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  1. Article ; Online: Elder Mistreatment: Emergency Department Recognition and Management.

    Gottesman, Elaine / Elman, Alyssa / Rosen, Tony

    Clinics in geriatric medicine

    2023  Volume 39, Issue 4, Page(s) 553–573

    Abstract: Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection ... ...

    Abstract Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.
    MeSH term(s) Humans ; Aged ; Emergency Service, Hospital ; Elder Abuse/diagnosis ; Elder Abuse/prevention & control
    Language English
    Publishing date 2023-06-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1064151-8
    ISSN 1879-8853 ; 0749-0690
    ISSN (online) 1879-8853
    ISSN 0749-0690
    DOI 10.1016/j.cger.2023.05.007
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  2. Article ; Online: Elder Abuse-A Guide to Diagnosis and Management in the Emergency Department.

    Cimino-Fiallos, Nicole / Rosen, Tony

    Emergency medicine clinics of North America

    2021  Volume 39, Issue 2, Page(s) 405–417

    Abstract: Elder abuse affects many older adults and can be life threatening. Older adults both in the community and long-term care facilities are at risk. An emergency department visit is an opportunity for an abuse victim to seek help. Emergency clinicians should ...

    Abstract Elder abuse affects many older adults and can be life threatening. Older adults both in the community and long-term care facilities are at risk. An emergency department visit is an opportunity for an abuse victim to seek help. Emergency clinicians should be able to recognize the signs of abuse, including patterns of injury consistent with mistreatment. Screening tools can assist clinicians in the diagnosis of abuse. Physicians can help victims of mistreatment by reporting the abuse to the appropriate investigative agency and by developing a treatment plan with a multidisciplinary team to include a safe discharge plan and close follow-up.
    MeSH term(s) Aged ; COVID-19 ; Culture ; Diagnostic Imaging ; Elder Abuse/diagnosis ; Elder Abuse/prevention & control ; Emergency Service, Hospital ; Geriatric Assessment ; Hematologic Tests ; Humans ; Mandatory Reporting ; Medical History Taking ; Patient Care Team ; Physical Abuse ; Urinalysis
    Language English
    Publishing date 2021-03-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 605637-4
    ISSN 1558-0539 ; 0733-8627
    ISSN (online) 1558-0539
    ISSN 0733-8627
    DOI 10.1016/j.emc.2021.01.009
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  3. Article ; Online: Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions.

    Lachs, Mark / Mosqueda, Laura / Rosen, Tony / Pillemer, Karl

    Journal of applied gerontology : the official journal of the Southern Gerontological Society

    2021  Volume 40, Issue 11, Page(s) 1437–1446

    Abstract: The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist. Significant advances have been made in elder abuse research methodology, measurement, justice theory, and ... ...

    Abstract The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist. Significant advances have been made in elder abuse research methodology, measurement, justice theory, and other relevant areas, which may remedy this gap. Particular advances include the use of elder abuse severity measures and goal attainment scaling, and the application of restorative justice theory to intervention. Elder abuse research also may benefit from advances in biomedical clinical trial methodology, including characterizing and following up with subjects excluded from trials or those who drop out, estimating numbers needed to treat to assess cost-effectiveness, and a priori stopping rules for when an intervention proves quickly beneficial or harmful. In this article, we argue these advances can and should inform elder abuse intervention research, propose a theoretical framework to guide such efforts, and demonstrate how this framework can inform practice, using elder abuse multidisciplinary teams and nursing home shelters as examples.
    MeSH term(s) Aged ; Elder Abuse ; Humans ; Nursing Homes ; Research Design ; Risk Factors
    Language English
    Publishing date 2021-02-13
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 155897-3
    ISSN 1552-4523 ; 0733-4648
    ISSN (online) 1552-4523
    ISSN 0733-4648
    DOI 10.1177/0733464821992182
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  4. Article ; Online: Changes in Elder Abuse Risk Factors Reported by Caregivers of Older Adults during the COVID-19 Pandemic.

    Makaroun, Lena K / Beach, Scott / Rosen, Tony / Rosland, Ann-Marie

    Journal of the American Geriatrics Society

    2021  Volume 69, Issue 3, Page(s) 602–603

    MeSH term(s) Aged ; COVID-19 ; Caregiver Burden/psychology ; Caregivers/psychology ; Caregivers/statistics & numerical data ; Elder Abuse/psychology ; Elder Abuse/statistics & numerical data ; Female ; Humans ; Income/statistics & numerical data ; Loneliness/psychology ; Male ; Middle Aged ; Pennsylvania ; Risk Factors ; SARS-CoV-2 ; Social Isolation/psychology ; Surveys and Questionnaires
    Language English
    Publishing date 2021-01-05
    Publishing country United States
    Document type Letter ; Research Support, N.I.H., Extramural
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.17009
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  5. Article ; Online: Elder abuse prevalence and risk factors: findings from the Canadian Longitudinal Study on Aging.

    Burnes, David / Pillemer, Karl / Rosen, Tony / Lachs, Mark S / McDonald, Lynn

    Nature aging

    2022  Volume 2, Issue 9, Page(s) 784–795

    Abstract: Elder abuse (EA) is a pervasive problem with serious consequences. Previous population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims, which threatens external ... ...

    Abstract Elder abuse (EA) is a pervasive problem with serious consequences. Previous population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims, which threatens external validity. Based on a national, prospective, population-based cohort sample of older adults (n = 23,468) over a 3-year period from the Canadian Longitudinal Study on Aging, the current study sought to estimate the prevalence of EA and identify risk and protective factors. Past-year prevalence of any EA was 10.0%. Older adults with greater vulnerability related to physical, cognitive and mental health, childhood maltreatment and shared living were at higher EA risk, while social support was protective against EA. Older adults identifying as Black or reporting financial need were at heightened EA risk. This longitudinal, population-based study advances our understanding of EA risk/protective factors across several domains and informs the development of EA prevention strategies.
    MeSH term(s) Aged ; Humans ; Aging ; Canada/epidemiology ; Cross-Sectional Studies ; Elder Abuse/prevention & control ; Elder Abuse/statistics & numerical data ; Longitudinal Studies ; Prevalence ; Prospective Studies ; Risk Factors
    Language English
    Publishing date 2022-09-23
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2662-8465
    ISSN (online) 2662-8465
    DOI 10.1038/s43587-022-00280-2
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  6. Article ; Online: Medical and Social Factors Associated With Referral for Elder Abuse Services in a National Health Care System.

    Makaroun, Lena K / Thorpe, Carolyn T / Mor, Maria K / Zhang, Hongwei / Lovelace, Elijah / Rosen, Tony / Dichter, Melissa E / Rosland, Ann-Marie

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2023  Volume 77, Issue 8, Page(s) 1706–1714

    Abstract: Background: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine ... ...

    Abstract Background: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national U.S. health care system.
    Methods: We conducted a national case-control study in U.S. Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010 and 2018. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models.
    Results: Of 5 567 664 Veterans meeting eligibility criteria during the study period, 15 752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (adjusted odds ratio; 95% confidence interval), age ≥ 85 (3.56 vs age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 vs spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28), and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services.
    Conclusion: In the largest cohort of patients receiving EA-related health care services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in health care-based EA surveillance and detection.
    MeSH term(s) Aged ; Case-Control Studies ; Delivery of Health Care ; Elder Abuse ; Female ; Humans ; Referral and Consultation ; Social Factors ; United States/epidemiology ; Veterans
    Language English
    Publishing date 2023-01-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glab354
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  7. Article ; Online: Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic.

    Elman, Alyssa / Gottesman, Elaine / Makaroun, Lena K / Chang, E-Shien / Baek, Daniel / Clark, Sunday / Rosen, Tony

    Journal of applied gerontology : the official journal of the Southern Gerontological Society

    2023  Volume 42, Issue 7, Page(s) 1551–1564

    Abstract: The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six ... ...

    Abstract The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six focus groups and seven interviews during March-April 2021 using a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and caseworkers in New York City, a community hard hit by the initial COVID surge. Data from transcripts were analyzed to identify themes. Participants identified challenges faced by APS (e.g., clients less willing to engage with APS, inability to perform necessary job tasks remotely, and low staffing levels) as well as strategies APS used in response (e.g., increasing collaboration with other community-based programs and service providers, enabling remote court hearings through technology and in-person facilitation, and ensuring staff had access to personal protective equipment). These findings may inform APS planning for future large-scale societal disruptions.
    MeSH term(s) Humans ; Aged ; COVID-19/epidemiology ; Elder Abuse/prevention & control ; Pandemics ; Social Welfare ; Focus Groups
    Language English
    Publishing date 2023-04-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 155897-3
    ISSN 1552-4523 ; 0733-4648
    ISSN (online) 1552-4523
    ISSN 0733-4648
    DOI 10.1177/07334648231166276
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  8. Article ; Online: Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study.

    Makaroun, Lena K / Rosland, Ann-Marie / Mor, Maria K / Zhang, Hongwei / Lovelace, Elijah / Rosen, Tony / Dichter, Melissa E / Thorpe, Carolyn T

    Journal of the American Geriatrics Society

    2023  Volume 71, Issue 6, Page(s) 1724–1734

    Abstract: Background: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. ...

    Abstract Background: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system.
    Methods: We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model.
    Results: The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation.
    Conclusions: A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.
    MeSH term(s) Humans ; Aged ; United States/epidemiology ; Frailty/diagnosis ; Frailty/epidemiology ; Elder Abuse ; Case-Control Studies ; Medicare ; Delivery of Health Care ; Frail Elderly
    Language English
    Publishing date 2023-01-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.18245
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  9. Article ; Online: ED/hospital program contributions to community multi-disciplinary team meetings: Different models.

    Chang, E-Shien / Bloemen, Elizabeth M / Tietz, Sarah / Lindberg, Daniel / Elman, Alyssa / Gottesman, Elaine / Baek, Daniel / Hancock, David / LoFaso, Veronica M / McAuley, Jennine / Sullivan, Michelle / Pino, Chloe / Rachmuth, Lisa / Rosen, Tony

    Journal of elder abuse & neglect

    2024  , Page(s) 1–10

    Abstract: Elder mistreatment (EM) is a complex problem, with response and prevention requiring contributions from professionals from many disciplines. Community-based multi-disciplinary teams (MDTs) that conduct meetings to discuss challenging cases and coordinate ...

    Abstract Elder mistreatment (EM) is a complex problem, with response and prevention requiring contributions from professionals from many disciplines. Community-based multi-disciplinary teams (MDTs) that conduct meetings to discuss challenging cases and coordinate services are a common strategy to ensure effective collaboration. Though they play an important role in EM identification, intervention, and prevention, hospitals and hospital-based healthcare professionals have been particularly difficult to engage in MDTs. Two hospitals in different communities recently launched Emergency Department (ED)/hospital-based response teams to consult in cases of potential EM, and both participate in MDTs. We explored similarities and differences between the MDTs in these communities including in the role of the ED/hospital-based response team. The comparison demonstrates both core common features as well as large variations. These differences reflect different circumstances in the models on which they were based, on MDT development in these communities, available resources and infrastructure, and the ED/hospital program's role.
    Language English
    Publishing date 2024-03-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1018101-5
    ISSN 1540-4129 ; 0894-6566
    ISSN (online) 1540-4129
    ISSN 0894-6566
    DOI 10.1080/08946566.2024.2324315
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  10. Article ; Online: A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers.

    Lee, Mihan / Rosen, Tony / Murphy, Kieran / Sagar, Pallavi

    Journal of elder abuse & neglect

    2019  Volume 31, Issue 2, Page(s) 163–180

    Abstract: Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; ... ...

    Abstract Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists' contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients' injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists' role in elder abuse detection.
    MeSH term(s) Aged ; Clinical Competence ; Communication ; Education, Medical, Continuing ; Elder Abuse/diagnosis ; Female ; Humans ; Interviews as Topic ; Male ; New England ; Physical Abuse ; Professional-Family Relations ; Radiologists ; Workflow
    Language English
    Publishing date 2019-02-10
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1018101-5
    ISSN 1540-4129 ; 0894-6566
    ISSN (online) 1540-4129
    ISSN 0894-6566
    DOI 10.1080/08946566.2019.1573160
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