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. 2017 Jan;65(1):91-97.
doi: 10.1111/jgs.14480. Epub 2016 Oct 18.

Diagnosis of Elder Abuse in U.S. Emergency Departments

Christopher S Evans  1   2 , Katherine M Hunold  3 , Tony Rosen  4 , Timothy F Platts-Mills  5   6
Affiliations

Diagnosis of Elder Abuse in U.S. Emergency Departments

Christopher S Evans et al. J Am Geriatr Soc. 2017 Jan.

Abstract

Objectives: To estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets.

Design: Retrospective cross-sectional analysis.

Setting: U.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS).

Participants: All ED visits of individuals aged 60 and older.

Measurements: The primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse.

Results: In 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012-0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68-2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36-3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84-2.65), and septicemia (OR = 1.92, 95% CI = 1.44-2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits.

Conclusion: The proportion of U.S. ED 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. Efforts to improve the identification of elder abuse in EDs may be warranted.

Keywords: elder abuse; emergency department; prevalence.

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Conflict of interest statement

Checklist: Elements of Financial/Personal Conflicts CE KH TR TPM Yes No Yes No Yes No Yes No Employment or Affiliation X X X X Grants/Funds X X X X Honoraria X X X X Speaker Forum X X X X Consultant X X X X Stocks X X X X Royalties X X X X Expert Testimony X X X X Board Member X X X X Patents X X X X Personal Relationship X X X X For “yes”, provide a brief explanation: Dr. Platts-Mills is supported by a K23 career development award from the National Institute on Aging (K23AG038548) and a grant from the National Institute of Justice to develop an ED-based screening instrument to identify elder abuse (2015-IJ-CX-0022).

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