title: Neglect assessment in urban emergency departments and confirmation by an expert clinical team.
abstract: BACKGROUND
  Elder neglect accounts for over 70% of all adult protective services reports in the nation annually, and it has been estimated that there are over 70,000 new cases each year. The purpose of this study was to conduct elder neglect research in the emergency department (ED), using a dyadic vulnerability/risk-profiling framework for elder neglect.
  
  
  METHODS
  Patients were recruited through four EDs in New York and Tampa from the beginning of February 2001 through the end of September 2003. Demographics, a Mini-Mental Status Examination score, and an initial elder assessment screen were collected. The diagnosis of neglect was then made by a Neglect Assessment Team (NAT) comprising a nurse, physician, and social worker, with extensive clinical experience in elder neglect.
  
  
  RESULTS
  Of the 3664 ED screens of adults 70 years and older, 405 (11%) met the inclusion criteria and agreed to participate. Neglect was diagnosed by the NAT in 86 of the 405 cases reviewed. Demographic differences between neglect versus no neglect cases were examined using Fisher's exact test, and differences emerged between the 2 groups.
  
  
  CONCLUSIONS
  This study documents the underreporting of cases of neglect as evidenced by differences in diagnoses by screeners versus experts. The research assistants screened positive for neglect in 5% (N=22) of the 405 cases. The NAT made the diagnosis of neglect in 22% (86/389) of the cases. This markedly different rate of neglect may mean that ED screens are important but may underestimate the true number of cases. Conversely, an NAT may make the diagnosis of neglect in an older adult more often given a higher sensitivity and a more robust knowledge base of the problem.
authors.affiliation: College of Nursing, New York University, 246 Greene Street, New York, NY 10003-6677, USA. terryfulmer.don@nyu.edu
authors.forename: Terry
authors.initials: T
authors.lastname: Fulmer
authors.forename: Gregory
authors.initials: G
authors.lastname: Paveza
authors.forename: Carla
authors.initials: C
authors.lastname: Vandeweerd
authors.forename: Lisa
authors.initials: L
authors.lastname: Guadagno
authors.forename: Susan
authors.initials: S
authors.lastname: Fairchild
authors.forename: Robert
authors.initials: R
authors.lastname: Norman
authors.forename: Ivo
authors.initials: I
authors.lastname: Abraham
authors.forename: Marguarette
authors.initials: M
authors.lastname: Bolton-Blatt
mesh_terms: D000368:Aged; D004552:Elder Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005104:Expert Testimony; D005260:Female; D005431:Florida; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D009518:New York; D012307:Risk Factors; D014481:United States