January 4, 2017

Diagnosis of Elder Abuse in U.S. Emergency Departments

Evans, C.S., et al, J Am Ger Soc 65(1):91, January 2017

BACKGROUND: Studies report that the prevalence of elder abuse in community-dwelling adults is about 5% to 10%.

METHODS: These authors, coordinated at the University of North Carolina, performed a retrospective cross-sectional study of the prevalence of elder abuse in US emergency departments (EDs). Data on ED visits among adults aged 60 years and older were taken from the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS) and the 2012 Nationwide Emergency Department Sample (NEDS). The primary outcome was the proportion of visits with a diagnosis of elder abuse according to ICD-9 codes, defined as physical abuse, emotional/psychological abuse, sexual abuse, nutritional neglect, or other abuse of a dependent older person by a caregiver. Predictors of abuse were explored.

RESULTS: No cases of elder abuse were recorded in the 2011 NHAMCS data set of 5965 older adults. The 2012 NEDS data indicated 3846 cases of elder abuse among a total 29,056,673 ED visits (6,723,667 ED visits of older adults), for a weighted period prevalence of 0.013%. Abuse victims were an average of 75 years of age (74% female). Neglect and physical abuse were the most common types (32% each). Significant predictors of abuse on multivariate analysis were female sex (adjusted odds ratio [OR] 1.95); patients presenting with bruises or superficial injuries (OR 2.91), urinary tract infection (OR 2.21), or septicemia (OR 1.92); western region of the US (OR 1.62); and teaching hospital facility (OR 1.74 versus non-teaching) (all, p<=0.001).

CONCLUSIONS: A large database of ED visits showed rates of elder abuse more than 100 times lower than those reported in community settings, suggesting that ED physicians are failing to identify abuse. 50 references (tim.platts-mills@med.unc.edu – no reprints)

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