A formal diagnosis of elder abuse is made in only one in 7,700 emergency department visits in the U.S., according to a new study by researchers at the University of North Carolina (UNC) at Chapel Hill, University of California San Diego, and Weil Cornell Medicine.
Prior research has shown that elder abuse affects approximately one in 10 older adults. The findings suggest that many cases of elder abuse either are not recognized and/or not reported.
With more than 23 million emergency department visits by older adults annually, the emergency department is an important setting to identify elder abuse and initiate interventions to ensure patient safety and address unmet care needs.
“These findings indicate that the vast majority of victims of elder abuse pass through the emergency department without the problem being identified,” said Timothy Platts-Mills, M.D., assistant professor of emergency medicine and co-director of the division of geriatric emergency medicine at the UNC School of Medicine and senior author of the study.
Given the severity of this problem, the researchers believe this is a major missed opportunity.
“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 has far-reaching negative effects on physical and mental health. Many victims of elder abuse, like other vulnerable populations, do not receive routine care from a primary care physician and often depend on the emergency department.
However, identifying elder abuse is quite challenging, said Platts-Mills. 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,” Platts-Mills said. “But those difficulties don’t change the reality that elder abuse is common, takes a tremendous toll on its victims, and is frequently missed.”
Emergency departments are seeing increasing numbers of older adults, and healthcare workers are struggling to meet the complex needs of these patients. There is a need for increased physician training and access to social workers who can identify and address gaps in care. The researchers plan on developing a new screening tool that would help improve the identification of elder abuse in the emergency department.
Currently, health care workers in emergency departments are trained to ask a single question about safety at home at the time of assessment. The new tool would use several questions to help uncover different aspects of elder abuse, including psychological abuse and neglect, and involve a physical exam for patients with significant cognitive impairment.
The findings are published in the Journal of the American Geriatrics Society.