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Background
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Citations
... Despite these challenges, systematic research similar to the work that provides the foundation for child abuse identification is critically needed to inform elder abuse detection, with the goal of identifying pathognomonic injury patterns and forensic findings. To date, physical findings, injury patterns, and other biomarkers potentially suggestive of abuse have been described (Bird et al., 1998;Bond & Butler, 2013;Chan et al., 2013;Chen & Koval, 2002;Cowen & Cowen, 2002;Dong & Simon, 2013;Friedman, Avila, Tanouye, & Joseph, 2011;Geroff & Olshaker, 2006;Golden, 2004;Heyborne, 2007;Kurrle, 2004;Lachs et al., 1997;Liao & Mosqueda, 2006;Palmer, Brodell, & Mostow, 2013;Senn, McDowell, & Alder, 2001;Yaffe & Tazkarji, 2012), but these descriptions have not been systematically validated or related to confirmed elder abuse cases. We were able to find only four studies (Murphy, Waa, Jaffer, Sauter, & Chan, 2013;Rosen et al., 2016;Wiglesworth et al., 2009;Ziminski, Wiglesworth, Austin, Phillips, & Mosqueda, 2013) that systematically evaluated injury patterns in elder abuse. ...
This paper provides an overview of elder abuse screening and detection methods for community dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency geriatric care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The paper provides descriptions of emerging screening and detection methods and technologies from the emergency geriatric care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, caregivers, providers, and the healthcare system; and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among key stakeholders should also be conducted.
Study objective
Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls.
Methods
We partnered with a large, urban district attorney’s office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014.
Results
We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%).
Conclusion
Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.
Elder abuse and neglect are highly prevalent but woefully underdetected and underreported. The presentation is rarely clear and requires the piecing together of clues that create a mosaic of the full picture. More research needed to better characterize findings that, when identified, can contribute to certainty in cases of suspected abuse. Medical and laboratory data can be helpful in the successful determination of abuse and neglect.
Copyright © 2014 Elsevier Inc. All rights reserved.
