Elder Abuse

There are opportunities to administer screening for elder mistreatment in the ER, with both screening tools in development and research funding from the National Institutes on Aging (NIA), the National Institutes of Health (NIH) overall, the John A. Hartford Foundation (JAHF), and others.

Elder mistreatment is defined by the Elder Justice Roadmap as “physical, sexual, or psychological abuse, as well as neglect, abandonment, and financial exploitation of an older person by another person or entity that occurs in any setting, either in a relationship where there is an expectation of trust and/or when an older person is targeted based on age or disability.” At least 5% of older ED patients are victims of elder mistreatment—making it more prevalent than child abuse or intimate partner violence—and victims are predominantly female. Elder abuse is a major social determinant of health, and is associated with increased mortality, depression, and exacerbation of chronic illness. Moreover, abuse often ripples through generations, and, in the words of Dr. Martin Luther King, “injustice anywhere is a threat to justice everywhere.”

Best Practice Notes

When older adults come to the ED for care, emergency physicians have a unique opportunity to identify victims of elder mistreatment and intervene; however, as noted by the United States Preventive Services Task Force, there is insufficient evidence to support screening for elder mistreatment. Other barriers to screening and intervention include:

absence of screening and intervention protocols,
lack of provider awareness,
fear and distrust on the part of patients,
difficulties distinguishing abuse from unintentional trauma,
and some patients’ refusal of treatment.

Research Priority Areas

Top voted Elder Abuse research priority areas ranked during the 2019 GEAR Consensus conference are as follows:

Can we effectively identify patients at high risk for elder abuse for whom we can then do targeted screening?
Does screening and structured interventions improve outcomes for victims of elder abuse?
Does an intervention to reduce caregiver stress among ED patients with cognitive impairment improve caregiver health and also reduce elder abuse?
Can a standardized approach to EMS screening for elder abuse increase case identification?
Should interventions that are developed and tested to treat elder abuse in the ED be type-specific (i.e. physical, psychological, sexual, financial, neglect or specific scenarios based on severity, perpetrator, setting, resources)?