New tool means better screening for elder abuse

Nov 16, 2016

Credit National Institutes of Health - Office of Behavioral and Social Sciences Research

As the baby boomer generation ages and people live longer, a new trend has emerged from the growing population of older adults.  Elder abuse affects approximately 1 in 10 seniors, according to the National Council on Aging.  

But that number could be higher since many cases go unreported.  Emergency Physician Dr. Tim Platts Mills.

“The number of older adults in our society is increasing and is in fact sort of going to double, almost.  Between about 2010 to 2045 or 2050, it’s going to double.  So, the total magnitude of the problem is increasing, whether or not the percentage of patients is increasing is less clear.”

Dr. Platts-Mills is an Assistant Professor and the Director of Clinical Research in the Department of Emergency Medicine at the University of North Carolina at Chapel Hill.   Elder abuse is defined as intentional acts by a caregiver that cause harm or a risk of harm to a vulnerable older adult.  With more than 23 million visits annually by seniors, emergency departments are increasingly becoming an important setting for identifying victims of elder abuse.  

“We tend to take care of patients with a little bit more cognitive impairment, and a little bit more medical problems, both of which are risk factors for elder abuse.”

Even though the majority of seniors who go to emergency departments are not harmed by their caretakers, they will most likely be screened.  This involves being asked a single question:  Do you feel safe at home?

“Our research in our emergency department suggest that it really doesn’t capture much. It doesn’t seem to identify a lot of cases.”

Dr. Platts-Mills believes the safety question isn’t effective when trying to diagnose the most common form of elder abuse: neglect.  He adds cognitively impaired patients, who are the most susceptible to elder abuse, may also slip through the cracks.

“It might be harder for them to say hey, I’m having a problem with abuse, they might not recognize that it’s a problem, and they may just feel that it’s the situation I’m in. And they might be scared about the solution because they might be scared about being sent to a nursing home and that sort of thing.”

Dr. Platts-Mills was part of a study published in mid-October in the Journal of the American Geriatrics Society that used a nationally-representative dataset to estimate the frequency with which emergency providers made a formal diagnosis of elder abuse.

“We thought that maybe we would see a rate around seven to ten percent and what we saw instead was that we saw less than point one percent.  So it was one out of 7,000 cases had a formal diagnoses of elder abuse. Which means that there are lots and lots of people who are coming through the doors of the emergency department with an ongoing problem of elder abuse and are not being diagnosed.”

Pinpointing elder abuse, he admits, is very difficult.

If you’re an older adult and you have a bruise, the number of reasons why you have a bruise is longer because they might have fallen, or maybe they’re on some medication that makes it easy for them to bruise, maybe they just bumped themselves.”

According to statistics from the North Carolina Department of Aging, there were 21,000 reported cases of elder abuse in 2013.  In only two years, the number rose to more than 179,000 cases. Dr. Nannette Lavoie-Vaughn is a Clinical Assistant Professor at East Carolina University College of Nursing.  She’s also a nurse practitioner for geriatric neuropsychiatry services.

“We’re also seeing an increase in the elder population here in North Carolina exponentially over the last several years and that’s going to continue to grow in the next five years.  And certainly anytime the elder population grows, than unfortunately, the amount and type of abuse is going to grow.”

Health care providers in any clinical setting are required to report abuse or suspected abuse to Adult Protective Services, part of the State Department of Health and Human Services. 

“A phone call is made and a report is given.  A complete physical examination is done and any abnormal signs such as bruising, fractures, things that would look like the person has had a recent weight loss or has been dehydrated, that would show signs of physical abuse would be documented.”

The patient is interviewed as well as a family member or caregiver that is responsible for the person. 

Dr. Platts-Mills wants to take screening for elder abuse a step further. He and a team of researchers from the University of California San Diego and Weil Cornell Medicine have developed a new screening tool that seeks to improve the identification of elder abuse. The series of questions asks the patient if they’ve been called names, forced to give money against their will, or been hurt or threatened in the past six months.   Platts-Mills says the more thorough tool will help doctors assess the patient’s cognition and safety and improve elder abuse diagnosis.

“If the patient is not cognitively intact, then we’re going to do some additional work.  We will still ask the safety questions, but we will ask the screening person to do physical examination of the patient to look for some findings that might suggest abuse.”

The tool is still in the developmental phase.  It will be tested in emergency departments in North Carolina, Michigan and Alabama.   If it is successful, he says it will be implemented more broadly around the state, including emergency departments in eastern North Carolina.