Elder Abuse Often Not Discovered at Emergency Rooms: Study

Nearly all elder abuse cases are going unrecognized and unreported during emergency room visits, placing a large population of older adults at continuing risk, according to the findings of new research. 

In a study published in last month’s issue of the Journal of the American Geriatrics Society, researchers indicate that elder abuse is formally diagnosed in only 1 in 7,700 cases involving older adults in emergency department hospital visits.

Researchers from the University of North Carolina at Chapel Hill, University of California San Diego, and Weil Cornell Medicine focused on emergency room data to estimate frequency of how often doctors make a formal diagnosis of elder abuse.

The study examined data from emergency room (ER) visits of adults 60 and older recorded in the 2012 Nationwide Emergency Department Sample or the 2011 National Hospital Ambulatory Medical Care Survey. Overall, the study sample for 2012 included 6.7 million ER visits of older adults representing about 29 million visits. In total, researchers found elder abuse was diagnosed in an estimated 3,846 visits.

The research data indicate elder abuse is discovered in only 1 in 7,700 visits, while prior research has suggested that about 1 in 10 older adults are victims of elder abuse. The data indicates most cases are not recognized or not reported.

“The proportion of U.S. emergency department visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population,” the study authors wrote. “Efforts to improve the identification of elder abuse in emergency departments may be warranted.”

The most common types of elder abuse diagnosed were neglect, which accounted for 33% of cases, and physical abuse, which accounted for 32% of cases. In general, women were more commonly abused and those abused had a higher likelihood of experiencing a contusion, urinary tract infection and sepsis.

Researchers said victims of elder abuse often do not receive routine care from primary care doctors and will often depend on ER care only when an emergency arises.

There are more than 23 million ER visits made each year by older adults. This means the majority of elder abuse cases going through the ER are unrecognized by the healthcare staff.

Experts say the emergency room is an important place to identify elder abuse and initiate necessary interventions to provide patient safety and focus on much needed care.

Signs of elder abuse can include, physical injuries, like broken bones, bruising, or cuts, anxiety, emotional distress, withdrawal, sudden changes in financial situations, bedsores, poor hygiene, and weight loss.

Older adults are often physically frail or have cognitive impairments, such as Alzheimer’s or dementia, making them more vulnerable to injuries or making it more difficult to care for themselves.

It can be difficult for the hospital staff to determine if an injury, such as a bruise, is from a fall or from physical abuse. Similarly, poor hygiene can result from a patient asking to be left alone or from neglect.

Currently, the ER staff is required to ask only one question about the safety at home of an elderly patient. The research team hopes to develop a screening tool designed specifically to help ER workers identify elder abuse. The new tool will use several questions to ask about a patient’s wellbeing, including psychological abuse and neglect. The tool will also include a physical exam for patients with significant cognitive impairment.