Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement

ABSTRACT

The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research – two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.

KEYWORDS:

• Emergency department
• elder abuse
• screening
• intervention
• review

Acknowledgments

The authors would like to acknowledge the Geriatric Emergency Applied Research (GEAR) network investigators for their role in this work. In addition to the named authors, this network includes the following: Debora Afezolli, Kevin Biese, Christine Binkley, Alycia Bristol, Abraham Brody, Christopher Carpenter, Edward Castillo, Scott Dresden, Savannah Forrester, Melissa Garrido, Cameron Gettel, Elizabeth Goldberg, Allyson Greenberg, Nada Hammouda, Jin Han, S. Nicole Hastings, Teresita Hogan, Libby Hoy, William Hung, Maura Kennedy, James Killeen, Kelly Ko, Adriane Lesser, Lee Lindquist, Elizabeth Linton, Shan Liu, Aaron Malsch, Carmen Morano, Denise Nassisi, Lori Nerbonne, Sylviah Nyamu, Ugochi Ohuabunwa, Luna Ragsdale, Mark Rosenberg, Lynne Richardson, Manish Shah, Kimberly Souffront, Laura Stabler, Joseph Suyama, E. Camiile Vaughan, Corrine Voils, Daniel Wei

Author contributions

Jay Kayser: Primary responsibility of manuscript drafting, organization, editing, and content. PICO #1 content review and contribution. Final review of transcript and submission.

Affiliations: (1) School of Social Work, University of Michigan – Ann Arbor, Ann Arbor, Michigan, USA (2) Department of Developmental Psychology, University of Michigan – Ann Arbor, Ann Arbor, Michigan, USA

Nancy Morrow-Howell: Assistance and feedback throughout drafting process of all sections, PICO #1 content review and contribution. Review of final manuscript

Affiliation: Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA

Tony E. Rosen: Content expertise and drafting results and conclusion. PICO #2 content review and contribution, review of final manuscript

Affiliation: Department of Emergency Medicine, Weill Cornell Medicine, New York – Presbyterian Hospital, New York City, New York, USA

Stephanie Skees: Feedback throughout drafting process of all sections, PICO #1 content review and contribution. Review of final manuscript

Affiliation: Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA

Michelle Doering: Literature review, methods formulation, and review of final manuscript

Affiliation: Becker Medical Library, Washington University in St. Louis, St. Louis, Missouri, USA

Sunday Clark: PICO #2 content review and contribution. Review of final manuscript

Affiliation: Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA

Karen Hurka Richardson: PICO #2 content review and contribution. Review of final manuscript

Affiliation:Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Rayad Shams: PICO #2 content review and contribution. Review of final manuscript

Affiliation: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Thom Ringer: PICO #2 content review and contribution. Review of final manuscript

Affiliations: (1) Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada, (2) Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Ontario, Canada, (3) Department of Emergency Medicine, University Health Network, Toronto, Ontario

Ula Hwang: Consensus conference organizational support, contributions, project oversight. Theoretical and process guidance, and review of final manuscript

Affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

Timothy F. Platts-Mills: Content expertise, group oversight consensus. Drafting of results, conclusions, and limitations. PICO #2 content review and contribution. Review of final manuscript

Affiliation: Quantworks, Inc., Healthcare and Life Sciences, Carrboro, North Carolina, USA

Affirmation

I affirm that I have listed everyone who has contributed significantly to the work and have obtained written consent from all contributors who are not authors and are named in the acknowledgement section

Financial conflicts

Dr. Rosen’s participation has also been supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76 AG054866) from the National Institute on Aging.

Dr. Rosen and Dr. Platts-Mills are both members of National Collaboration to Address Elder Mistreatment, a group funded by the John A. Hartford Foundation and the Gordon and Betty Moore Foundation

Full or adequate disclosure

The funding partially supporting Dr. Rosen’s work (K76 054866–02) totalled $171,335 in direct costs and $12,691 in indirect costs

Impact statement

We certify that this work is novel. This work contains a detailed scoping review of findings related to screening and intervention of elder abuse specifically in the emergency department setting. Using this work and the input of an interdisciplinary team assembled at a consensus conference, we provide suggestions to guide future investigations in the form of high priority research questions.

Personal conflicts

No authors have personal conflicts to declare in relation to the content of this manuscript or the sponsoring parties that supported this work.

Potential conflict

No authors have potential conflicts to declare

Sponsor’s role

The project was supported by the National Institute on Aging grant R21AG058926 (Hwang), the John A Hartford Foundation, and the Gary and Mary West Health Institute. The work presented here are the responsibility of the authors and the GEAR Network and have not been approved nor influenced by the funders.

Additional information

Funding

This work was supported by The John A. Hartford Foundation, Gary and Mary West Health Institute, and National Institute on Aging (R21AG058926). The John A. Hartford Foundation; Gary and Mary West Health Institute;