Association between Type of Residence and Clinical Signs of Neglect in Older Adults.

BACKGROUND: Studies have demonstrated that measures of lower quality of care and associated adverse health effects are more prevalent in for-profit nursing homes compared to not-for-profit facilities. However, these studies omit persons who receive care in the community setting, and exclusively focus on isolated clinical signs that may obscure the true effect size, since these clinical signs rarely occur in isolation. OBJECTIVE: In this study, we use the Clinical Signs of Neglect Scale (CSNS), which is an aggregate measure of clinical signs of neglect and substandard care, to evaluate the association of residence type on health outcomes among individuals living in both private community residences and for-profit and not-for-profit long-term care facilities. METHODS: In a multicenter, retrospective data analysis of 1,149 patients identified from an inpatient hospital registry, we assessed the relationship between residence type (community dwelling, not-for-profit, and for-profit facilities) and clinical signs of neglect. Adjusted parameter estimates and 95% CIs were estimated with linear regression in 3 models using different reference groups. RESULTS: The most serious clinical signs were consistently more prevalent among residents of for-profit facilities, as were measures of poor institutional quality. Relative to low-functioning community-dwelling patients, the mean difference in CSNS scores was higher among patients residing in not-for-profit facilities by 1.99 (p = 0.012) and 3.55 (p ≤ 0.001) among patients in for-profit facilities. In a separate model, the mean difference in CSNS scores among patients living in for-profit facilities compared to not-for-profit facilities was 1.90 (p = 0.035). CONCLUSIONS: Using an aggregate measure, our findings support prior studies demonstrating an association between residence type and adverse health outcomes for disabled elderly.

Using clinical signs of neglect to identify elder neglect cases.

Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual's residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.

Physical Abuse of Elderly Adults: Victim Characteristics and Determinants of Revictimization.

OBJECTIVES: To describe victim characteristics and determinants of recurrent physical abuse of elderly. DESIGN: Multicenter retrospective analysis of multiple data systems to study victims of elder mistreatment in the greater Chicago metropolitan area. SETTING: Five teaching hospitals with Level 1 trauma centers. PARTICIPANTS: Individuals aged 60 and older treated for physical and sexual abuse between 2000 and 2011. MEASUREMENTS: History of revictimization was based on hospital admission histories, Adult Protective Services records, and self-report. Death records were also linked to participant files. RESULTS: Fifty-eight individuals (52.3%) out of 111 cases suffering physical abuse had documented histories of revictimization. Based on multivariable models, individuals who were female, widowed, diagnosed with dementia, and returning to the home where the perpetrator lived or visited were substantially more likely to be revictimized. Revictimized individuals were more likely to be assaulted through unarmed force by a proximal relative, in particular a husband, boyfriend, child, or child-in-law. Based on hospital records, only 57% of community-dwelling cases had their abuse reported to Adult Protective Services or the police, and only 26.6% had Adult Protective Services investigations on record. CONCLUSION: Better screening that connects victims of abuse with community services, police action, and alternative residential options is important in reducing the risk of revictimization and connecting individuals with resources that can improve their safety at home, regardless of whether it is in the community or a residential facility.

A description of cases of severe physical abuse in the elderly and 1-year mortality.

We conducted a case-control study to evaluate severe physical abuse of the elderly treated in two Chicago area Level I trauma centers. This report details whether physicians are adequately reporting cases of abuse to Adult Protective Services (APS), and assesses 1 year. The failure to report two-thirds of the cases and the substantially higher risk of death during the first year after hospitalization indicates the need for improved identification, reporting, and intervention. It is important that clinicians understand the complexity of elder abuse in order to better identify suspected victims and report these cases to professionals in APS.

Screening for traumatic stress among survivors of urban trauma.

OBJECTIVE: This study piloted the use of the Primary Care PTSD (PC-PTSD) screening tool in an outpatient setting to determine its utility for broader use and to gather data on traumatic stress symptoms among direct (patients) and indirect (families) survivors of traumatic injuries. METHODS: Using the PC-PTSD plus one question exploring openness to seeking help, participants were screened for PTSD in the outpatient clinic of an urban Level 1 trauma center. The survey was distributed during a 23-week period from April to September 2011. The screen was self-administered, a sample of convenience, and participation was voluntary and anonymous. RESULTS: With a response rate of 66%, 307 surveys were completed. Forty-two percent of participants had a positive screen. Patients greater than 30 and 90 days from injury had 1.5 and 1.7 times more positive screens than those less than 30 days. Patients with gunshot wounds were 13 times as likely as those with falls and twice as likely as those in a motor vehicle crash to have a positive screen. Sixty percent of patients with a positive screen noted it would be helpful to talk to someone. CONCLUSION: The PC-PTSD was an easy to administer screening tool. Patients reported PTSD symptoms at higher rates than previous studies. Patients with gunshot wounds and those injured greater than 30 days from the time of the screen were more likely to report PTSD symptoms. Although males represented 82% of positive screens, there was no statistical difference in PTSD symptoms between male and female participants because of the small number of females represented. Families also reported significant levels of PTSD. Both patients and families may benefit from additional screening and intervention in the early posttrauma period.

Medical interpretation for immigrant workers.

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. Our goal was to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages. We conducted interviews and a focus group of MIs regarding their attitudes toward foreign-born workers, knowledge of occupational health, and perceived roles. They were familiar with occupational injuries and sympathetic toward foreign-born workers, and they described their roles as conduits, cultural brokers, and advocates for hospitals, providers, and patients. More detailed and representative data would require a larger investigation. However, the time-sensitive nature of policy-making at this point mandates that occupational health stakeholders participate in the national dialogue on standards, training, and licensure for MIs to promote improved access and quality of health care for LEP patients who have been injured at work.

A case-control study of severe physical abuse of older adults.

UNLABELLED: To characterize the severity and outcome of traumatic injuries suffered by victims of elder abuse, describe the characteristics of the perpetrators, and identify risk factors associated with severe traumatic elder abuse. DESIGN: Case-control study. SETTING: Two Level I trauma units in the greater Chicago, Illinois, metropolitan area. PARTICIPANTS: Forty-one cases of elder abuse resulting in severe traumatic injury were identified between 1999 and 2006. Controls were randomly selected from the list of elderly patients in the trauma registry (N=123). MEASUREMENTS: Elder abuse was defined according to the Illinois Elder Abuse and Neglect Act. RESULTS: In this study, 85% of the perpetrators were family members or intimate partners. In the final multivariable logistic regression model, victims of severe traumatic elder abuse were more likely to be female, to have a neurological or mental disorder, and to abuse drugs or alcohol. CONCLUSION: This is the first clinical case-control study detailing clinical outcomes and evaluating risk factors of persons suffering severe physical abuse. Of elderly trauma victims, those who are physically abused have more-severe injuries than their nonabused counterparts. More research is needed to better evaluate risk factors of physical abuse and effective interventions.

Youth violence prevention curriculum evaluation: outcomes of a Cook County, Illinois community based partnership.

The John H. Stroger, Jr. Hospital Departments of Trauma and Emergency created a youth violence prevention curriculum for healthcare providers and staff with a community partnership of practitioners and professionals. A participatory, train-the-trainer approach was used to develop and present the curriculum. Participants were offered voluntary participation in the anonymous evaluation survey to determine their interests, work experience, expectations, knowledge, and skill development, use of, and improvement for the curriculum. Responses from 49 complete surveys were qualitatively analyzed with a response rate of 42% (49/116). The activity, and efforts of professionals and community members to engage and educate themselves through this violence prevention partnership, are an example of how healthcare providers can deploy resources to benefit communities as well as to respond to the needs of individual patients, particularly in the compelling area of youth violence prevention.

Traumatic occupational injuries in Hispanic and foreign born workers.

BACKGROUND: Hispanic and foreign-born workers suffer high rates of occupational fatality. Reasons for this are not well understood. Our aim was to gather information about the details related to severe, non-fatal occupational injuries in this vulnerable population. METHODS: Eight years of data were obtained from an urban trauma center. In addition, medical consultations of individuals admitted for an occupational injury during an 8-month period are reported. RESULTS: Hispanics were more highly represented than expected; their number of injuries steadily rose. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job. CONCLUSION: Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations.