ED Use by Older Victims of Family Violence☆,☆☆,★,★★,♢

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Abstract

Study objective: To determine the nature and frequency of ED use by victims of physical elder abuse. Methods: Community-dwelling victims of abuse were identified through a state elderly protective service program independent of the health care system in a geographic area served by two EDs. ED records were reviewed and abstracted to determine if and how victims used emergency services. Results: During a 7-year period, 182 elderly victims of physical abuse were identified in the catchment area of the study, and 114 (62.6%) had been seen in one or both EDs at least once during a 5-year “window” surrounding the initial identification of abuse. These 114 individuals accounted for 628 visits (median 3, range 1-46); 30.6% of visits resulted in a hospital admission. An ordinal system was used that assigned a probability of any single ED visit being referable to abuse; 37.8% of subjects had at least one visit categorized as being of high probability, and 66% of subjects had at least one visit that resulted in an injury-related chief symptom or ICD-9 discharge diagnosis. Conclusion: Elder abuse victims have substantial interactions with EDs and these visits frequently result in admission. Strategies that identify elder abuse in less acute settings and effectively address the needs of victims would improve quality of life and likely result in substantial savings in health care expenditures. [Lachs S, Williams CS, O'Brien, S, Hurst L, Kossack A, Siegal A, Tinetti ME. ED Use by older victims of family violence. Ann Emerg Med October 1997;30:448-454.]

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INTRODUCTION

Elder abuse is a recently recognized form of family violence about which much less is known than child abuse or spousal abuse. Initial prevalence studies have been conducted (32 cases per 1,000 adults older than age 65 in the most widely quoted study1), but little is known about how victims of elder abuse interact with the health care system both before and after the definitive identification of abuse. Accordingly, we conducted a descriptive study in which we examined the frequency and nature

Identification of cases

In Connecticut, reported cases of elder abuse, neglect, exploitation, and abandonment are investigated by the State Elderly Protective Service Program (EPS), which visits the home of the allegedly victimized older adult to verify cases and to develop an intervention plan. The EPS has responsibility for such cases in individuals older than age 60. Abuse is defined as the willful infliction of pain, injury, or mental anguish or the willful deprivation of services by a responsible caretaker; for

RESULTS

A manual review of records identified 274 individuals who experienced reported and verified physical abuse between 1985 and 1992 in the jurisdiction of the regional EPS office that serves the city of New Haven and surrounding towns (New Haven County). The subjects were mostly women (76.3%) and white (85.3%) with a mean age of 73.1 years. An adult son was the abuser in 28.9% of cases, a spouse in 26.8%, and an adult daughter in 21.6%.

Other abusers included grandchildren, other relatives, and

DISCUSSION

In this descriptive study we examined the prevalence and nature of ED use by elder abuse victims in an urban area. We specifically excluded cases of elder neglect. Because the city of New Haven is served by only two EDs, it is an ideal place to study the problem of elder mistreatment and ED utilization. We discovered substantial ED use by elder abuse victims over the sampling frame (>60% of subjects). One fourth of visits had ICD-9 codes consistent with injury, and 66% of the subjects who used

Acknowledgements

We are indebted to the Connecticut Department of Social Services for their tireless work on behalf of the disenfranchised elderly, and to Pamela Giannini and Drs. Ken Fine and Al Weihl for reviewing earlier drafts of the manuscript.

References (8)

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From the Geriatrics Unit, Division of General Internal Medicine, Department of Medicine, New York Hospital–Cornell Medical Center, New York, NY;* Department of Medicine, Yale University School of Medicine, New Haven, CT;‡ and Connecticut Department of Social Services, Hartford, CT.§

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Supported by an Emergency Medicine Geriatric Seed Grant by the Hartford Foundation through the Society for Academic Emergency Medicine.

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Dr. Lachs is a Paul Beeson Physician Faculty Scholar (American Federation For Aging Research), recipient of Academic Award No. K0800580 from the National Institutes on Aging, and an American College of Physicians Teaching and Research Scholar.

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Reprint no.47/1/84917

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Address for reprints: Mark S Lachs, MD, MPH, The New York Hospital–Cornell University Medical Center, 515 East 71st Street, Room S200, New York, NY 10028, 212-746-1677, Fax 212-746-8965

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