Reflections of Medical Students on Visiting Chronically Ill Older Patients in the Home

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66114/1/j.1532-5415.2006.00918.x.pd

Radiologists' Training, Experience, and Attitudes About Elder Abuse Detection

Elder abuse is underrecognized, and identification of subtle cases requires a high index of suspicion among all health care providers. Because many geriatric injury victims undergo radiographic imaging, diagnostic radiologists may be well positioned to identify injury patterns suggestive of abuse. Little is known about radiologists' experience with elder abuse. Our goal was to describe knowledge, attitudes, training, and practice experience in elder abuse detection among diagnostic radiologists. We conducted 19 interviews with diagnostic radiologists at a large urban academic medical center using a semistructured format. Data from these sessions were coded and analyzed to identify themes. Only two radiologists reported any formal or informal training in elder abuse detection. All subjects believed they had missed cases of elder abuse. Even experienced radiologists reported never having received a request from a referring physician to assess images for evidence suggestive of elder abuse. All subjects reported a desire for additional elder abuse training. Also, subjects identified radiographic findings or patterns potentially suggestive of elder abuse, including high-energy injuries such as upper rib fractures, injuries in multiple stages of healing, and injuries inconsistent with reported mechanism. Radiologists are uniquely positioned to identify elder abuse. Though training in detection is currently lacking, providers expressed a desire for increased knowledge. In addition, radiologists were able to identify radiographic findings suggestive of elder abuse. On the basis of these findings, we plan to conduct additional studies to define pathognomonic injury patterns and to explore how to empower radiologists to incorporate detection into their practice

Imaging Findings in Elder Abuse: A Role for Radiologists in Detection

Emergency department assessment represents a critical but often missed opportunity to identify elder abuse, which is common and has serious consequences. Among emergency care providers, diagnostic radiologists are optimally positioned to raise suspicion for mistreatment when reviewing imaging of geriatric injury victims. However, little literature exists describing relevant injury patterns, and most radiologists currently receive neither formal nor informal training in elder abuse identification. We present 2 cases to begin characterisation of the radiographic findings in elder abuse. Findings from these cases demonstrate similarities to suspicious findings in child abuse including high-energy fractures that are inconsistent with reported mechanisms and the coexistence of acute and chronic injuries. Specific injuries uncommon to accidental injury are also noted, including a distal ulnar diaphyseal fracture. We hope to raise awareness of elder abuse among diagnostic radiologists to encourage future large-scale research, increased focus on chronic osseous findings, and the addition of elder abuse to differential diagnoses. Les cas de mauvais traitements infligés aux personnes âgées sont courants et lourds de conséquences. L’évaluation au service d'urgence pourrait jouer un rôle crucial dans leur détection, mais fait souvent figure d'occasion manquée. De tous les professionnels de la santé qui interviennent au service d'urgence, les médecins spécialistes en diagnostique sont particulièrement bien placés pour sonner l'alarme tandis qu'ils interprètent les examens radiologiques des personnes âgées présentant des lésions traumatiques. Malheureusement, peu de documents décrivent les aspects caractéristiques des lésions résultant de mauvais traitements infligés aux personnes âgées et aucune formation structurée ni informelle n'est actuellement offerte aux radiologistes en la matière. Nous présentons deux cas afin d'amorcer le travail de caractérisation sur les aspects radiographiques de la violence envers les personnes âgées. Les caractéristiques relevées sont semblables à celles évocatrices de mauvais traitements infligés aux enfants, à savoir des fractures à haut transfert d’énergie qui ne cadrent pas avec le mécanisme de blessure déclaré, et la présence de lésions graves et de lésions chroniques concomitantes. Des blessures rarement observées dans le cadre de lésions traumatiques accidentelles ont également été observées, par exemple une fracture à la portion distale du cubitus. Nous visons à sensibiliser les médecins spécialistes de la radiologie diagnostique à la violence envers les personnes âgées afin de favoriser les activités de recherche à grande échelle, de mettre l'accent sur les caractéristiques associées aux lésions osseuses chroniques et d'intégrer les mauvais traitements infligés aux personnes âgées aux diagnostics différentiels

Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data

Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response

Initial steps in addressing the challenges of elder mistreatment evaluation: Protocol for evaluating the Vulnerable Elder Protection Team

Introduction Although many programmes have been developed to address elder mistreatment, high-quality, rigorous evaluations to assess their impact are lacking. This is partly due to challenges in conducting programme evaluation for such a complex phenomenon. We describe here the development of a protocol to mitigate these challenges and rigorously evaluate a first-of-its-kind emergency department/hospital-based elder mistreatment intervention, the Vulnerable Elder Protection Team (VEPT).Methods and analysis We used a multistep process to develop an evaluation protocol for VEPT: (1) creation of a logic model to describe programme activities and relevant short-term and long-term outcomes, (2) operationalisation of these outcome measures, (3) development of a combined outcome and (4) design of a protocol using telephone follow-up at multiple time points to obtain information about older adults served by VEPT. This protocol, which is informing an ongoing evaluation of VEPT, may help researchers and health system leaders design evaluations for similar elder mistreatment programmes.Ethics and dissemination This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #20-02021422. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public