Ability of Older Adults to Report Elder Abuse: An Emergency Department–Based Cross‐Sectional Study

Abstract

OBJECTIVES To characterize assessments of a patient's ability to report elder abuse within the context of an emergency department (ED)–based screen for elder abuse. DESIGN Cross‐sectional study in which participants were screened for elder abuse and neglect. SETTING Academic ED in the United States. PARTICIPANTS Patients, aged 65 years and older, presenting to an ED for acute care were assessed by trained research assistants or nurses. MEASUREMENTS All patients completed the four‐item Abbreviated Mental Test 4 (AMT4), then completed a safety interview (using the Emergency Department Senior Abuse Identification tool) designed to detect multiple domains of elder abuse and received a physical examination. Based on the cognitive assessment and safety interview, assessors ranked their confidence in the patient's ability to report abuse as absolutely confident, confident, somewhat confident, or not confident. To assess interrater reliability, two assessors independently rated confidence for a subset of patients. RESULTS Assessors suspected elder abuse in 18 of 276 patients (6.5%). Assessors were absolutely confident in the patient's ability to report abuse for 95.7% of patients, confident for 2.5%, somewhat confident for 1.5%, and not confident for 0.3%. Among patients with an AMT4 of 4 (n = 249), assessors were confident or absolutely confident in 100% of patients. Among patients with an AMT4 of less than 4 (n = 27), they were confident or absolutely confident in the patient's ability to report abuse for 81% of patients, including 11 of 12 patients with mild cognitive impairment and 7 of 11 patients with severe cognitive impairment. For patients receiving paired evaluations (n = 131), agreement between assessors regarding patient ability to report abuse was 97% (κ = 0.5). CONCLUSIONS In this sample of older adults receiving care in an ED, research assistants and nurses felt that the vast majority were able to report elder abuse, including many patients with cognitive impairment. J Am Geriatr Soc 68:170–175, 2019

Still under our radar: elder mistreatment

“…A cognitive screen may be of use to differentiate between patients for whom questions are sufficient to screen for abuse and those older individuals who might need further assessment. However, a recent study suggests that even patients with cognitive impairment are able to report mistreatment [9]. ED staff may be uniquely positioned to identify elder mistreatment as older people who experience abuse are twice as likely to visit the ED compared with older adults who do not [10].…”

“…A cognitive screen may be of use to differentiate between patients for whom questions are sufficient to screen for abuse and those older individuals who might need further assessment. However, a recent study suggests that even patients with cognitive impairment are able to report mistreatment [9].…”