Can diagnostic imaging help improve elder abuse detection?

Abstract

Elder abuse is an underdetected, under-reported issue with severe consequences. Its detection presents unique challenges based on characteristics of this vulnerable population, including cognitive impairment, age-related deconditioning, and an increased number of co-morbidities, all of which predispose to increase vulnerability to injury. While radiologists play a critical role in detection of child abuse, this role is currently not paralleled in detection of elder abuse. We conducted a thorough review of the literature using MEDLINE to describe the current knowledge on injury patterns and injury findings seen in elder abuse, as well as barriers to and recommendations for an increased role of diagnostic imaging in elder abuse detection. Barriers limiting the role of radiologists include lack of training and paucity of rigorous systematic research delineating distinctive imaging findings for physical elder abuse. We outline the current ways in which imaging can help raise clinical suspicion for elder abuse, including inconsistencies between purported mechanism of injury and imaging findings, injury location, multiple injuries at differing stages of healing, and particular patterns of injury likely to be intentionally inflicted. We additionally outline the mechanism by which medical education and clinical workflow may be modified to increase the role for imaging and radiologist participation in detecting abuse in older adult patients, and identify potential future directions for further systematic research.

Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review

“…Some studies described physical signs due to elder abuse to be specifically located on the left respectively right side of the body [ 13 , 24 , 26 , 27 , 30 , 38 , 39 ]. Furthermore Rosen et al [ 26 ] described that physical abuse victims were more likely to have visible injuries in the maxillofacial, dental or neck area without the presence of injuries to the upper or lower extremities.…”

“…The design of the included studies concerned eight descriptive studies [13,[21][22][23][24][25][26][27], three case studies [28][29][30], five narrative reviews [11,[31][32][33][34], six mixed methods studies [12,[35][36][37][38][39] and two books [40,41]. See Tables 1, 2, 3 and 4 for characteristics studies.…”

“…Furthermore studies described that the distribution of physical signs in a stocking or glove distribution (e.g., due to immersion of the extremities in hot water), the presence of a cutaneous casal necklace (dermatitis around the neck due to vitamin B3 deficiency in case of neglect), and injuries in multiple stages of healing or multifocal fractures to be caused by elder abuse [30,36]. No description of characteristics of physical signs were given in six out of eight descriptive studies [21,[23][24][25][26][27], two out of nine case report studies (primary case report studies) [28,29], and two out of six mixed methods studies [38,39].…”

“…Other anatomic locations mentioned to be associated with elder abuse included the lower extremities, abdomen, lumbar area and gluteal/genital/rectal area, the latter location often mentioned as being associated with the presence of sexual elder abuse or neglect (e.g., decubitus ulcers) [12, 13, 21-27, 29, 30, 35-39]. Some studies described physical signs due to elder abuse to be specifically located on the left respectively right side of the body [13,24,26,27,30,38,39]. Furthermore Rosen et al [26] described that physical abuse victims were more likely to have visible injuries in the maxillofacial, dental or neck area without the presence of injuries to the upper or lower extremities.…”

Maltrato en adultos mayores: importancia de la valoración médico forense

“…El rol de la evaluación médico forense tiene mayor protagonismo en hechos de abuso sexual, donde el establecimiento del delito requiere obligatoriamente una evaluación pericial, siendo secundaria y limitada a la autopsia médico legal en circunstancias de maltrato físico y negligencia. abuso físico, sin embargo, la alta prevalencia de fracturas patológicas en este grupo de edad, limitan el uso de los estudios radiológicos en este tipo de eventos, y, actualmente, no se indican como insumo determinante para el diagnóstico preciso de lesiones producto de maltrato físico (38).…”