Imaging Findings in Elder Abuse: A Role for Radiologists in Detection

Abstract

Purpose Emergency department assessment represents a critical but often missed opportunity to identify elder abuse, which is common and has serious consequences. Among emergency care providers, diagnostic radiologists are optimally positioned to raise suspicion for mistreatment when reviewing imaging of geriatric injury victims. However, little literature exists describing relevant injury patterns, and most radiologists currently receive neither formal nor informal training in elder abuse identification. Methods We present 2 cases to begin characterisation of the radiographic findings in elder abuse. Results Findings from these cases demonstrate similarities to suspicious findings in child abuse including high-energy fractures that are inconsistent with reported mechanisms and the coexistence of acute and chronic injuries. Specific injuries uncommon to accidental injury are also noted, including a distal ulnar diaphyseal fracture. Conclusions We hope to raise awareness of elder abuse among diagnostic radiologists to encourage future large-scale research, increased focus on chronic osseous findings, and the addition of elder abuse to differential diagnoses.

Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool

“…Bruising or abrasions could be a sign of accidental trauma from falls, but clinicians should also be aware of the physical signs of potential nonaccidental trauma or neglect, which are often underrecognized in older adults. 10,11 The physical examination should assess for signs of stroke, intracranial hemorrhage, or subclinical seizures, all of which are less common but potentially life-threatening causes of agitation or altered mental status.…”

Trauma Caused by Injury or Abuse in Late Life: Experiences, Impacts, and the Federal Response

“…These include caregiver support interventions to reduce re-victimization; money management support programs to prevent fi nancial exploitation; telephone helplines to facilitate early intervention; and MDTs to support service coordination among criminal justice, health care, victim legal services, APS, fi nancial services, long-term care and proxy decision-making systems [10], and psychotherapeutic interventions to reduce depression (for example, PROTECT, which combines psychotherapy with services to address elder abuse [107]). Existing research on forensic markers of abuse may help health care professionals distinguish between abuse-related injuries (for example, an arm fracture that occurred as a result of being pushed [108] or a bruise caused by an intentionally forceful touch [109]) and non-abuse-related trauma (for example, a fracture or a bruise caused by a fall). Recent research also supports the development of MDTs comprising emergency medical services providers, triage providers, nurses, radiologists, radiology technicians, social workers, and case managers.…”

Recognizing and Managing Elder Abuse in the Emergency Department

“…Emergency radiologists are contributing additional concerning findings indicative of elder abuse, 38,41,42 such as the concomitant presence of old and new fractures, high-energy fractures inconsistent with the purported mechanism, and distal ulnar diaphyseal fractures. 41,42 The ultimate goal is to identify pathognomonic injury patterns similar to those found in child abuse cases, to assist ED providers.…”