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Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System

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Abstract

Background

Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening.

Objective

Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA.

Design

Survey of all 139 VHA medical centers from January to August 2021.

Participants

Surveys were completed by the Social Work Chief, or delegate, at each site.

Main Measures

The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey.

Key Results

Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents’ understanding of the definition of screening.

Conclusions

High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.

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References

  1. Hall J, Karch DL, Crosby A. Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements. [Internet]. Atlanta, Georgia: Center for Disease Control and Prevention National Center for Injury Prevention and Control; 2016 [cited 2016 Sep 21]. Available from: http://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf.

  2. Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W, et al. Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study. Am J Public Health. 2010;100(2):292–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lachs MS, Pillemer KA. Elder Abuse. N Engl J Med. 2015;373(20):1947–56.

    Article  CAS  PubMed  Google Scholar 

  4. Under the Radar: New York State Elder Abuse Prevalence Study [Internet]. New York, NY: Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, and New York City Department for the Ageing; 2011 May [cited 2016 Oct 12]. Available from: http://ocfs.ny.gov/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf.

  5. Lachs MS, Pillemer K. Elder abuse. Lancet. 2004;364(9441):1263–72.

    Article  PubMed  Google Scholar 

  6. Dyer CB, Pavlik VN, Murphy KP, Hyman DJ. The High Prevalence of Depression and Dementia in Elder Abuse or Neglect. J Am Geriatr Soc. 2000;48(2):205–8.

    Article  CAS  PubMed  Google Scholar 

  7. Lachs MS, Williams C, O’Brien S, Hurst L, Horwitz R. Risk factors for reported elder abuse and neglect: A nine-year observational cohort study. Gerontologist. 1997;37:469–74.

    Article  CAS  PubMed  Google Scholar 

  8. Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, Fitzgerald W. Screening for abuse and neglect of people with dementia. J Am Geriatr Soc. 2010;58(3):493–500.

    Article  PubMed  Google Scholar 

  9. Cooney C, Howard R, Lawlor B. Abuse of vulnerable people with dementia by their carers: Can we identify those most at risk? Int J Geriatr Psychiatry. 2006;21:564–71.

    Article  Google Scholar 

  10. Lachs MS, Teresi JA, Ramirez M, van Haitsma K, Silver S, Eimicke JP, et al. The Prevalence of Resident-to-Resident Elder Mistreatment in Nursing Homes. Ann Intern Med. 2016;165(4):229.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lachs MS, Williams CS, O’Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. JAMA. 1998;280(5):428–32.

    Article  CAS  PubMed  Google Scholar 

  12. Schofield MJ, Powers JR, Loxton D. Mortality and disability outcomes of self-reported elder abuse: a 12-year prospective investigation. J Am Geriatr Soc. 2013;61(5):679–85.

    Article  PubMed  Google Scholar 

  13. Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA. 2009;302(5):517–26.

  14. Dong X, Simon MA. Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project. Am J Emerg Med. 2013;31(4):693–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dong X, Simon MA. Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013;173(10):911–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lachs MS, Williams CS, O’Brien S, Pillemer KA. Adult protective service use and nursing home placement. The Gerontologist. 2002;42(6):734–9.

    Article  PubMed  Google Scholar 

  17. Murphy K, Waa S, Jaffer H, Sauter A, Chan A. A literature review of findings in physical elder abuse. Can Assoc Radiol J J Assoc Can Radiol. 2013;64(1):10–4.

    Article  Google Scholar 

  18. Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF. Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach. Ann Emerg Med. 2016;68(3):378–82.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018;320(16):1678–87.

    Article  PubMed  Google Scholar 

  20. Platts-Mills TF, Dayaa JA, Reeve BB, Krajick K, Mosqueda L, Haukoos JS, et al. Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool. J Elder Abuse Negl. 2018;30(4):247–70.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Platts-Mills TF, Hurka-Richardson K, Shams RB, Aylward A, Dayaa JA, Manning M, et al. Multicenter Validation of an Emergency Department–Based Screening Tool to Identify Elder Abuse. Ann Emerg Med. 2020;76(3):280–90.

  22. Wang ZJ, Dgabureddt P, Prince C, Larsen M, Schimpf M, Pearman G. 2021 Survey of Veteran Enrollees’ Health and Use of Health Care - Data Findings Report [Internet]. Office of Strategic Planning and Analysis (OSPA), Veterans Health Administration; 2021 Sep. Available from: https://www.va.gov/VHASTRATEGY/SOE2021/2021_Enrollee_Data_Findings_Report-508_Compliant.pdf. Accessed 11/17/2023.

  23. Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and Military Sexual Trauma. Am J Public Health. 2007;97(12):2160–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Iverson KM, Adjognon O, Grillo AR, Dichter ME, Gutner CA, Hamilton AB, et al. Intimate Partner Violence Screening Programs in the Veterans Health Administration: Informing Scale-up of Successful Practices. J Gen Intern Med. 2019;34(11):2435–42.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Makaroun LK, Taylor L, Rosen T. Veterans Experiencing Elder Abuse: Improving Care of a High‐Risk Population About Which Little Is Known. J Am Geriatr Soc. 2018;66(2):389–93.

  26. VHA Directive 1199: Reporting Cases of Abuse and Neglect [Internet]. Department of Veterans Affairs, Veterans Health Administration; 2017 [cited 2018 May 7]. Available from: https://www.va.gov/vhapublications/publications.cfm?Pub=1.

  27. Jones LA, Makaroun LK, Boris LM, Halaszynski JJ, Koget JA. To Confront Elder Mistreatment, Look To The VA’s Social Work Response [Internet]. Health Affairs Forefront. 2022 [cited 2023 Jul 3]. Available from: https://www.healthaffairs.org/content/forefront/confront-elder-mistreatment-look-va-s-social-work-response.

  28. MCISc MJYM, PhD CW, MSW ML, MSc DW. Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI)©. J Elder Abuse Negl. 2008;20(3):276–300.

  29. Hwalek MA, Sengstock MC. Assessing the Probability of Abuse of the Elderly: Toward Development of a Clinical Screening Instrument. J Appl Gerontol. 1986;5(2):153–73.

    Article  Google Scholar 

  30. Platts-Mills TF, Sivers-Teixeira T, Encarnacion A, Tanksley B, Olsen B. EM-SART: A Scalable Elder Mistreatment Screening and Response Tool for Emergency Departments. Gener J Am Soc Aging. 2020;44(1):51–8.

    Google Scholar 

  31. Hamilton GP. Prevent Elder Abuse: Using a Family Systems Appraoch. J Gerontol Nurs. 1989;15(3):21.

    Article  CAS  PubMed  Google Scholar 

  32. Dong X. Screening for Elder Abuse in Healthcare Settings: Why Should We Care, and Is It a Missed Quality Indicator? J Am Geriatr Soc. 2015 Aug;63(8):1686–8.

  33. Beach SR, Carpenter CR, Rosen T, Sharps P, Gelles R. Screening and detection of elder abuse: Research opportunities and lessons learned from emergency geriatric care, intimate partner violence, and child abuse. J Elder Abuse Negl. 2016;28(4–5):185–216.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gallione C, Dal Molin A, Cristina FVB, Ferns H, Mattioli M, Suardi B. Screening tools for identification of elder abuse: a systematic review. J Clin Nurs. 2017;26(15–16):2154–76.

    Article  PubMed  Google Scholar 

  35. Dichter ME, Wagner C, Goldberg EB, Iverson KM. Intimate Partner Violence Detection and Care in the Veterans Health Administration: Patient and Provider Perspectives. Womens Health Issues. 2015;25(5):555–60.

    Article  PubMed  Google Scholar 

  36. Dichter ME, Haywood TN, Butler AE, Bellamy SL, Iverson KM. Intimate Partner Violence Screening in the Veterans Health Administration: Demographic and Military Service Characteristics. Am J Prev Med. 2017;52(6):761–8.

    Article  PubMed  Google Scholar 

  37. Iverson KM, King MW, Gerber MR, Resick PA, Kimerling R, Street AE, et al. Accuracy of an intimate partner violence screening tool for female VHA patients: a replication and extension. J Trauma Stress. 2015;28(1):79–82.

    Article  PubMed  Google Scholar 

  38. Makaroun LK, Brignone E, Rosland AM, Dichter ME. Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women. JAMA Netw Open. 2020;3(4):e203138–e203138.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Dichter ME, Sorrentino AE, Haywood TN, Bellamy SL, Medvedeva E, Roberts CB, et al. Women’s Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration. J Gen Intern Med. 2018;33(6):936–41.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Joint Commissions Standard PC 01.02.09 on Victims of Abuse [Internet]. Futures Without Violence. 2014 [cited 2023 Jul 14]. Available from: https://www.futureswithoutviolence.org/joint-commissions-standard-pc-01-02-09-on-victims-of-abuse/.

  41. McQuown C, Gruber E, Runels T, Ragsdale L, Hwang U. 28 Geriatric Emergency Department Accreditation Accelerates Integration of Geriatric Care at the Veterans Health Administration. Ann Emerg Med. 2021;78(4):S12.

    Article  Google Scholar 

  42. Makaroun LK, Halaszynski JJ, Rosen T, Haggerty KL, Blatnik JK, Froberg R, et al. Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool. Acad Emerg Med. 2023;30(4):428–36.

    Article  PubMed  Google Scholar 

  43. Shay K, Hyduke B, Burris JF. Strategic Plan for Geriatrics and Extended Care in the Veterans Health Administration: Background, Plan, and Progress to Date. J Am Geriatr Soc. 2013;61(4):632–8.

    Article  PubMed  Google Scholar 

  44. Health Services Research Priority Research Areas [Internet]. 2023 p. 13. Available from: https://www.hsrd.research.va.gov/funding/PriorityDomains.pdf. Accessed 1/1/2024.

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Acknowledgements:

We would like to acknowledge and thank Jennifer Koget, MS, LCSW, National Director of Social Work, Fisher House & Family Hospitality and Intimate Partner Violence Assistance Programs for the Veterans Health Administration, for her support in the initial publicizing and distribution of the elder abuse screening evaluation to national sites. We would also like to acknowledge and thank Scott Beach, PhD, for his input on earlier versions of the screening evaluation questions.

Funding

This work was funded by the US Department of Veterans Affairs (VA HSR&D CDA grant number IK2HX003330 to L. K. M.) and the National Institutes of Health (grant number K76 AG054866 to T. R.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US Department of Veterans Affairs or the National Institutes of Health. The sponsors had no role in the design, methods, data collection, analysis, or preparation of this paper.

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Authors and Affiliations

  1. VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Lena K. Makaroun MD, MS, Karley Atchison MA, Ann-Marie Rosland MD, MS & Carolyn T. Thorpe PhD, MPH

  2. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Lena K. Makaroun MD, MS & Ann-Marie Rosland MD, MS

  3. VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Lena K. Makaroun MD, MS

  4. Butler VA Health Care System, Butler, PA, USA

    Jaime J. Halaszynski MSW

  5. Fargo VA Health Care System, Fargo, ND, USA

    Kathrine A. Smith MSW

  6. G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA

    Ruth Drake MSW

  7. Hines VA Medical Center, Hines, IL, USA

    Vanessa Amelio-Hering MSW

  8. VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Melissa E. Dichter PhD

  9. School of Social Work, Temple University Philadelphia, Philadelphia, PA, USA

    Melissa E. Dichter PhD

  10. Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA

    Carolyn T. Thorpe PhD, MPH

  11. Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, NY, USA

    Tony Rosen MD, MPH

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  1. Lena K. Makaroun MD, MS
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Contributions

Conceptualization: L. K. M., C. T. T., T. R., A. M. R.; data collection: M. K. M., H. Z., E. L.; data analysis: L. K. M., M. K. M., H. Z., E. L.; data interpretation: L. K. M., C. T. T., M. K. M., T. R., M. E. D., A. M. R.; writing—original draft preparation: L. K. M.; writing—review and editing: L. K. M., C. T. T., M. K. M., H. Z., E. L., T. R., M. E. D., A. M. R.; final approval: L. K. M., C. T. T., M. K. M., H. Z., E. L., T. R., M. E. D., A. M. R. The corresponding author (L. K. M.) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Lena K. Makaroun MD, MS.

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Makaroun, L.K., Halaszynski, J.J., Smith, K.A. et al. Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-023-08560-2

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