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Isa MI, Fenton TW, Goots AC, Watson EO, Vaughan PE, Wei F. Effects of input energy and impactor shape on cranial fracture patterns. Forensic Sci Int 2023; 352:111859. [PMID: 37857182 DOI: 10.1016/j.forsciint.2023.111859] [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: 02/20/2023] [Revised: 08/18/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
This study documents relationships between input energy, impactor shape, and the formation of fractures in human crania. Parietal impact experiments (n = 12) were performed at 67% higher input energy compared to previously reported experiments. Fracture origins, characteristics, and locations were compared at two input energy levels with three impactor shapes (focal "hammer", flat "brick", and curved "bat"). Impacts with all three impactors at both energy levels produced fractures originating at and remote to the impact site, indicating both mechanisms are typical in temporoparietal blunt force impacts. Higher energy impacts generally produced more impact site fractures, depression, and comminution than lower energy impacts. A small, focal impactor produced cone cracks, depression, and fractures localized near the impact site. A broad, curved impactor produced circumferential fractures and linear fractures extending into adjacent bones. A broad, flat impactor produced fracture patterns ranging from linear fractures to large depressed and comminuted defects.
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Affiliation(s)
- Mariyam I Isa
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, 48824 MI, United States.
| | - Todd W Fenton
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, 48824 MI, United States
| | - Alexis C Goots
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, 48824 MI, United States
| | - Elena O Watson
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, 48824 MI, United States
| | - Patrick E Vaughan
- Orthopaedic Biomechanics Laboratories, Michigan State University, 965 Fee Rd., East Lansing 48824, MI, United States
| | - Feng Wei
- Orthopaedic Biomechanics Laboratories, Michigan State University, 965 Fee Rd., East Lansing 48824, MI, United States
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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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3
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Yurdakul ES, Veizi BGY, Avcı C, Yazır HT, Avaner E, Naharcı Mİ, Sarı O. Reliability and validity of the Turkish version of the elder abuse suspicion index in community-dwelling older adults. Turk J Med Sci 2023; 53:432-438. [PMID: 36945952 PMCID: PMC10388021 DOI: 10.55730/1300-0144.5600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/04/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults. METHODS This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed. RESULTS EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity. DISCUSSION The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.
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Affiliation(s)
- Eray Serdar Yurdakul
- Department of Medical History and Bioethics, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Betül Gülsüm Yavuz Veizi
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Candeniz Avcı
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hatice Tuğba Yazır
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Elif Avaner
- Department of Medical History and Bioethics, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mehmet İlkin Naharcı
- Division of Geriatrics, University of Health Sciences, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Ankara, Turkey
| | - Oktay Sarı
- Department of Family Medicine, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Older adult abuse in a service for sexual and domestic violence: Medico-legal implications from the experience of an Italian center. Forensic Sci Int 2022; 338:111383. [PMID: 35841731 DOI: 10.1016/j.forsciint.2022.111383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/12/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022]
Abstract
Older adults are subject to vulnerability and abusive behaviors have serious negative health consequences. Since the phenomenon is underestimated, several challenges are faced to prevent, diagnose, and treat abuses on older adults. In this context, clinical forensic medicine practitioners can play a pivotal role. A retrospective monocentric analysis of all the files concerning victims of violence observed in the SVSeD Center in Milan over the age of 65 for a five-year period was performed. For each medical report, data regarding the variables of the victims, the type of violence, and the variables of the perpetrators were analysed. Older adult victims of abuses were 166. Abuses against women were more frequent than against men (less than 6 % of consultations). In one third of cases, subjects also suffered from disabling diseases and reported signs of physical violence. Perpetrators were male known individuals in almost 90 % of cases. Violence was perpetrated by a partner or a family member. The present study may help in identifying risk factors for domestic violence against older adults. Consequently, preventive policies should be designed to interrupt the vicious circle of violence. Older adult abuse deserves additional focus and better education for healthcare professionals and further research should be carried out to better understand the actual epidemiology of the phenomenon and to develop therapeutical and caring strategies.
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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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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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Farnia V, Bajoghli H, Golshani S, Shakeri J, Maurandi-López A, Rubio L, Perez-Carceles MD. Elder abuse among Spanish and Iranian people: new methodological approach to the same old story. Int J Legal Med 2021; 135:1515-1524. [PMID: 33783603 DOI: 10.1007/s00414-020-02475-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 12/09/2020] [Indexed: 10/21/2022]
Abstract
Elder abuse continues to be a taboo, mostly underestimated, ignored by societies across the world. Recent systematic reviews and meta-analyses have revealed significant variations in the prevalence of elder abuse, with large geographic variations. This is the first study that compares the prevalence of elder abuse and risk factors between a European and Asian countries and using the same method. Cross-sectional surveys were conducted in Spain and Iran. Eight hundred forty subjects, aged 65 and over, were chosen randomly from patients in primary care health centres. Prevalence of abuse and subtypes and risk factors were obtained using structured interviews. To minimize the potential effects of selection bias, a propensity score matching was performed. Multiple correspondence analysis was used to evaluate the possible relationships among all the variables and to identify specific profiles. Five hundred thirty-two older people remained for the analysis after matching. The prevalence of abuse was 39.1% in Spain and 80.5% in Iran. Elder abuse and its subtypes are significantly more probable in Iran than in Spain. Out of every five elderly people questioned, two in Spain and four in Iran responded affirmatively to a question concerning elder abuse. Multiple correspondence analysis allows the differences between patterns of elder abuse between both populations to be visualized. Elder abuse is a prevalent problem in Spain and Iran. While some characteristics are shared in the pattern of abuse there are different profiles between the two countries. Detecting elder abuse should be a priority objective in clinical and forensic setting. Key points • This is the first study that compares the prevalence of elder abuse between a European and Asian country, using the same methodology. • Multiple correspondence analysis allows specific elder abuse profiles to be identified. • Elder abuse is significantly more likely to occur in Iran than in Spain. • Out of every five elderly people questioned, two in Spain and four in Iran responded affirmatively to a question concerning elder abuse.
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Affiliation(s)
- Vahid Farnia
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hafez Bajoghli
- Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Senobar Golshani
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jalal Shakeri
- Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Antonio Maurandi-López
- Department of Didactics of Mathematical and Social Sciences, University of Murcia, E-30100, Murcia, Spain
| | - Luis Rubio
- Primary Care Management, Murcia Health Service, E-30100 Espinardo, Murcia, Spain
| | - Maria D Perez-Carceles
- Institute of Research into Aging, Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence "Campus Mare Nostrum", School of Medicine, University of Murcia, E-30100, Murcia, Spain.
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8
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Altendorf A, Draper B, Wijeratne C, Schreiber J, Kanareck D. Neglect of Older People: Touching on Forensic and Pathophysiological Aspects. THE GERONTOLOGIST 2020; 60:e449-e465. [PMID: 31348828 DOI: 10.1093/geront/gnz084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neglect of older people is common and may result in fatal and nonfatal outcomes. Normal changes of aging and disease-related symptoms may overlap with markers of neglect and lead to under-detection. This review aims to delineate medical, psychiatric, and pathophysiological indicators in the victim-identified in forensic case reports-to point out areas of overlap and raise awareness in Health Care Professionals. RESEARCH DESIGN AND METHODS Medical and forensic databases were searched with the search terms: neglect, elder, elderly, forensic, homicide for detailed case reports on elder neglect. Cases were reviewed as to victim age, sex, medical/psychiatric diagnosis, perpetrator, victim-to-perpetrator relationship, cause of death (if fatal), location of incident, autopsy findings (if fatal), and ancillary studies. A total of 168 publications were retrieved, of these 11 publications, containing a total of 25 cases, yielded sufficient detail on each case to be included in the qualitative analysis. RESULTS Neglect is associated with poor physical, psychological, and mental health. Neglect can be a direct cause of death or contribute to a fatal outcome by exacerbating existing conditions. Red flags of neglect included malnutrition, dehydration, poor hygiene, untreated decubitus ulcers, hypothermia, contractures, and an uncooperative caregiver. However, incontrovertible evidence of neglect is not always easy to obtain due to age and disease-related changes. DISCUSSION AND IMPLICATIONS The findings document the extent and seriousness of elder neglect and highlight the importance of detailed documentation as well as collaboration between clinicians, allied health professionals, law enforcement and medical forensic services to improve patient outcomes and reduce the risk of further incidents.
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Affiliation(s)
- Annette Altendorf
- Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales
| | - Brian Draper
- Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales.,School of Psychiatry, University of New South Wales, Sydney
| | - Chanaka Wijeratne
- Sydney School of Medicine, University of Notre Dame.,Department of Aged Care Psychiatry, Prince of Wales Hospital, Randwick, New South Wales
| | - Jason Schreiber
- Clinical Forensic Medicine (CFM), Victorian Institute of Forensic Medicine (VIFM), Melbourne.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniella Kanareck
- Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales
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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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10
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Forero Borda LM, Hoyos Porto SDJ, Buitrago Martínez V, Heredia Ramírez RA. Maltrato a las personas mayores: una revisión narrativa. UNIVERSITAS MÉDICA 2019. [DOI: 10.11144/javeriana.umed60-4.malt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
El maltrato a las personas mayores es un tema de interés creciente, tanto así que se considera un problema de salud pública. Hay particularidades que hacen del entorno colombiano un ambiente propicio para generar situaciones de maltrato: la exposición a la “violencia a gran escala”, la diferencia de género y el cambio de la pirámide poblacional. Según el estudio SABE Colombia, el 12,9 % de las personas mayores informó haber sufrido maltrato, del cual el más común es el psicológico, seguido por el físico, el financiero y el sexual. A pesar de que el Estado reconoce al adulto mayor como “sujeto de especial protección”, aún hay desconocimiento por parte de los profesionales de la salud a la hora de enfrentar estos casos. Este debería ser un tema de obligatoriedad moral, por lo que se debe abordar a profundidad para así identificarlo oportunamente y proponer estrategias de prevención de una manera contextualizada. Esta revisión de la literatura tiene por objetivos sintetizar la información epidemiológica disponible, los factores de riesgo y las estrategias de evaluación y plantear las rutas de atención idóneas asentadas en los aspectos legales alrededor del maltrato hacia los ancianos en Colombia.
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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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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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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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Tsang LF, Sham SYA, Chan SK. Identifying reasons, gaps and prevalence of diaper usage in an acute hospital. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2017. [DOI: 10.1111/ijun.12143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lap Fung Tsang
- Nursing Services Division, United Christian Hospital; Hong Kong Special Administrative Region; China
| | - So Yuen Alice Sham
- Nursing Services Division, United Christian Hospital; Hong Kong Special Administrative Region; China
| | - Sau Kuen Chan
- Nursing Services Division, United Christian Hospital; Hong Kong Special Administrative Region; China
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15
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Rosen T, Reisig C, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Mtui EP, Flomenbaum NE, Lachs MS. Describing visible acute injuries: development of a comprehensive taxonomy for research and practice. Inj Prev 2016; 23:340-345. [PMID: 27913598 DOI: 10.1136/injuryprev-2016-042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little literature exists classifying and comprehensively describing intentional and unintentional acute injuries, which would be valuable for research and practice. In preparation for a study of injury patterns in elder abuse, our goal was to develop a comprehensive taxonomy of relevant types and characteristics of visible acute injuries and evaluate it in geriatric patients. METHODS We conducted an exhaustive review of the medical and forensic literature focusing on injury types, descriptions, patterns and analyses. We then prepared iteratively, through consensus with a multidisciplinary, national panel of elder abuse experts, a comprehensive classification system to describe these injuries. RESULTS We designed a three-step process to fully describe and classify visible acute injuries: (1) determining the type of injury, (2) assigning values to each of the characteristics common to all geriatric injuries and (3) assigning values to additional characteristics relevant for specific injuries. We identified nine unique types of visible injury and seven characteristics critical to describe all these injuries, including body region(s) and precise anatomic location(s). For each injury type, we identified two to seven additional critical characteristics, such as size, shape and cleanliness. We pilot tested it on 323 injuries on 83 physical elder abuse victims and 45 unintentional fall victims from our ongoing research to ensure that it would allow for the complete and accurate description of the full spectrum of visible injuries encountered and made modifications and refinements based on this experience. We then used the classification system to evaluate 947 injuries on 80 physical elder abuse victims and 195 unintentional fall victims to assess its practical utility. CONCLUSIONS Our comprehensive injury taxonomy systematically integrates and expands on existing forensic and clinical research. This new classification system may help standardise description of acute injuries and patterns among clinicians and researchers.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Christopher Reisig
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA.,Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Veronica M LoFaso
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Thomas J McCarthy
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Estomih P Mtui
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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16
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Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF. Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach. Ann Emerg Med 2016; 68:378-82. [PMID: 27005448 PMCID: PMC5391043 DOI: 10.1016/j.annemergmed.2016.01.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, NY
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17
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Abstract
Elder abuse is a growing problem in the United States. Incidents of physical and sexual abuse, as well as neglect, continue to rise as the population ages. Maltreatment of the elderly is associated with increased morbidity and mortality rate, as well as increased health care costs. Fear, shame, and lack of knowledge contribute to underreporting of elder abuse and put the safety of elders at risk. This paper describes indicators of physical and sexual abuse and neglect in the elderly intensive care unit patient and presents how abuse can be identified in the critical care setting.
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18
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The role of the dermatologist in detecting elder abuse and neglect. J Am Acad Dermatol 2015; 73:285-93. [DOI: 10.1016/j.jaad.2015.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022]
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