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Original article

Vol. 154 No. 6 (2024)

Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study

  • Henk B. Riedel
  • Tanguy Espejo
  • Thomas Dreher-Hummel
  • Roland Bingisser
  • Christian H. Nickel
DOI
https://doi.org/10.57187/s.3775
Cite this as:
Swiss Med Wkly. 2024;154:3775
Published
10.06.2024

Summary

AIM OF THE STUDY: The mistreatment of older adults is a global and complex problem with varying prevalence. As there are no data on the prevalence of elder mistreatment in European emergency department populations, we aimed to translate and culturally adapt the Emergency Department Senior Abuse Identification (ED Senior AID) tool for German use, assess the positive screen rate for elder mistreatment with the German version, and compare characteristics of patients who screened positive and negative.

METHODS: To assess the prevalence of elder mistreatment, we created a German version of the ED Senior AID tool. This tool identifies intentional or negligent actions by a caregiver or trusted person that cause harm or risk to an older adult. Then, the German ED Senior AID tool was applied to all consecutively presenting patients aged ≥65 years at our academic emergency department in the Northwest of Switzerland from 25 April to 30 May 2022. Usability was defined as the percentage of patients with completed assessments using the German ED Senior AID tool.

RESULTS: We included 1010 patients aged ≥65 years, of whom 29 (2.9%) screened positive with the ED Senior AID tool. The patients who screened positive were older, more severely cognitively impaired, hospitalised more frequently, and presented with higher frailty scores than those who screened negative. Mortality up to 100 days after presentation was comparable in all patients (p = 0.861), regardless of their screening result. The tool showed good usability, with 73% of assessments completed.

CONCLUSION: This is the first prospective investigation on the prevalence of elder mistreatment in a European emergency department setting. Overall, 2.9% of patients screened positive using a validated screening tool translated into German.

TRIAL REGISTRATION: This study was registered with the National Institute of Health on ClinicalTrials.gov with the registration number NCT05400707.

References

  1. Lachs MS, Pillemer K. Elder abuse. Lancet. 2004 Oct;364(9441):1263–72. 10.1016/S0140-6736(04)17144-4 DOI: https://doi.org/10.1016/S0140-6736(04)17144-4
  2. Yon Y, Mikton CR, Gassoumis ZD, Wilber KH. Elder abuse prevalence in community settings: a systematic review and meta-analysis. Lancet Glob Health. 2017 Feb;5(2):e147–56. 10.1016/S2214-109X(17)30006-2 DOI: https://doi.org/10.1016/S2214-109X(17)30006-2
  3. Mercier É, Nadeau A, Brousseau AA, Émond M, Lowthian J, Berthelot S, et al. Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review. Ann Emerg Med. 2020 Feb;75(2):181–91. 10.1016/j.annemergmed.2019.12.011 DOI: https://doi.org/10.1016/j.annemergmed.2019.12.011
  4. Simone L, Wettstein A, Senn O, Rosemann T, Hasler S. Types of abuse and risk factors associated with elder abuse. Swiss Med Wkly. 2016 Jan;146:w14273. 10.4414/smw.2016.14273 DOI: https://doi.org/10.4414/smw.2016.14273
  5. Lachs MS, Pillemer KA. Elder Abuse. N Engl J Med. 2015 Nov;373(20):1947–56. 10.1056/NEJMra1404688 DOI: https://doi.org/10.1056/NEJMra1404688
  6. Shah SJ, Oreper S, Jeon SY, Boscardin WJ, Fang MC, Covinsky KE. Social Frailty Index: development and validation of an index of social attributes predictive of mortality in older adults. Proc Natl Acad Sci USA. 2023 Feb;120(7):e2209414120. 10.1073/pnas.2209414120 DOI: https://doi.org/10.1073/pnas.2209414120
  7. Platts-Mills TF, Dayaa JA, Reeve BB, Krajick K, Mosqueda L, Haukoos JS, et al.; Development of the Emergency Department Senior Abuse Identification. (ED Senior AID) tool. J Elder Abuse Negl. 2018;30(4):247–70. 10.1080/08946566.2018.1460285 DOI: https://doi.org/10.1080/08946566.2018.1460285
  8. Gruneir A, Silver MJ, Rochon PA. Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev. 2011 Apr;68(2):131–55. 10.1177/1077558710379422 DOI: https://doi.org/10.1177/1077558710379422
  9. Hullick C, Carpenter CR, Critchlow R, Burkett E, Arendts G, Nagaraj G, et al. Abuse of the older person: is this the case you missed last shift? Emerg Med Australas. 2017 Apr;29(2):223–8. 10.1111/1742-6723.12756 DOI: https://doi.org/10.1111/1742-6723.12756
  10. Schofield MJ, Powers JR, Loxton D. Mortality and disability outcomes of self-reported elder abuse: a 12-year prospective investigation. J Am Geriatr Soc. 2013 May;61(5):679–85. 10.1111/jgs.12212 DOI: https://doi.org/10.1111/jgs.12212
  11. Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA. 2009 Aug;302(5):517–26. 10.1001/jama.2009.1109 DOI: https://doi.org/10.1001/jama.2009.1109
  12. Dong X, Chen R, Chang ES, Simon M. Elder abuse and psychological well-being: a systematic review and implications for research and policy—a mini review. Gerontology. 2013;59(2):132–42. 10.1159/000341652 DOI: https://doi.org/10.1159/000341652
  13. Dong X, Simon MA. Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project. Am J Emerg Med. 2013 Apr;31(4):693–8. 10.1016/j.ajem.2012.12.028 DOI: https://doi.org/10.1016/j.ajem.2012.12.028
  14. Rosen T, Zhang H, Wen K, Clark S, Elman A, Jeng P, et al.; Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. JAMA Netw Open. 2023 Feb;6(2):e2255853–2255853. 10.1001/jamanetworkopen.2022.55853 DOI: https://doi.org/10.1001/jamanetworkopen.2022.55853
  15. Mercier E, Jones A, Brousseau A, Hirdes J, Mowbray F, Emond M, et al. Characteristics of emergency department visits by community-dwelling older adults who screened positive for elder abuse during home care assessments. CJEM. 2019;21 S1:S11–11. 10.1017/cem.2019.56 DOI: https://doi.org/10.1017/cem.2019.56
  16. Dong X, Simon MA. Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013 May;173(10):911–7. 10.1001/jamainternmed.2013.238 DOI: https://doi.org/10.1001/jamainternmed.2013.238
  17. Evans CS, Hunold KM, Rosen T, Platts-Mills TF; Diagnosis of Elder Abuse in U.S. Emergency Departments. Diagnosis of Elder Abuse in U.S. Emergency Departments. J Am Geriatr Soc. 2017 Jan;65(1):91–7. 10.1111/jgs.14480 DOI: https://doi.org/10.1111/jgs.14480
  18. Cham GW, Seow E. The pattern of elderly abuse presenting to an emergency department. Singapore Med J. 2000 Dec;41(12):571–4.
  19. Reges ML. Forensic Nurse Identification of Elder Abuse: Implementing the Elder Assessment Instrument. 2023, Salisbury University: United States -- Maryland. p. 90.
  20. Gottesman E, Elman A, Rosen T. Elder Mistreatment: Emergency Department Recognition and Management. Clin Geriatr Med. 2023 Nov;39(4):553–73. 10.1016/j.cger.2023.05.007 DOI: https://doi.org/10.1016/j.cger.2023.05.007
  21. Platts-Mills TF, Hurka-Richardson K, Shams RB, Aylward A, Dayaa JA, Manning M, et al.; Investigators for the ED Senior AID Research Group. Multicenter Validation of an Emergency Department-Based Screening Tool to Identify Elder Abuse. Ann Emerg Med. 2020 Sep;76(3):280–90. 10.1016/j.annemergmed.2020.07.005 DOI: https://doi.org/10.1016/j.annemergmed.2020.07.005
  22. Kayser J, Morrow-Howell N, Rosen TE, Skees S, Doering M, Clark S, et al. Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement. J Elder Abuse Negl. 2021;33(2):123–44. 10.1080/08946566.2021.1904313 DOI: https://doi.org/10.1080/08946566.2021.1904313
  23. Jauslin AS, Schultze L, Knuchel D, Simon NR, Nickel CH, Bingisser R. Disparities in emergency department access, resource allocation, and outcomes between migrants and the local population. Swiss Med Wkly. 2021 Nov;151(4344):w30070. 10.4414/SMW.2021.w30070 DOI: https://doi.org/10.4414/SMW.2021.w30070
  24. Prevention, C.f.D.C.a. Elder Abuse: Definitions. 2017 [cited 2018 February 2nd]; Available from: https://www.cdc.gov/violenceprevention/elderabuse/definitions.html
  25. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344–9. 10.1016/j.jclinepi.2007.11.008 DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
  26. Prusaczyk B, Cherney SM, Carpenter CR, DuBois JM. Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities. Clin Gerontol. 2017;40(1):63–73. 10.1080/07317115.2016.1201714 DOI: https://doi.org/10.1080/07317115.2016.1201714
  27. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al.; ISPOR Task Force for Translation and Cultural Adaptation. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94–104. 10.1111/j.1524-4733.2005.04054.x DOI: https://doi.org/10.1111/j.1524-4733.2005.04054.x
  28. Schofield I, Stott DJ, Tolson D, McFadyen A, Monaghan J, Nelson D. Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test. Eur J Emerg Med. 2010 Dec;17(6):340–2. 10.1097/MEJ.0b013e32833777ab DOI: https://doi.org/10.1097/MEJ.0b013e32833777ab
  29. . Team RC. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2022.
  30. . Fibbi R (Office SF, editor). Les personnes âgées en Suisse [Older persons in Switzerland]Neuchatel, Switzerland; 2000.
  31. Schweizerische Gesundheitsbefragung 2017 - Telefonischer und schriftlicher Fragebogen (pdf). Schweizerische Gesundheitsbefragung 2017 - Telefonischer und schriftlicher Fragebogen (pdf). 2020. 130.
  32. Roulet Schwab D, Wangmo T. Perceptions of Elder Abuse From Community-Dwelling Older Persons and Professionals Working in Western Switzerland. J Interpers Violence. 2021 Jan;36(1-2):NP135–61. 10.1177/0886260517732345 DOI: https://doi.org/10.1177/0886260517732345
  33. Wangmo T, Nordström K, Kressig RW. Preventing elder abuse and neglect in geriatric institutions: solutions from nursing care providers. Geriatr Nurs. 2017;38(5):385–92. 10.1016/j.gerinurse.2016.12.016 DOI: https://doi.org/10.1016/j.gerinurse.2016.12.016
  34. Fulmer T, Paveza G, VandeWeerd C, Fairchild S, Guadagno L, Bolton-Blatt M, et al. Dyadic vulnerability and risk profiling for elder neglect. Gerontologist. 2005 Aug;45(4):525–34. 10.1093/geront/45.4.525 DOI: https://doi.org/10.1093/geront/45.4.525
  35. Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. Am J Public Health. 2010 Feb;100(2):292–7. 10.2105/AJPH.2009.163089 DOI: https://doi.org/10.2105/AJPH.2009.163089
  36. Kojima G. Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. J Geriatr Phys Ther. 2018;41(1):42–8. 10.1519/JPT.0000000000000097 DOI: https://doi.org/10.1519/JPT.0000000000000097
  37. Makaroun LK, et al. Leveraging VA Geriatric Emergency Department Accreditation to Improve Elder Abuse Detection in Older Veterans using a Standardized Tool [n/a]. Acad Emerg Med. 2022;•••. DOI: https://doi.org/10.1111/acem.14646
  38. Lachs MS, Fulmer T. Recognizing elder abuse and neglect. Clin Geriatr Med. 1993 Aug;9(3):665–81. 10.1016/S0749-0690(18)30399-9 DOI: https://doi.org/10.1016/S0749-0690(18)30399-9
  39. Nixon B, Quinlan E. Asking the Hard Questions: Psychologists’ Discomfort With Inquiring About Sexual Abuse Histories. Violence Against Women. 2022 Apr;28(5):1358–76. 10.1177/10778012211014558 DOI: https://doi.org/10.1177/10778012211014558
  40. Rovi S, Chen PH, Vega M, Johnson MS, Mouton CP. Mapping the elder mistreatment iceberg: U.S. hospitalizations with elder abuse and neglect diagnoses. J Elder Abuse Negl. 2009 Oct;21(4):346–59. 10.1080/08946560903005109 DOI: https://doi.org/10.1080/08946560903005109
  41. Friedman B, Santos EJ, Liebel DV, Russ AJ, Conwell Y. Longitudinal prevalence and correlates of elder mistreatment among older adults receiving home visiting nursing. J Elder Abuse Negl. 2015;27(1):34–64. 10.1080/08946566.2014.946193 DOI: https://doi.org/10.1080/08946566.2014.946193
  42. Beach SR, Carpenter CR, Rosen T, Sharps P, Gelles R. Screening and detection of elder abuse: research opportunities and lessons learned from emergency geriatric care, intimate partner violence, and child abuse. J Elder Abuse Negl. 2016;28(4-5):185–216. 10.1080/08946566.2016.1229241 DOI: https://doi.org/10.1080/08946566.2016.1229241
  43. Rosen T, Elman A, Dion S, Delgado D, Demetres M, Breckman R, et al.; National Collaboratory to Address Elder Mistreatment Project Team. Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed. J Am Geriatr Soc. 2019 Jun;67(6):1286–94. 10.1111/jgs.15773 DOI: https://doi.org/10.1111/jgs.15773
  44. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al.; US Preventive Services Task Force. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct;320(16):1678–87. 10.1001/jama.2018.14741 DOI: https://doi.org/10.1001/jama.2018.14741
  45. Platts-Mills TF, et al. EM-SART: A Scalable Elder Mistreatment Screening and Response Tool for Emergency Departments. Generations. 2020;44(1):51–8.

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