih Kavak
- Department of Emergency Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey
| | - Rasime Pelin Kavak
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey
| | - Meltem Özdemir
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey
| | - Mustafa Sever
- Department of Emergency Medicine, Başkent University Faculty of Medicine Ankara Hospital, Ankara-Turkey
| | - Nurcan Ertan
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey
| | - Aslı Suner
- Department of Bioistatistics and Medical Informatics, Ege University Faculty of Medicine, İzmir-Turkey
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Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review : Awareness and recognition of injury patterns. Eur Geriatr Med 2021; 13:53-85. [PMID: 34514555 PMCID: PMC8860961 DOI: 10.1007/s41999-021-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/28/2021] [Indexed: 11/05/2022]
Abstract
Aim Identify types, characteristics and anatomic location of physical signs in elder abuse. Findings Physical signs in elder abuse are most common bruises and anatomically predominantly located on the head, face/maxillofacial area, neck, upper extremities and torso. Message Increase knowledge on physical signs in elder abuse so as to enhance timely detection and intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00550-z. 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. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00550-z.
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Sweileh WM. Global Research Activity on Elder Abuse: A Bibliometric Analysis (1950-2017). J Immigr Minor Health 2021; 23:79-87. [PMID: 32488667 DOI: 10.1007/s10903-020-01034-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Elder abuse is an emerging worldwide public health, human right, and social priority for governments and health policy makers. The aim of the current study was to provide an in-depth quantitative analysis of literature on elder abuse published in academic journals. A bibliometric method was implemented using Scopus database for the study period from 1950 to 2017. The search strategy utilized specific keywords to retrieve relevant documents. One thousand eight hundred seventy-two documents appeared in Scopus when using the search strategy. The annual number of publications showed a fluctuating pattern in the past four decades. Publications on elder abuse originated mainly from Northern America and Western Europe. International research collaboration on elder abuse was relatively low. The mean number of authors per document was 1.4. The Journal of Elder Abuse and Neglect published almost one third of the retrieved documents. The Rush University was the most active institution and Professor Dong, X.Q. was the most active author in this field. The most frequently encountered keywords were risk factors, prevalence, intervention, prevention, dementia, and nursing homes. Physical abuse was the most common type of elder abuse studied followed by psychological and financial abuse. Elder abuse is under-researched and of limited priority in most world regions. Governments need to take into consideration preventive policies of elder abuse based on research findings.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Bloemen EM, Rosen T, Lindberg DM, Krugman RD. How Experiences of Child Abuse Pediatricians and Lessons Learned May Inform Health Care Providers Focused on Improving Elder Abuse Geriatrics Clinical Practice and Research. JOURNAL OF FAMILY VIOLENCE 2021; 36:389-398. [PMID: 34121804 PMCID: PMC8189565 DOI: 10.1007/s10896-020-00143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The experience of physicians and other health care providers in child abuse pediatrics in the last six decades includes successes and failures, which can offer critical insights to inform the growing field of health care providers focusing on elder abuse clinical practice and research. We identify and describe in detail relevant lessons learned, including balancing an urgent call to action with a need for robust evidence to support clinical conclusions. We discuss solutions to research challenges, including the lack of a uniform gold standard for abuse diagnosis and how to ethically recruit subjects who may have cognitive impairment and also be crime victims. We offer recommendations on recruiting and training a specialized health care workforce. We make suggestions for health care providers about how to navigate the legal world including issues with expert testimony and also how to participate in policymaking and development of rational systems. We emphasize the importance of developing and supporting partnerships within the field, with allied fields inside and outside medicine, and internationally. We also highlight the value of connecting researchers and clinicians focused on different types of family violence.
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Affiliation(s)
- Elizabeth M. Bloemen
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, New York, NY 10065, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 E. 68 St., Room M130, New York, NY 10065, USA
| | - Daniel M. Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12401 E. 17th Ave. Mailstop B-215, Aurora, CO 80045, USA
| | - Richard D. Krugman
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12401 E. 17th Ave. Mailstop B-215, Aurora, CO 80045, USA
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Rosen T, Bao Y, Zhang Y, Clark S, Wen K, Elman A, Jeng P, Bloemen E, Lindberg D, Krugman R, Campbell J, Bachman R, Fulmer T, Pillemer K, Lachs M. Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case-control study using data linkage and machine learning. BMJ Open 2021; 11:e044768. [PMID: 33550264 PMCID: PMC7925867 DOI: 10.1136/bmjopen-2020-044768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims. METHODS AND ANALYSIS We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims' healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation. ETHICS AND DISSEMINATION This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip Jeng
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard Krugman
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jacquelyn Campbell
- John Hopkins University School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Ronet Bachman
- Department of Criminology, University of Delaware, Newark, Delaware, USA
| | - Terry Fulmer
- John A Hartford Foundation, New York, New York, USA
| | - Karl Pillemer
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Mark Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Rosen T, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Reisig C, Gogia K, Elman A, Markarian A, Flomenbaum NE, Sharma R, Lachs MS. Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases. Ann Emerg Med 2020; 76:266-276. [PMID: 32534832 DOI: 10.1016/j.annemergmed.2020.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls. METHODS We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014. RESULTS We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%). CONCLUSION Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY.
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Christopher Reisig
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Arlene Markarian
- Elder Abuse Unit, King's County District Attorney's Office, Brooklyn, NY
| | - Neal E Flomenbaum
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Mark S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
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Rohringer TJ, Rosen TE, Lee MR, Sagar P, Murphy KJ. Can diagnostic imaging help improve elder abuse detection? Br J Radiol 2020; 93:20190632. [PMID: 32108517 PMCID: PMC10993220 DOI: 10.1259/bjr.20190632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/05/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022] Open
Abstract
Elder abuse is an underdetected, under-reported issue with severe consequences. Its detection presents unique challenges based on characteristics of this vulnerable population, including cognitive impairment, age-related deconditioning, and an increased number of co-morbidities, all of which predispose to increase vulnerability to injury. While radiologists play a critical role in detection of child abuse, this role is currently not paralleled in detection of elder abuse. We conducted a thorough review of the literature using MEDLINE to describe the current knowledge on injury patterns and injury findings seen in elder abuse, as well as barriers to and recommendations for an increased role of diagnostic imaging in elder abuse detection. Barriers limiting the role of radiologists include lack of training and paucity of rigorous systematic research delineating distinctive imaging findings for physical elder abuse. We outline the current ways in which imaging can help raise clinical suspicion for elder abuse, including inconsistencies between purported mechanism of injury and imaging findings, injury location, multiple injuries at differing stages of healing, and particular patterns of injury likely to be intentionally inflicted. We additionally outline the mechanism by which medical education and clinical workflow may be modified to increase the role for imaging and radiologist participation in detecting abuse in older adult patients, and identify potential future directions for further systematic research.
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Affiliation(s)
- Taryn J Rohringer
- University of Toronto, 1 King’s College
Circle, Toronto, ON M5S 1A8,
Canada
| | - Tony E Rosen
- Assistant Professor of Emergency Medicine, Weill Cornell
Medical Center, 525 E 68 Street, New York, NY,
10065, USA
| | - Mihan R Lee
- Diagnostic Radiologist at Weill Cornell Medical Center, 525 E
68 street, New York, NY, 10065,
USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114,
USA
| | - Kieran J Murphy
- Professor of Medical Imaging, University of Toronto, University
Health Network, 399 Bathurst Street, Toronto,
ON M5T 2S8, Canada
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16
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Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review. Ann Emerg Med 2020; 75:181-191. [PMID: 31959308 DOI: 10.1016/j.annemergmed.2019.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/22/2022]
Abstract
This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.
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17
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Kavak RP, Özdemir M. Radiological appearance of physical elder abuse. Eur Geriatr Med 2019; 10:871-878. [DOI: 10.1007/s41999-019-00246-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
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18
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Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med 2019; 75:136-145. [PMID: 31563402 DOI: 10.1016/j.annemergmed.2019.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022]
Abstract
Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.
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Affiliation(s)
- Christina Shenvi
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
| | - Maura Kennedy
- Massachusetts General Hospital Department of Emergency Medicine and Harvard Medical School, Boston, MA
| | - Charles A Austin
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, AR
| | - Michael Gerardi
- Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ; Coalition on Psychiatric Emergencies
| | - Sandy Schneider
- American College of Emergency Physicians, Irving, TX; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX; Hofstra Northwell School of Medicine, Hempstead, NY
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Lee M, Rosen T, Murphy K, Sagar P. A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers. J Elder Abuse Negl 2019; 31:163-180. [PMID: 30741114 DOI: 10.1080/08946566.2019.1573160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists' contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients' injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists' role in elder abuse detection.
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Affiliation(s)
- Mihan Lee
- a Department of Radiology , Weill Cornell Medicine , New York , NY , USA
| | - Tony Rosen
- b Division of Emergency Medicine , Weill Cornell Medical College , NY , USA
| | - Kieran Murphy
- c Department of Medical Imaging , Toronto Western Hospital , Toronto , ON , CAN
| | - Pallavi Sagar
- d Department of Radiology , Massachusetts General Hospital , Boston , MA , USA
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20
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George E, Phillips CH, Shah N, Lewis-O'Connor A, Rosner B, Stoklosa HM, Khurana B. Radiologic Findings in Intimate Partner Violence. Radiology 2019; 291:62-69. [PMID: 30720401 DOI: 10.1148/radiol.2019180801] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the radiologic findings associated with intimate partner violence (IPV). Materials and Methods Electronic medical records of 185 patients referred to the IPV support program from the emergency department (ED) between January 2015 and October 2016 were retrospectively reviewed and compared with an age- and sex-matched control group of 555 subjects (1:3 ratio of IPV victims to control subjects) who presented to the ED. Reports of all imaging studies performed within 5 years prior to the index ED visit were reviewed. Results The majority of patients who experienced IPV (mean age, 34.2 years ± 12.2 [standard deviation]) were female (178 of 185 [96.2%]) and were largely African American (69 of 185 [37.3%]). Demographic and clinical variables independently associated with IPV were race (odds ratio [OR] range, 3.2-5.9; 95% confidence interval [CI]: 1.8, 12.7), psychiatric comorbidities (OR, 5.4; 95% CI: 3.4, 8.8), and homelessness (OR, 13.0; 95% CI: 5.4, 31.2). IPV victims underwent more imaging studies in the preceding 5 years (median, four studies) than did control subjects (median, one study). Obstetric-gynecologic findings (OR, 4.4; 95% CI: 2.1, 9.6) and acute fractures (OR, 2.4, 95% CI: 1.1, 5.3) seen on images were independently associated with IPV. The addition of imaging findings to demographic and clinical variables increased the area under the receiver operating characteristic curve (AUC) of the multivariate model to detect IPV (0.87 vs 0.86, P < .01), and the cross-validated multivariate model had an AUC of 0.85. Acute fractures involved the face or skull (range, P < .01 to P = .05), and chronic fractures affected the extremities and nasal bone (P < .01 and P = .05, respectively) more frequently in the IPV group than in the control group. Conclusion Intimate partner violence victims undergo more imaging studies and have a higher frequency of potential violence-related imaging findings when compared with age- and sex-matched control subjects. © RSNA, 2019 See also the editorial by Flores and Narayan in this issue.
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Affiliation(s)
- Elizabeth George
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
| | - Catherine H Phillips
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
| | - Nandish Shah
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
| | - Annie Lewis-O'Connor
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
| | - Bernard Rosner
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
| | - Hanni M Stoklosa
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
| | - Bharti Khurana
- From the Departments of Radiology (E.G., C.H.P., N.S., B.K.) and Emergency Medicine (A.L., H.M.S.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (B.R.)
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Iyengar V, Link G, Beatty PW, Boel M, Crockett C, DiCocco C, Fink D, Gray JS, LaCounte C, Miller AC, Phillippi M, Skowronski S, Twomey MS, Williams T. Trauma Caused by Injury or Abuse in Late Life: Experiences, Impacts, and the Federal Response. NAM Perspect 2019. [DOI: 10.31478/201901a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Vijeth Iyengar
- Administration on Aging, Administration for Community Living
| | - Greg Link
- Administration on Aging, Administration for Community Living
| | - Phillip W. Beatty
- National Institute on Disability, Independent Living, and Rehabilitation Research
| | - Madeleine Boel
- Administration for Community Living Traumatic Brain Injury Coordinating Center
| | - Cailin Crockett
- Administration on Aging, Administration for Community Living
| | - Casey DiCocco
- Administration on Aging, Administration for Community Living
| | - Dana Fink
- Independent Living Administration, Administration for Community Living
| | | | | | - A. Cate Miller
- National Institute on Disability, Independent Living, and Rehabilitation Research
| | - Megan Phillippi
- Administration on Aging, Administration for Community Living
| | | | - Mary S. Twomey
- Administration on Aging, Administration for Community Living
| | - Timothy Williams
- Administration for Community Living Traumatic Brain Injury Coordinating Center
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22
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Russo A, Reginelli A, Pignatiello M, Cioce F, Mazzei G, Fabozzi O, Parlato V, Cappabianca S, Giovine S. Imaging of Violence Against the Elderly and the Women. Semin Ultrasound CT MR 2018; 40:18-24. [PMID: 30686363 DOI: 10.1053/j.sult.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Emergency department assessment is a critical opportunity to identify elder abuse and violence against women, which represent a growing problem, requiring the attention of health care systems. Elder abuse is most frequently perpetrated by family members because of the higher levels of stress, burnout, and financial problems affecting the caregivers that can even lead to deadly consequences. Intimate partner violence is defined as physical, sexual, or psychological harm caused to another by a current or former partner or spouse, and can range from a single acute hit to chronic battering, varying in frequency and severity. Radiologists have a critical role in detecting those injury findings suggestive of abuse and violence. When appropriate, additional information about the social circumstances in which an injury took place, linked with imaging findings, may also be helpful in diagnosing abuse. The purpose of this article is to highlight the role of diagnostic imaging in the detection of lesions compatible with domestic abuse in elderly patients and women, and to allow the recognition of the alterations most frequently associated with this type of violence.
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Affiliation(s)
- Anna Russo
- Department of Radiology, SG Moscati Hospital, Aversa Caserta, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, Radiology and Radiotherapy, University of Campania Luigi Vanvitelli. Piazza Miraglia, Naples Italy.
| | - Maria Pignatiello
- Department of Precision Medicine, Radiology and Radiotherapy, University of Campania Luigi Vanvitelli. Piazza Miraglia, Naples Italy
| | - Fabrizio Cioce
- Department of Precision Medicine, Radiology and Radiotherapy, University of Campania Luigi Vanvitelli. Piazza Miraglia, Naples Italy
| | - Giovanni Mazzei
- School of Medicine, University St. Kliment Ohridski, Sofia, Bulgaria
| | - Olimpia Fabozzi
- Department of Radiology, SG Moscati Hospital, Aversa Caserta, Italy
| | - Vincenzo Parlato
- Department of Precision Medicine, Radiology and Radiotherapy, University of Campania Luigi Vanvitelli. Piazza Miraglia, Naples Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, Radiology and Radiotherapy, University of Campania Luigi Vanvitelli. Piazza Miraglia, Naples Italy
| | - Sabrina Giovine
- Department of Radiology, SG Moscati Hospital, Aversa Caserta, Italy
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Rubin KM, Stock MK. Early Signs of Fracture Repair in the Human Rib Cage: Implications for Forensic Casework. J Forensic Sci 2018; 64:672-679. [DOI: 10.1111/1556-4029.13909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/30/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Katie M. Rubin
- C.A. Pound Human Identification Laboratory Department of Anthropology University of Florida 2033 Mowry Road Room G‐17 Gainesville FL 32610
| | - Michala K. Stock
- C.A. Pound Human Identification Laboratory Department of Anthropology University of Florida 2033 Mowry Road Room G‐17 Gainesville FL 32610
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Rosen T, Stern ME, Elman A, Mulcare MR. Identifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department. Clin Geriatr Med 2018; 34:435-451. [PMID: 30031426 PMCID: PMC6057151 DOI: 10.1016/j.cger.2018.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Elder abuse and neglect are common and may have serious medical and social consequences but are infrequently identified. An emergency department (ED) visit represents a unique but usually missed opportunity to identify potential abuse and initiate intervention. ED assessment should include observation of patient-caregiver interaction, comprehensive medical history, and head-to-toe physical examination. Formal screening protocols may also be useful. ED providers concerned about elder abuse or neglect should document their findings in detail. ED interventions for suspected or confirmed elder abuse or neglect include treatment of acute medical, traumatic, and psychological issues; ensuring patient safety; and reporting to the authorities.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA.
| | - Michael E Stern
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| | - Alyssa Elman
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| | - Mary R Mulcare
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
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Lee M, Rosen T, Murphy K, Sagar P. A Role for Imaging in the Detection of Physical Elder Abuse. J Am Coll Radiol 2018; 15:1648-1650. [PMID: 30017624 DOI: 10.1016/j.jacr.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Mihan Lee
- Harvard Medical School, Boston, Massachusetts.
| | - Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Kieran Murphy
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Improving Quality of Care in Hospitals for Victims of Elder Mistreatment: Development of the Vulnerable Elder Protection Team. Jt Comm J Qual Patient Saf 2018; 44:164-171. [PMID: 29499813 DOI: 10.1016/j.jcjq.2017.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022]
Abstract
PROBLEM DEFINITION Hospitals have an opportunity to improve the quality of care provided to a particularly vulnerable population: victims of elder mistreatment. Despite this, no programs to prevent or stop elder abuse in the acute care hospital have been reported. An innovative, multidisciplinary emergency department (ED)-based intervention for elder abuse victims, the Vulnerable Elder Protection Team (VEPT), was developed at NewYork-Presbyterian / Weill Cornell Medical Center (New York City). APPROACH The VEPT is a consultation service available 24 hours a day/7 days a week to improve identification, comprehensive assessment, and treatment for potential victims of elder abuse or neglect. All ED providers have been trained on how to recognize signs of elder mistreatment. Any provider can activate the VEPT via a single page/telephone call, which triggers the VEPT's often time-consuming, complex assessment of the potential mistreatment victim. First, the ED social worker on duty performs the initial bedside assessment and separately interviews the potential perpetrator and/or caregiver. He or she then contacts the on-call VEPT medical provider to discuss next steps and other team members' potential involvement. For patients admitted to the hospital, the VEPT connects with the inpatient social workers and medical team to ensure appropriate follow-up and care planning. NEXT STEPS/PLANNED EVALUATION The VEPT program was launched in April 2017 after comprehensive training. Its impact will be measured by tracking the short-term and long-term mistreatment-related outcomes, as well as medical, mental health, functional, psychosocial, and legal outcomes of the vulnerable ED patients for whom the team provides care.
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