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Segal M. Protecting older consumers in the digital age: a commentary on ChatGPT, helplines and the way to prevent accessible fraud. J Elder Abuse Negl 2024:1-6. [PMID: 38836695 DOI: 10.1080/08946566.2024.2364208] [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: 06/06/2024]
Abstract
Older people are often targeted by fraudsters due to their unique characteristics and vulnerabilities. Being a victim of exploitation can lead to negative emotional and financial consequences. The purpose of this commentary is to present ChatGPT's potential to provide accessible information and support, helping older consumers protect themselves when confronted with exploitation, address the limitations of ChatGPT and propose solutions to overcome these limitations. Integrating tailored human and technological solutions, such as helplines, AI chatbots, and involving older adults in development, is crucial. By providing adequate training and support, the goal of ensuring accessibility for all users can be achieved.
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Affiliation(s)
- Michal Segal
- Department of Social Work, Tel-Hai College Upper Galilee, Kiryat Shmona, Israel
- Research Center for innovation in Social Work, Israel
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2
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Khurana B, Bayne HN, Prakash J, Loder RT. Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings. J Am Geriatr Soc 2024; 72:1011-1022. [PMID: 38376211 PMCID: PMC11127187 DOI: 10.1111/jgs.18801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/14/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Falls and interpersonal violence pose significant threats to older adults, leading to injuries, hospitalizations, and emergency department (ED) visits. This study investigates the demographics and injury patterns in older adults (aged 60 and above) who sought ED care due to assaults, comparing them with those who experienced falls to gain a deeper understanding of older adult abuse patterns. METHOD This study utilizes data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (2005-2019) to examine injuries among older adults aged 60 years and above. Participants were categorized into two groups: older adult abuse and injuries due to falls. The differences between the groups by demographics, injury locations, patterns, and temporal trends were analyzed using statistical methods accounting for the weighted stratified nature of the data. Cosinor analysis and Joinpoint regression were used for temporal analysis. RESULTS Over 15 years, there were an estimated 307,237 ED visits for older adult abuse and 39,477,217 for falls. Older adults experiencing abuse were younger and had lower hospital admission rates compared to fall patients. Injuries associated with abuse included contusions/abrasions, penetrating injuries, and fractures to the head/neck, fingers, toes, ribs, and lower extremities. In contrast, fall patients had higher admission rates, with more fractures, including cervical spine and hip fractures. Temporal patterns showed a higher rate of assaults during the summer, whereas abuse demonstrated bimodal peaks in the summer and fall. CONCLUSIONS Injuries associated with abuse such as facial, upper trunk, and upper extremity fractures should raise suspicion even in the absence of severe symptoms. These findings emphasize the importance of early identification to connect older adults with support resources, as patients experiencing abuse often get discharged from the ED.
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Affiliation(s)
- Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology and Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Haley N. Bayne
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405
| | - Jaya Prakash
- Trauma Imaging Research and Innovation Center, Department of Radiology and Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis St, Boston MA 02115
| | - Randall T. Loder
- Department of Orthopedic Surgery, Indiana University School of Medicine, Riley Children’s Hospital, 705 Riley Hospital Drive, Indianapolis, IN 46202
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Bednorz A, Mak JKL, Jylhävä J, Religa D. Use of Electronic Medical Records (EMR) in Gerontology: Benefits, Considerations and a Promising Future. Clin Interv Aging 2023; 18:2171-2183. [PMID: 38152074 PMCID: PMC10752027 DOI: 10.2147/cia.s400887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/05/2023] [Indexed: 12/29/2023] Open
Abstract
Electronic medical records (EMRs) have many benefits in clinical research in gerontology, enabling data analysis, development of prognostic tools and disease risk prediction. EMRs also offer a range of advantages in clinical practice, such as comprehensive medical records, streamlined communication with healthcare providers, remote data access, and rapid retrieval of test results, ultimately leading to increased efficiency, enhanced patient safety, and improved quality of care in gerontology, which includes benefits like reduced medication use and better patient history taking and physical examination assessments. The use of artificial intelligence (AI) and machine learning (ML) approaches on EMRs can further improve disease diagnosis, symptom classification, and support clinical decision-making. However, there are also challenges related to data quality, data entry errors, as well as the ethics and safety of using AI in healthcare. This article discusses the future of EMRs in gerontology and the application of AI and ML in clinical research. Ethical and legal issues surrounding data sharing and the need for healthcare professionals to critically evaluate and integrate these technologies are also emphasized. The article concludes by discussing the challenges related to the use of EMRs in research as well as in their primary intended use, the daily clinical practice.
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Affiliation(s)
- Adam Bednorz
- John Paul II Geriatric Hospital, Katowice, Poland
- Institute of Psychology, Humanitas Academy, Sosnowiec, Poland
| | - Jonathan K L Mak
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
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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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5
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Rosen T, Zhang H, Wen K, Clark S, Elman A, Jeng P, Baek D, Zhang Y, Gassoumis Z, Fettig N, Pillemer K, Lachs MS, Bao Y. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. JAMA Netw Open 2023; 6:e2255853. [PMID: 36787139 PMCID: PMC9929702 DOI: 10.1001/jamanetworkopen.2022.55853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/15/2023] Open
Abstract
Importance Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment. Objective To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults. Design, Setting, and Participants This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022. Main Outcomes and Measures We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses. Results This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001). Conclusions and Relevance In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | | | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Zhou J, Wang Z, Liu Y, Yang J. Research on the influence mechanism and governance mechanism of digital divide for the elderly on wisdom healthcare: The role of artificial intelligence and big data. Front Public Health 2022; 10:837238. [PMID: 36062111 PMCID: PMC9428348 DOI: 10.3389/fpubh.2022.837238] [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: 12/16/2021] [Accepted: 07/04/2022] [Indexed: 01/21/2023] Open
Abstract
With the rapid development of digital information technology, life has become more convenient for people; however, the digital divide for the elderly was even more serious, so they became a forgotten group in the internet age over time. Residents' demand for healthcare is rising, but the wisdom healthcare service supported by digital information technology is less acceptable to the elderly due to the digital divide. Based on the knowledge gap theory and combining the value perception and satisfaction model, this study explores the influence of the digital divide for the elderly on wisdom healthcare satisfaction and takes the perceived value of wisdom healthcare as a mediator, and artificial intelligence and big data as moderators into the research framework. Based on the data of 1,052 elderly people in China, the results show that the digital divide for the elderly has a negative influence on wisdom healthcare satisfaction and perceived value. Moreover, it is found that wisdom healthcare perception value mediated the relationship between the digital divide for the elderly and the wisdom healthcare satisfaction, which enhances the negative effect of the digital divide for the elderly on wisdom healthcare satisfaction. Furthermore, the moderating effect of artificial intelligence and big data on the relationship between the digital divide for the elderly and the perceived value of wisdom healthcare is opposite to that between the perceived value of wisdom healthcare and wisdom healthcare satisfaction. Therefore, this study has a reference value for the development and optimization of smart medical industry.
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Affiliation(s)
- Jian Zhou
- Department of Business Management, School of Business, Qingdao University, Qingdao, China
| | - Zeyu Wang
- Department of Business Administration, Edinburgh Business School, Heriot-Watt University, Edinburgh, United Kingdom
| | - Yang Liu
- Department of Cultural Industry, Cultural Industry Research Institute, Qilu University of Technology, Jinan, China,*Correspondence: Yang Liu
| | - Jian Yang
- Department of Computer Science and Technology, Ocean University of China, Qingdao, China
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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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Rosen T, Wen K, Makaroun LK, Elman A, Zhang Y, Jeng PJ, LoFaso VM, Lachs MS, Clark S, Bao Y. Diagnostic Coding of Elder Mistreatment: Results From a National Database of Medicare Advantage and Private Insurance Patients, 2011-2017. J Appl Gerontol 2021; 41:918-927. [PMID: 34075830 PMCID: PMC8636549 DOI: 10.1177/07334648211018530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health care providers may play an important role in detection of elder mistreatment, which is common but underrecognized. We used the Health Care Cost Institute insurance claims database to describe elder mistreatment diagnosis among Medicare Advantage (MA) and private insurance patients in the United States from 2011 to 2017. We used International Classification of Diseases (ICD) coding to identify cases, examining the impact of transition from ICD-9 (Ninth Revision) to ICD-10 (Tenth Revision), which occurred in October 2015 and added 14 new codes for "suspected" mistreatment. 8,127 patients (0.051% of all aged ≥ 65), including 6,304 with MA (0.058%) and 1,823 with private insurance (0.026%) received elder mistreatment diagnosis. Transition from ICD-9 to ICD-10 was associated with a small increase in diagnosis rate, with "suspected" codes used in 45.3% of ICD-10 versus 9.7% of ICD-9 cases. Overall rates remained low. Rates, settings, and types of diagnosis differed between MA and private insurance patients.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, 2301 Martha Van Rensselaer Hall, Ithaca, NY 14853
| | - Lena K. Makaroun
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medicine, 402 East 67 Street New York, NY 10065
| | - Philip J. Jeng
- Department of Health Policy & Research, Weill Cornell Medicine, 402 East 67 Street New York, NY 10065
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68 Street, New York, NY 10065
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medicine, 402 East 67 Street New York, NY 10065
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Khoujah D, Cimino-Fiallos N. The geriatric emergency literature 2020: COVID and beyond. Am J Emerg Med 2021; 44:177-183. [PMID: 33905980 DOI: 10.1016/j.ajem.2021.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/11/2023] Open
Abstract
Older adults are a rapidly growing patient population with unique characteristics and health considerations. Over the past few years, emergency physicians have started to recognize the complexities and importance of Geriatric Emergency Medicine. Several noteworthy elements of their healthcare were brought to the forefront of emergency medicine because this especially vulnerable patient population was disproportionately affected by the pandemic. Clinical topics such as delirium, telehealth, end-of-life care, and elder abuse came into focus; select relevant articles are reviewed. We also highlight equally notable literature which address clinically challenging topics, such as hip fractures and syncope. Finally, articles about improving the experience of and decreasing recidivism in geriatric emergency department patients are reviewed. In short, this review article summarizes geriatric emergency medicine literature that can help you improve your practice while caring for older adults.
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Affiliation(s)
- Danya Khoujah
- Department of Emergency Medicine, Franklin Square Medical Center, Adjunct Volunteer Assistant Professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Nicole Cimino-Fiallos
- Department of Emergency Medicine, Meritus Medical Center, US Acute Care Solutions, Hagerstown, MD, United States of America
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Cimino-Fiallos N, Rosen T. Elder Abuse-A Guide to Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am 2021; 39:405-417. [PMID: 33863468 DOI: 10.1016/j.emc.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Elder abuse affects many older adults and can be life threatening. Older adults both in the community and long-term care facilities are at risk. An emergency department visit is an opportunity for an abuse victim to seek help. Emergency clinicians should be able to recognize the signs of abuse, including patterns of injury consistent with mistreatment. Screening tools can assist clinicians in the diagnosis of abuse. Physicians can help victims of mistreatment by reporting the abuse to the appropriate investigative agency and by developing a treatment plan with a multidisciplinary team to include a safe discharge plan and close follow-up.
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Affiliation(s)
- Nicole Cimino-Fiallos
- Department of Emergency Medicine, Meritus Medical Center, 11116 Medical Campus Road, Hagerstown, MD 21742, USA.
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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11
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Rosen T, Platts-Mills TF, Fulmer T. Screening for elder mistreatment in emergency departments: current progress and recommendations for next steps. J Elder Abuse Negl 2021; 32:295-315. [PMID: 32508284 DOI: 10.1080/08946566.2020.1768997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emergency Department (ED) visits provide an important but seldom realized opportunity to identify elder mistreatment. Many screening tools exist, including several that are brief and may be effective, but few have been specifically designed for or tested in EDs. In addition to the absence of validated tools, other challenges with implementing ED elder mistreatment screening include difficulty integrating anything longer than a few questions into a busy clinical encounter and resources required to respond to positive screens. The Electronic Health Record (EHR) offers a critical tool to facilitate elder mistreatment screening through required data entry and real-time monitoring of compliance and results. We describe current work in the field and recommend next steps including design and testing of a two-step screening process, implementation research to accelerate adoption, development of ED-based interventions and referral protocols for positive cases, and consideration of the important role of pre-hospital providers in case identification.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital , New York, NY, USA
| | - Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina School of Medicine , Chapel Hill, North Carolina, USA
| | - Terry Fulmer
- The John A. Hartford Foundation , New York, NY, USA
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12
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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: 5] [Impact Index Per Article: 1.3] [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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