ERASE: a feasible early warning tool for elder abuse, developed for use in the Dutch emergency department.

BACKGROUND: Elder abuse is a worldwide problem with serious consequences for individuals and society. To effectively deal with elder abuse, a timely identification of signals as well as a systematic approach towards (suspected) elder abuse is necessary. This study aimed to develop and test the acceptability and appropriateness of ERASE (EldeR AbuSE) in the emergency department (ED) setting. ERASE is an early warning tool for elder abuse self-administered by the healthcare professional in patients ≥ 70 years. METHODS: A systematic literature review was previously conducted to identify potential available instruments on elder abuse for use in the ED. Furthermore, a field consultation in Dutch hospitals was performed to identify practice tools and potential questions on the recognition of elder abuse that were available in clinical practice. Based on this input, in three subsequent rounds the ERASE tool was developed. The ERASE tool was tested in a pilot feasibility study in healthcare professionals (n = 28) working in the ED in three Dutch hospitals. A semi-structured online questionnaire was used to determine acceptability and appropriateness of the ERASE tool. RESULTS: The systematic literature review revealed seven screening instruments developed for use in the hospital and/or ED setting. In total n = 32 (44%) hospitals responded to the field search. No suitable and validated instruments for the detection of elder abuse in the ED were identified. The ERASE tool was developed, with a gut feeling awareness question, that encompassed all forms of elder abuse as starting question. Subsequently six signalling questions were developed to collect information on observed signs and symptoms of elder abuse and neglect. The pilot study showed that the ERASE tool raised the recognition of healthcare professionals for elder abuse. The tool was evaluated acceptable and appropriate for use in the ED setting. CONCLUSIONS: ERASE as early warning tool is guided by an initial gut feeling awareness question and six signalling questions. The ERASE tool raised the recognition of healthcare professionals for elder abuse, and was feasible to use in the ED setting. The next step will be to investigate the reliability and validity of the ERASE early warning tool.

[What to do when elder abuse is suspected?] / Wat te doen als je ouderenmishandeling vermoedt?

Elder abuse is a worldwide problem with serious consequences for individuals and society. The recognition of elder abuse is complex due to a lack of awareness and knowledge. We present a case of a patient with signs of elder abuse. This case concerns a patient who showed signs of neglect and physical abuse as a result of possible derailed informal care provision. The mandatory reporting code on domestic violence of The Royal Dutch Medical Association was followed and measures were taken by the general practitioner. In the discussion, information on signs and types of elder abuse were provided, together with the description of risk factors.

The domestic elder abuse in China: Scale development and psychometric properties.

An effective screening tool is essential to elder abuse research. Although several instruments have been developed in China to measure elder abuse, they present several limitations. The instrument development involved three components: (1) generating questionnaire items; (2) questionnaire testing and data collection in older adults; and (3) psychometric evaluation of the Domestic Elder Abuse Scale (DEAS). We collected questionnaire responses from 3725 community-dwelling Chinese older adults. The 26-item DEAS showed good reliability and validity across five dimensions: physical abuse, psychological abuse, financial exploitation, neglect, and abandonment. These five factors accounted for 78.432 % of the total variance, and model fitting results were acceptable. The Cronbach's alpha coefficient of the scale was 0.975, and the test-retest intraclass correlation coefficient (ICC) was 0.934 after 2 weeks. This study developed a five-dimension instrument to measure elder abuse, with good psychometric properties, which can play an essential role in community-based studies in China.

The effect of health empowerment on elder abuse in older adults.

BACKGROUND: Understanding elder abuse requires an assessment of variables that may limit older adults' capacities to handle their everyday lives, to live independently, and to defend themselves. This study was conducted to examine the effect of health empowerment on elder abuse in older adults. METHODS: This cross-sectional and correlational study was conducted with 250 elderly individuals who applied to the internal medicine clinics of a university hospital in Elazig, eastern Turkey. Data were collected using the Descriptive Information Form, Elders Health Empowerment Scale (EHES) and the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). RESULTS: The average EHES total score of participants was 25.52 ± 6.58. The H-S/EAST total score was 4.22 ± 3.49. Among subscales, the score of "Characteristics of the elder that make him or her vulnerable to abuse" subscale was 1.04 ± 0.83, the score of 'Overt violation of personal rights and direct abuse' subscale was 1.55 ± 1.30, and the score of 'Characteristics of potentially abusive situations' subscale was 1.62 ± 1.94. It was determined that the EHES (ß = -0.163, P < 0.01) variable had a negative and significant effect on H-S/EAST. It was found that a one-unit decrease in the EHES variable increased the level of H-S/EAST 0.849 times. CONCLUSION: It was determined that the level of empowerment of the participants was moderate. Elderly individuals were found to have a moderate risk of elder abuse. It was found that the risk of elder abuse decreased as older individuals became stronger.

The relationship between activities of daily living and abuse in the elderly: cross-sectional study during covid 19.

To determine the relationship between activities of daily living in the elderly and elder abuse, the research was conducted during the COVID-19 process. This study was performed as descriptive and cross -sectional. For data collection, the Standardized Mini-Mental State Examination (SMMSE), Personal Information Form, Barthel Index of Activities of Daily Living (BIADL) and Hwalek-Sengstock Elder Abuse Screening Test (HS/EAST) were used. It was determined that 43.8% of the elderly participants were moderately dependent while performing activities of daily living, and 63.4% were exposed to some kind of abuse. The HS/EAST total mean scores of elderly people who were highly dependent while performing activities of daily living were found to be higher. It was determined that as the dependency levels of the elderly in their activities of daily living increased, the rate of exposure to abuse increased.

Healthcare costs for legally adjudicated elder mistreatment victims in comparison to non-mistreated older adults.

BACKGROUND: Elder mistreatment (EM) is associated with adverse health outcomes and healthcare utilization patterns that differ from other older adults. However, the association of EM with healthcare costs has not been examined. Our goal was to compare healthcare costs between legally adjudicated EM victims and controls. METHODS: We used Medicare insurance claims to examine healthcare costs of EM victims in the 2 years surrounding initial mistreatment identification in comparison to matched controls. We adjusted costs using the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk score. RESULTS: We examined healthcare costs in 114 individuals who experienced EM and 410 matched controls. Total Medicare Parts A and B healthcare costs were similar between cases and controls in the 12 months prior to initial EM detection ($11,673 vs. $11,402, p = 0.92), but cases had significantly higher total healthcare costs during the 12 months after initial mistreatment identification ($15,927 vs. $10,805, p = 0.04). Adjusting for CMS-HCC scores, cases had, in the 12 months after initial EM identification, $5084 of additional total healthcare costs (95% confidence interval [$92, $10,077], p = 0.046) and $5817 of additional acute/subacute/post-acute costs (95% confidence interval [$1271, $10,362], p = 0.012) compared with controls. The significantly higher total costs and acute/sub-acute/post-acute costs among EM victims in the post-year were concentrated in the 120 days after EM detection. CONCLUSIONS: Older adults experiencing EM had substantially higher total costs during the 12 months after mistreatment identification, driven by an increase in acute/sub-acute/post-acute costs and focused on the period immediately after initial EM detection.

Managing reports of trouble: designated officials' responses to reports of mistreatments initiated by service users and relatives.

Mandatory reporting of elder abuse aims to detect and prevent mistreatment and improve services. Service users and their relatives can raise concerns, but only staff can file mandatory reports. This article examines how the concerns of service users and relatives were managed by designated officials in reports of mistreatments in care for older adults in Sweden. We lean on sociological theories of "interpersonal trouble" and organizational "disputes domains." The thematic analysis is based on 28 incident reports initiated by service users or their relatives. The analysis shows that the reports were managed in one of three ways: asymmetrically, by 1) dismissing or 2) supporting the complainant's position, or symmetrically, by 3) treating complainants' accounts as credible but minimizing their seriousness. There were differences between reports initiated by service users and relatives. Dismissing concerns about abuse, mainly those made by relatives, risks support for service users failing.

Elder Abuse: The Hidden Epidemic.

Elder abuse is a major public health problem. Prior to the pandemic, approximately 1 in 10 older adults in the United States experienced elder mistreatment. In 2020, this number doubled to 1 in 5, a nearly 84% increase (Liu, 2022). More distressing is that in almost 60% of elder abuse and neglect cases, a family member is the offender and two-thirds of the perpetrators are adult children or spouses (Nursing Home Justice Team, 2021). Financial abuse is reportedly the fastest-growing form of elder abuse with theft scams at the forefront (Hillendahl, 2022). It is essential that healthcare providers, especially those who care for patients in their homes, understand what elder abuse is, how it can be identified, what conditions may lead to elder abuse, and what home care providers can do to properly intervene when it is suspected that older adults are being abused.

Prevalence and predictors of elder abuse among older adults attending emergency departments: a prospective cohort study.

INTRODUCTION: Elder abuse is associated with impaired physical and psychological health. It is, however, rarely identified in emergency departments (EDs). The objective was to determine the prevalence and the predictors of elder abuse among older adults visiting EDs. METHODS: This prospective cohort study was conducted in eight Canadian EDs between May and August 2021. Patients were eligible if they were ≥ 65 years old, oriented to time, and with a Canadian Triage and Acuity Scale score 3, 4 or 5. In a private setting, participants were questioned directly about abuse as part of a larger questionnaire exploring ten non-medical problems. We used multivariable logistic regression to identify predictors of elder abuse. RESULTS: A total of 1061 participants were recruited (mean age: 77.1 (SD 7.6) years, female sex: 55.7%, lived alone: 42.5%). Patients mostly attended EDs for pain (19.6%), neurologic (11.3%) or cardiovascular (8.4%) symptoms. The most frequent pre-existing comorbidities were hypertension (67.2%), mental health conditions (33.3%) and cardiac insufficiency (29.6%). Mobility issues outside (41.0%) or inside their home (30.7%) and loneliness (29.4%) were also frequent. Fifty-four (5.1%) participants reported elder abuse, of which 34.3% were aware of available community-based resources. Identified predictors of elder abuse were female sex (OR 2.8 [95%CI 1.4; 5.6]), financial difficulties (OR 3.6 [95%CI 1.8; 7.3]), food insecurity (OR 2.7 [95%CI 1.2; 5.6]), need for a caregiver (OR 2.7 [95%CI 1.5; 5.0]) and at least one pre-existing mental health condition (OR 2.6 [95%CI 1.4; 4.9]). CONCLUSION: When questioned directly, 5.1% of older adults attending EDs reported experiencing abuse. Female sex, functional impairment, social vulnerability, and mental health comorbidities are associated with elder abuse. Given its importance and relatively high prevalence, ED professionals should have a low threshold to ask directly about elder abuse.

RéSUMé: INTRODUCTION: La maltraitance des personnes âgées est associée à une détérioration de la santé physique et psychologique. Elle est cependant rarement identifiée dans les services d'urgence. L'objectif était de déterminer la prévalence et les prédicteurs de l'abus envers les aînés chez les personnes âgées qui consultent dans un service d'urgence. MéTHODES: Cette étude de cohorte prospective a été menée dans huit services d'urgence canadiens entre mai et août 2021. Les patients étaient éligibles s'ils étaient âgés de ≥ 65 ans, s'ils étaient orientés vers le temps et s'ils avaient un score de 3, 4 ou 5 sur l'échelle canadienne de triage et d'acuité. Dans un cadre privé, les participants ont été interrogés directement sur la maltraitance dans le cadre d'un questionnaire plus large explorant 10 problèmes non médicaux. Nous avons utilisé une régression logistique multivariable pour identifier les facteurs prédictifs de la maltraitance envers les personnes âgées. RéSULTATS: Au total, 1 061 participants ont été recrutés (âge moyen : 77,1 (SD 7,6) ans, sexe féminin : 55,7 %, vivant seul : 42,5 %). Les patients se sont surtout rendus aux urgences pour des douleurs (19,6 %), des symptômes neurologiques (11,3 %) ou cardiovasculaires (8,4 %). Les comorbidités préexistantes les plus fréquentes étaient l'hypertension (67,2 %), les problèmes de santé mentale (33,3 %) et l'insuffisance cardiaque (29,6 %). Les problèmes de mobilité à l'extérieur (41,0 %) ou à l'intérieur du domicile (30,7 %) et la solitude (29,4 %) sont également fréquents. Cinquante-quatre (5,1 %) participants ont signalé des cas de maltraitance des personnes âgées, dont 34,3 % connaissaient les ressources communautaires disponibles. Les facteurs prédictifs identifiés de maltraitance envers les personnes âgées étaient le sexe féminin (RC 2,8 [IC 95 % 1,4 ; 5,6]), les difficultés financières (RC 3,6 [IC 95 % 1,8 ; 7,3]), l'insécurité alimentaire (RC 2,7 [IC 95 % 1,2 ; 5,6]), besoin d'un aidant (RC 2,7 [IC 95 % 1,5 ; 5,0]) et au moins un problème de santé mentale préexistant (RC 2,6 [IC 95 % 1,4 ; 4,9]). CONCLUSION: Interrogées directement, 5,1 % des personnes âgées fréquentant les urgences ont déclaré avoir été victimes de maltraitance. Le sexe féminin, les déficits fonctionnels, la vulnérabilité sociale et les problématiques de santé mentale sont associés à la maltraitance des personnes âgées. Compte tenu de son importance et de sa prévalence relativement élevée, les professionnels des urgences ne devraient pas hésiter à poser directement des questions sur la maltraitance aux personnes âgées.

Elder Mistreatment: Emergency Department Recognition and Management.

Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.

Development and validation of the short form domestic elder abuse assessment questionnaire (SF-DEAQ).

BACKGROUND: The present study aimed to design and determine the psychometric properties of a short-form questionnaire to investigate the domestic elder abuse. METHODS: This study consisted of two phases: in phase 1 we employed a modified Delphi approach with 18 participants. Consequently, content and face validity, and item analysis were applied. In Phase 2 we evaluated structural validity and convergent validity. Reliability was assessed by looking at internal consistency, stability, and absolute reliability. RESULTS: The findings led to the development of a 27-items short form of domestic elder abuse in four domains that jointly accounted for 74.14% of the variance observed. The short form showed high internal consistency (Cronbach's alpha = 0.93) and significantly correlated (r = 0.91; p < 0.001 for both scales) with the comprehensive (49-item) domestic elder abuse. CONCLUSION: The short form of domestic elder abuse was found to be reliable and valid as the longer version. The short form of domestic elder abuse could lessen the burden on respondents.

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.

The prevalence of elder abuse and risk factors: a cross-sectional study of community older adults.

BACKGROUND: The old people population is increasing worldwide. Along with their increasing population, an increase in elder abuse cases is predicted. Elder abuse is a neglected problem, and many cases go unreported. This study was conducted to identify types of elder abuse and examine associated risk factors. METHODS: This cross-sectional analytical study was conducted on 500 older people in Ardabil (northwestern Iran). Data was collected over three months, from June to September 2020. Data was collected using a demographic information form and the Domestic Elder Abuse questionnaire. The data were analyzed using SPSS software (version 22). Logistic regression was used to identify factors related to elder abuse. RESULTS: The results showed that out of the 500 participants, 258 (51.6%) were male, and 242 (48.2%) were female. Among the 500 participants, 377 individuals (75/4%) reported experiencing at least one type of abuse in the past year. The highest rate of elder abuse was observed for emotional neglect (47.2%) and psychological abuse (40.8%), while the lowest rate was measured for rejection (15.4%) and physical abuse (12.4%). The results indicated that elder abuse was significantly associated with chronic illness (OR = 0.601, 95% CI: 0.391-0.922) and having 1-4 children (OR = 1.275, 95% CI: 1.137-1.430). CONCLUSION: Considering the high level of elder abuse and its dangerous effects on the quality of life for older people, it is essential to develop appropriate programs to increase awareness among older people and their families.

Determining depression, abuse, and neglect in elderly individuals.

BACKGROUND: This study was conducted to investigate depression, abuse, and neglect in elderly individuals. METHODS: The sample of the research consisted of 315 elderly individuals. Data were collected using a personal information form, an elder abuse assessment form, and the Geriatric Depression Scale. RESULTS: Emotional abuse, neglect, economic abuse, physical abuse, and sexual abuse were detected in 51.4%, 35.6%, 21.9%, 3.8%, and 0.03% of the elderly individuals, respectively. It was observed that elderly individuals in the advanced age group (75-95 years) experienced only emotional abuse, while women, single persons, those with low education levels, those without income of their own, and those who could not perform their self-care experienced both emotional abuse and neglect to a greater extent (P < 0.05). A total of 68.3% of the elderly individuals showed symptoms of depression at a significant level. The elderly individuals who were exposed to physical and emotional abuse and neglect had higher mean depression scores compared to those who were not (P < 0.05). CONCLUSIONS: The study showed that the severity of depression and prevalence of emotional abuse, neglect, financial abuse, and physical abuse were high among older adults. Mental health professionals have a very critical role in recognizing, detecting, and managing elder abuse and they should investigate elder abuse by integrating it into routine screening, especially in high-risk populations. It is recommended that guidelines for the detection and treatment of abuse and neglect be prepared and implemented.

Reliability and validity of the Turkish version of the elder abuse suspicion index in community-dwelling older adults.

BACKGROUND: Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults. METHODS: This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed. RESULTS: EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity. DISCUSSION: The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.

Detecting elder abuse in dermatology: A clinical and practical review.

The pace of aging in our population is dramatically increasing, raising concern for rising prevalence of elder abuse. Given the visual nature of the occupation, dermatologists can play a crucial role in identifying certain types of elder mistreatment, especially physical abuse, sexual abuse, and neglect. Nonetheless, many dermatologists report insufficient training in the diagnosis of elder abuse as well as appropriate interventions. This review article aims to synthesize and assess recent clinical, screening, and practical developments surrounding elder abuse. Implementation of some of these screening methods and recommendations in clinical practice and in dermatology residency curriculums could lead to increased awareness among physicians and improved patient outcomes. Like all other clinicians, dermatologists have a legal, moral, and ethical obligation to report suspicion of mistreatment and help suffering patients. Elder abuse is and will continue to be, an important issue that will require efforts from physicians across all fields to ensure the health and safety of patients.

Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool.

Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.