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Prevalence and predictors of elder abuse among older adults attending emergency departments: a prospective cohort study

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Abstract

Introduction

Elder abuse is associated with impaired physical and psychological health. It is, however, rarely identified in emergency departments (EDs). The objective was to determine the prevalence and the predictors of elder abuse among older adults visiting EDs.

Methods

This prospective cohort study was conducted in eight Canadian EDs between May and August 2021. Patients were eligible if they were ≥ 65 years old, oriented to time, and with a Canadian Triage and Acuity Scale score 3, 4 or 5. In a private setting, participants were questioned directly about abuse as part of a larger questionnaire exploring ten non-medical problems. We used multivariable logistic regression to identify predictors of elder abuse.

Results

A total of 1061 participants were recruited (mean age: 77.1 (SD 7.6) years, female sex: 55.7%, lived alone: 42.5%). Patients mostly attended EDs for pain (19.6%), neurologic (11.3%) or cardiovascular (8.4%) symptoms. The most frequent pre-existing comorbidities were hypertension (67.2%), mental health conditions (33.3%) and cardiac insufficiency (29.6%). Mobility issues outside (41.0%) or inside their home (30.7%) and loneliness (29.4%) were also frequent. Fifty-four (5.1%) participants reported elder abuse, of which 34.3% were aware of available community-based resources. Identified predictors of elder abuse were female sex (OR 2.8 [95%CI 1.4; 5.6]), financial difficulties (OR 3.6 [95%CI 1.8; 7.3]), food insecurity (OR 2.7 [95%CI 1.2; 5.6]), need for a caregiver (OR 2.7 [95%CI 1.5; 5.0]) and at least one pre-existing mental health condition (OR 2.6 [95%CI 1.4; 4.9]).

Conclusion

When questioned directly, 5.1% of older adults attending EDs reported experiencing abuse. Female sex, functional impairment, social vulnerability, and mental health comorbidities are associated with elder abuse. Given its importance and relatively high prevalence, ED professionals should have a low threshold to ask directly about elder abuse.

Résumé

Introduction

La maltraitance des personnes âgées est associée à une détérioration de la santé physique et psychologique. Elle est cependant rarement identifiée dans les services d'urgence. L’objectif était de déterminer la prévalence et les prédicteurs de l'abus envers les aînés chez les personnes âgées qui consultent dans un service d’urgence.

Méthodes

Cette étude de cohorte prospective a été menée dans huit services d'urgence canadiens entre mai et août 2021. Les patients étaient éligibles s'ils étaient âgés de ≥ 65 ans, s'ils étaient orientés vers le temps et s'ils avaient un score de 3, 4 ou 5 sur l'échelle canadienne de triage et d'acuité. Dans un cadre privé, les participants ont été interrogés directement sur la maltraitance dans le cadre d'un questionnaire plus large explorant 10 problèmes non médicaux. Nous avons utilisé une régression logistique multivariable pour identifier les facteurs prédictifs de la maltraitance envers les personnes âgées.

Résultats

Au total, 1 061 participants ont été recrutés (âge moyen : 77,1 (SD 7,6) ans, sexe féminin : 55,7 %, vivant seul : 42,5 %). Les patients se sont surtout rendus aux urgences pour des douleurs (19,6 %), des symptômes neurologiques (11,3 %) ou cardiovasculaires (8,4 %). Les comorbidités préexistantes les plus fréquentes étaient l'hypertension (67,2 %), les problèmes de santé mentale (33,3 %) et l'insuffisance cardiaque (29,6 %). Les problèmes de mobilité à l'extérieur (41,0 %) ou à l'intérieur du domicile (30,7 %) et la solitude (29,4 %) sont également fréquents. Cinquante-quatre (5,1 %) participants ont signalé des cas de maltraitance des personnes âgées, dont 34,3 % connaissaient les ressources communautaires disponibles. Les facteurs prédictifs identifiés de maltraitance envers les personnes âgées étaient le sexe féminin (RC 2,8 [IC 95 % 1,4 ; 5,6]), les difficultés financières (RC 3,6 [IC 95 % 1,8 ; 7,3]), l'insécurité alimentaire (RC 2,7 [IC 95 % 1,2 ; 5,6]), besoin d'un aidant (RC 2,7 [IC 95 % 1,5 ; 5,0]) et au moins un problème de santé mentale préexistant (RC 2,6 [IC 95 % 1,4 ; 4,9]).

Conclusion

Interrogées directement, 5,1 % des personnes âgées fréquentant les urgences ont déclaré avoir été victimes de maltraitance. Le sexe féminin, les déficits fonctionnels, la vulnérabilité sociale et les problématiques de santé mentale sont associés à la maltraitance des personnes âgées. Compte tenu de son importance et de sa prévalence relativement élevée, les professionnels des urgences ne devraient pas hésiter à poser directement des questions sur la maltraitance aux personnes âgées.

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Data availability

The data that support the findings of this study could be available from the corresponding author, [EM], upon reasonable request.

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Acknowledgements

We would like to acknowledge the work of Leila Adam, Pénélope Haguette and Jeanne Lavallée who helped with the recruitment for this project.

Funding

This study was funded by Réseau-1 Québec (Projets de développement, 2020).

Author information

Authors and Affiliations

  1. Centre de recherche du CHU de Québec–Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada

    Samuel Gagnon, Alexandra Nadeau, Marcel Emond, Axel Benhamed, Pierre-Gilles Blanchard & Eric Mercier

  2. VITAM–Centre de recherche en santé durable, Quebec, QC, Canada

    Alexandra Nadeau, Patrick M. Archambault, Pierre-Hugues Carmichael, Marcel Emond, Pierre-Gilles Blanchard & Eric Mercier

  3. Département de médecine de famille et de médecine d’urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada

    Katherine Tanguay, Patrick M. Archambault, Marcel Emond, Pierre-Gilles Blanchard & Eric Mercier

  4. Département de médecine de famille et de médecine d’urgence, Faculté de médecine et sciences de la santé, Université de Sherbrooke, Sherbooke, QC, Canada

    Audrey-Anne Brousseau

  5. Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière Appalaches, Lévis, QC, Canada

    Patrick M. Archambault & Jean-Francois Deshaies

  6. Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hopitaux Civils de Lyon, Lyon, France

    Axel Benhamed

  7. College of Nursing, Michigan State University, East Lansing, MI, USA

    Fabrice I. Mowbray

Authors
  1. Samuel Gagnon
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  2. Alexandra Nadeau
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  3. Katherine Tanguay
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  4. Patrick M. Archambault
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  5. Audrey-Anne Brousseau
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  6. Pierre-Hugues Carmichael
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  7. Marcel Emond
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  8. Jean-Francois Deshaies
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  9. Axel Benhamed
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  10. Pierre-Gilles Blanchard
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  11. Fabrice I. Mowbray
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  12. Eric Mercier
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Contributions

EM, KT and AN wrote the study protocol with inputs from all other authors. AAB, JFD, ME, PMA, PGB and AB supervised the recruitment. SG, KT, PHC, FIM and AN compiled data and performed the statistical analysis with inputs from all other authors. SG, AN and EM drafted the first version of the manuscript. All authors contributed substantially to its revision. EM takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Eric Mercier.

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Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Communicated by Daniel K. Ting.

Supplementary Information

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Supplementary file1 (DOCX 41 KB)

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Gagnon, S., Nadeau, A., Tanguay, K. et al. Prevalence and predictors of elder abuse among older adults attending emergency departments: a prospective cohort study. Can J Emerg Med 25, 953–958 (2023). https://doi.org/10.1007/s43678-023-00600-4

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  • DOI: https://doi.org/10.1007/s43678-023-00600-4

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