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  • Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team

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Original article
Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team
  1. Tony Rosen1,
  2. Michael E Stern1,
  3. Mary R Mulcare1,
  4. Alyssa Elman1,
  5. Thomas J McCarthy2,
  6. Veronica M LoFaso3,
  7. Elizabeth M Bloemen4,
  8. Sunday Clark1,
  9. Rahul Sharma1,
  10. Risa Breckman3,
  11. Mark S Lachs3
  1. 1 Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York City, New York, USA
  2. 2 Tulane University School of Medicine, New Orleans, Louisiana, USA
  3. 3 Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
  4. 4 University of Colorado School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Tony Rosen, Division of Emergency Medicine, Weill Cornell Medical College, New York City, NY 10065, USA; aer2006{at}med.cornell.edu

Abstract

Background An ED visit provides a unique opportunity to identify elder abuse, which is common and has serious medical consequences. Despite this, emergency providers rarely recognise or report it. We have begun the design of an ED-based multidisciplinary consultation service to improve identification and provide comprehensive medical and forensic assessment and treatment for potential victims.

Methods We qualitatively explored provider perspectives to inform intervention development. We conducted 15 semistructured focus groups with 101 providers, including emergency physicians, social workers, nurses, technologists, security, radiologists and psychiatrists at a large, urban academic medical centre. Focus groups were transcribed, and data were analysed to identify themes.

Results Providers reported not routinely assessing for elder mistreatment and believed that they commonly missed it. They reported 10 reasons for this, including lack of knowledge or training, no time to conduct an evaluation, concern that identifying elder abuse would lead to additional work, and absence of a standardised response. Providers believed an ED-based consultation service would be frequently used and would increase identification, improve care and help ensure safety. They made 21 recommendations for a multidisciplinary team, including the importance of 24/7 availability, the value of a positive attitude in a consulting service and the importance of feedback to referring ED providers. Participants also highlighted that geriatric nurse practitioners may have ideal clinical and personal care training to contribute to the team.

Conclusions An ED-based multidisciplinary consultation service has potential to impact care for elder abuse victims. Insights from providers will inform intervention development.

  • violence, domestic
  • geriatrics
  • qualitative research
  • emergency department

https://doi.org/10.1136/emermed-2017-207303

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    Footnotes

    • Contributors TR contributed to study concept and design, focus group scheduling and leadership, analysis and interpretation of the data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. MES contributed to study concept and design, focus group scheduling and leadership, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. MRM contributed to study concept and design, focus group scheduling and leadership, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. AE contributed to analysis and interpretation of the data and critical revision of the manuscript for important intellectual content. TJM contributed to study concept and design, focus group scheduling, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. VMLF contributed to study concept, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. EMB contributed to analysis and interpretation of the data and critical revision of the manuscript for important intellectual content. SC contributed to study concept and critical revision of the manuscript for important intellectual content. RS contributed to study concept and critical revision of the manuscript for important intellectual content. RB contributed to study concept and design and critical revision of the manuscript for important intellectual content. MSL contributed to study concept and design, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content.

    • Funding This project has been supported by a grant from The Fan Fox and Leslie R. Samuels Foundation and by a Change AGEnts Grant from the John A. Hartford Foundation. TR’s participation was supported by a GEMSSTAR (Grants for Early Medical and Surgical Subspecialists’ Transition to Aging Research) grant (R03 AG048109) and by a Paul B. Beeson Emerging Leaders in Aging Career Development Award (K76 AG054866) from the National Institute on Aging. TR is also the recipient of a Jahnigen Career Development Award, supported by the John A. Hartford Foundation, the American Geriatrics Society, the Emergency Medicine Foundation and the Society of Academic Emergency Medicine. MSL’s participation was supported by a mentoring award in patient-oriented research from the National Institute on Aging (K24 AG022399).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Weill Cornell Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The complete topic guide for this research is available online.

    • Presented at Preliminary results from this work were presented at the International Association of Gerontology and Geriatrics meeting in San Francisco, California on 24 July 2017.