title: Mapping the elder mistreatment iceberg: U.S. hospitalizations with elder abuse and neglect diagnoses.
abstract: OBJECTIVE
  This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM).
  
  
  METHODS
  Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older.
  
  
  RESULTS
  Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63-2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than "routinely" discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92-4.59). Elder mistreatment-coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389).
  
  
  CONCLUSIONS
  Knowledge about EM is often likened to the "tip of the iceberg." Our study contributes to "mapping the EM iceberg"; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.
authors.affiliation: Department of Family Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103, USA. rovisl@umdnj.edu
authors.forename: Sue
authors.initials: S
authors.lastname: Rovi
authors.forename: Ping-Hsin
authors.initials: PH
authors.lastname: Chen
authors.forename: Marielos
authors.initials: M
authors.lastname: Vega
authors.forename: Mark S
authors.initials: MS
authors.lastname: Johnson
authors.forename: Charles P
authors.initials: CP
authors.lastname: Mouton
mesh_terms: D000368:Aged; D004552:Elder Abuse / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology