title: Diagnosis of Elder Abuse in U.S. Emergency Departments.
abstract: To estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets.
  
  
  
  Retrospective cross-sectional analysis.
  
  
  
  U.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS).
  
  
  
  All ED visits of individuals aged 60 and older.
  
  
  
  The primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse.
  
  
  
  In 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012-0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68-2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36-3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84-2.65), and septicemia (OR = 1.92, 95% CI = 1.44-2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits.
  
  
  
  The proportion of U.S. ED visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population. Efforts to improve the identification of elder abuse in EDs may be warranted.
authors.affiliation: School of Medicine, University of California, San Diego, California.|Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Evans
authors.affiliation: School of Medicine, University of Virgina, Charlottesville, Virginia.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Hunold
authors.affiliation: Division of Emergency Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Tony
authors.initials: T
authors.lastname: Rosen
authors.affiliation: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003288:Contusions / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004552:Elder Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology
keywords: elder abuse; emergency department; prevalence