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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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