Elder abuse is under-identified in the US, says study

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Elder abuse

In the US, elder abuse affects approximately 1 in 10 older adults and has far-reaching bad effects on physical and mental health.

Victims of elder abuse tend not to receive routine care from a primary care physician and often depend on the emergency department.

With over 23 million emergency department visits by older adults every year, the emergency department is an important setting to identify elder abuse and initiate interventions to ensure patient safety and address unmet care needs.

In a study newly published in the Journal of the American Geriatrics Society, researchers find that the vast majority of victims of elder abuse pass through the emergency department without the problem being identified.

The University of North Carolina at Chapel Hill, University of California San Diego, and Weil Cornell Medicine conducted the study.

Researchers used a nationally representative dataset to estimate the frequency with which emergency providers make a formal diagnosis of elder abuse. They found the answer was 1 in 7,700 visits, which was much less than that in real life.

One reason is that identifying elder abuse is challenging. Older adults who are physically frail or have cognitive impairment are vulnerable to injuries and may have difficulty caring for themselves.

It can be very difficult distinguishing whether a bruise is from a fall or physical abuse, or whether poor hygiene is a result of a patient asking to be left alone or the result of overt neglect on the part of a care provider.

But those difficulties do not change the reality that elder abuse is common and frequently missed.

In the study, researchers developed a new tool to identify abuse victims.

The new tool will use several questions to inquire about different aspects of elder abuse including psychological abuse and neglect, and it will include a physical exam for patients with significant cognitive impairment.

Following development, the tool will be tested in emergency departments in North Carolina, Michigan, and Alabama. The work is funded by the National Institute of Justice.

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Citation: Evans CS, et al. (2016). Diagnosis of Elder Abuse in U.S. Emergency Departments. Journal of the American Geriatrics Society, published online. DOI: 10.1111/jgs.14480.
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