Study identifies injury patterns of elder abuse

Certain injury patterns in fall patients who present to the ED can indicate physical abuse of older adults, according to research published in the Annals of Emergency Medicine.

“With this research, we’re essentially trying to develop a forensic medicine for elder abuse, similar to the one that researchers developed decades ago for detecting child abuse,” Anthony E. Rosen, MD, MPH, an assistant professor of emergency medicine at Weill Cornell Medicine and assistant attending emergency physician at New York-Presbyterian/Weill Cornell Medical Center, said in a press release.

Rosen and colleagues noted that 5% to 10% of older adults in the United States are victims of elder abuse each year, and that this abuse is associated with depression, exacerbation of chronic illnesses, hospitalization, placement in nursing homes and increased mortality.

For many older adults, health care visits and assessments may be their only interaction outside their home, the researchers said. Therefore, clinicians have an opportunity to identify suspected elder abuse, report it and initiate intervention.

Rosen and colleagues conducted a comparative case-control study to identify injury patterns in physical elder abuse and unintentional injuries. The researchers compared injuries in elder abuse cases where the perpetrator was convicted or pleaded guilty with injuries among patients who presented to the ED after an unintentional fall. They used data from cases from 2001 to 2014 where the victim was aged 60 years or older.

A total of 78 cases of elder abuse with visible injury and 78 unintentional fall patients were matched and included in the study.

The researchers determined that bruising was more likely to be present in cases of physical abuse (78%) than unintentional falls (54%).

Victims of physical abuse were also more likely to have maxillofacial, dental and neck area injuries (67%) compared with cases of unintentional falls (28%), Rosen and colleagues found.

However, physical abuse victims were less likely to have fractures or lower extremity injuries (8%) than older adults who experienced unintentional falls (22%).

Overall, 50% of abuse victims experienced maxillofacial, dental or neck injuries but no upper or lower extremity injuries vs. 8% of unintentional fall patients.

When examining precise injury location, Rosen and colleagues determined that physical elder abuse victims were more likely to have injury on their left cheek or zygoma (22%) compared with fall patients (3%).

They also found that elder abuse victims were more likely to have injuries on their neck (15%) compared with fall patients (0%) and were more likely to have injury on the ear (6%) than fall patients.

“When people fall, their head and shoulders tend to protect their neck so it’s less commonly injured,” Rosen said in the press release. “Therefore, a neck injury in a case of a ‘fall’ may be suggestive of abuse, at least based on the cases we examined.”

The researchers added that while more research is needed to confirm the findings, the results can serve as “red flags” for clinicians to raise concerns of elder abuse in patients with these injury patterns.