CASE STUDY: screening

ED Nurse Michelle arrives at the bedside to introduce herself to Ms. L. Michelle asks Ms. L’s son to step away so that she can talk with and assess Ms. L alone. As part of her initial assessment, Michelle asks Ms. L whether anyone close to her has harmed her or not provided the help that she needed.

Ms. L is initially reluctant to answer, glancing at the door. She then reveals that her son screamed at her recently because she urinated on herself and slapped her twice earlier that week. Michelle also notes bruising on Ms. L’s right ear. Michelle thanks Ms. L for letting her know about this and discusses with the medical providers and social worker, so that the team can assess the situation and work together to ensure Ms. L’s safety.

A single home-safety question may be asked routinely in many EDs,
but it is likely inadequate...especially if the potential abuser is at the bedside.

Emergency departments can screen older adults for elder abuse by taking advantage of the unique opportunity that an ED visit provides to identify this often hidden issue. A single home-safety question may be asked routinely in many EDs, but it is likely inadequate, especially if the potential abuser is at the bedside. Multiple more comprehensive screening tools exist that ED providers may consider, though none have yet been validated for use in the ED setting.

The Elder Abuse Suspicion Index (EASI) is a short tool validated for cognitively-intact patients in ambulatory care and may be appropriate for ED patients. The ED Senior AID (Abuse Identification) tool is a promising, novel, ED-specific screening tool that is currently undergoing validation. It’s a  multi-step process that includes a brief initial screen for all patients and a more comprehensive screen if concern is identified.

Notably, though screening for elder abuse in the ED has the potential to identify cases and initiate an intervention, evidence of improved outcomes to support screening does not yet exist. The US Preventative Services Task Force has not recommended screening for elder abuse in health care settings. The American College of Emergency Physicians, in a policy statement, recommends that emergency personnel assess patients for intimate-partner violence, child and elder maltreatment and neglect.

Targeted screening for high-risk patients may be an attractive alternative to universal screening. Unfortunately, existing research has not yet consistently identified demographic factors that dramatically alter risk, raising the concern that operationalizing targeting may be challenging and that any such strategy is likely to exclude victims from screening.

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