Elder Abuse Identification in Emergency Departments is Abysmal

The proportion of hospital emergency department (ED) seniors receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population, according to a new study.

Researchers at the University of California, San Diego (UCSD, USA), the University of North Carolina (UNC, Chapel Hill, USA), and other institutions examined U.S. ED visits of individuals aged 60 and older as recorded in the 2012 Nationwide Emergency Department Sample (NEDS), or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). The primary outcome was the proportion of ED visits with elder abuse, estimated using survey weights.

The results showed that of an estimated 29,056,673 ED visits, elder abuse was diagnosed in 3,846 visits, corresponding to 0.013%, or 1 in 7,700 visits. Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. But according to conflicting studies, elder abuse affects 6-10% of the older adult population, indicating that it is vastly under-diagnosed in the ED setting. The study was published in the September 2016 issue of Journal of the American Geriatrics Society.

“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,” said senior author Timothy Platts-Mills MD, MSc, co-director of the division of geriatric emergency medicine at UNC. “But those difficulties don't change the reality that elder abuse is common, takes a tremendous toll on its victims, and is frequently missed.”

“These findings indicate that the vast majority of victims of elder abuse pass through the emergency department without the problem being identified. Given the burden of this problem, this is a major missed opportunity,” concluded Dr. Platts-Mills. “Emergency physicians strive to make sure that for each patient who comes through the door, all serious and life-threatening conditions are identified and addressed. For elder abuse, EDs across the country are falling short.”

Elder abuse is defined as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust. Thus, it includes harm by people the older person knows, has a relationship with, such as a spouse, partner, or family member, friend or neighbor, or people that the older person relies on for services. Many forms of elder abuse are recognized as types of domestic violence, since they are committed by family members. Paid caregivers have also been known to prey on their elderly patients.

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