Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases.

Study Objective: Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls.

Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect.

Background: Emergency Medical Services (EMS) providers, who perform initial assessments of ill and injured patients, often in a patient's home, are uniquely positioned to identify potential victims of elder abuse, neglect, or self-neglect. Despite this, few organized programs exist to ensure that EMS concerns are communicated to or further investigated by other health care providers, social workers, or the authorities.

Objective: To explore attitudes and self-reported practices of EMS providers surrounding identification and reporting of elder mistreatment.

Introductory Emergency Medicine Clinical Skills Course: A Daylong Course Introducing Preclinical Medical Students to the Role of First Responders.

Introduction: A complete medical school curriculum must include an introduction to first aid; the management of airway, breathing, and circulation; and basic medical emergencies. The September 11, 2001, terrorist attacks in New York underscored the need for such training for US students even in their preclinical years. During that tragedy, many Weill Cornell Medical College (WCMC) preclinical students were eager to volunteer at Ground Zero and in the emergency department, yet it was clear they were not prepared for even basic medical emergencies this early in their training.

Describing visible acute injuries: development of a comprehensive taxonomy for research and practice.

Background: Little literature exists classifying and comprehensively describing intentional and unintentional acute injuries, which would be valuable for research and practice. In preparation for a study of injury patterns in elder abuse, our goal was to develop a comprehensive taxonomy of relevant types and characteristics of visible acute injuries and evaluate it in geriatric patients.

Methods: We conducted an exhaustive review of the medical and forensic literature focusing on injury types, descriptions, patterns and analyses.

Imaging Findings in Elder Abuse: A Role for Radiologists in Detection.

Purpose: Emergency department assessment represents a critical but often missed opportunity to identify elder abuse, which is common and has serious consequences. Among emergency care providers, diagnostic radiologists are optimally positioned to raise suspicion for mistreatment when reviewing imaging of geriatric injury victims. However, little literature exists describing relevant injury patterns, and most radiologists currently receive neither formal nor informal training in elder abuse identification.

Radiologists' Training, Experience, and Attitudes About Elder Abuse Detection.

Objective: Elder abuse is underrecognized, and identification of subtle cases requires a high index of suspicion among all health care providers. Because many geriatric injury victims undergo radiographic imaging, diagnostic radiologists may be well positioned to identify injury patterns suggestive of abuse. Little is known about radiologists' experience with elder abuse.

Geriatric assault victims treated at U.S. trauma centers: Five-year analysis of the national trauma data bank.

Introduction: While geriatric trauma patients have begun to receive increased attention, little research has investigated assault-related injuries among older adults. Our goal was to describe characteristics, treatment, and outcomes of geriatric assault victims and compare them both to geriatric victims of accidental injury and younger assault victims.

Patients And Methods: We conducted a retrospective analysis of the 2008-2012 National Trauma Data Bank.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse.

Increasing frequency and fatality of poison control center reported exposures involving medication and multiple substances: data from reports of the American Association of Poison Control Centers 1984-2013.

Context: Medication use has become increasingly prevalent in the United States, with up trending use of both prescription and over the counter medication. The increasing use and availability of medication may be changing the nature of poisoning fatality.

Objective: To evaluate changes in fatal poisoning over time, with respect to fatalities involving one or more medications, using annual reports published by the American Association of Poison Control Centers (AAPCC).

The ED as the primary source of hospital admission for older (but not younger) adults.

Introduction: The elderly population in the United States is growing. This age shift has important implications for emergency departments (EDs), which currently account for more than 50% of inpatient hospitalizations. Our objective was to compare the percentage of inpatient admissions starting in the ED between elderly and younger patients.

Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice.

Background: Photographing injuries in the acute setting allows for improved documentation as well as assessment by clinicians and others who have not personally examined a patient. This tool is important, particularly for telemedicine, tracking of wound healing, the evaluation of potential abuse, and injury research. Despite this, protocols to ensure standardization of photography in clinical practice, forensics, or research have not been published.

Emergency Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse.

Background: Elder abuse is under-recognized by emergency department (ED) providers, largely due to challenges distinguishing between abuse and accidental trauma.

Objective: To describe patterns and circumstances surrounding elder abuse-related and potentially abuse-related injuries in ED patients independently known to be physical elder abuse victims.

Methods: ED utilization of community-dwelling victims of physical elder abuse in New Haven, CT from 1981-1994 was analyzed previously.

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department.

Objectives: Indwelling urinary catheters (IUCs) are placed frequently in older adults (age ≥ 65 years) in the emergency department (ED) and carry significant risks. The authors developed, implemented, and assessed a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in elders in the ED.

Methods: A comprehensive, evidence-based clinical protocol was built from an extensive literature review and ED provider focus groups.

Assessment and Management of Delirium in Older Adults in the Emergency Department: Literature Review to Inform Development of a Novel Clinical Protocol.

Delirium occurs frequently in older patients in the emergency department (ED), is underrecognized, and has potentially serious consequences. Despite its seriousness, delirium is frequently missed by emergency providers, and patients with unrecognized delirium are often discharged from the ED. Even when it is appropriately recognized, managing delirium in older adults poses a significant challenge for ED providers.

Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults: Knowledge, Attitudes, and Practice.

Unlabelled: Indwelling urinary catheters (IUCs) are placed frequently in older adults in the emergency department (ED). Though often a critical intervention, IUCs carry significant risks. Our objective was to examine current knowledge, attitudes, and practice of emergency nurses and other providers regarding IUC placement and management in older adults.

Provider perspectives on the use of indwelling urinary catheters in older adults in emergency department settings: developing a novel clinical protocol.

Background: Indwelling urinary catheters (IUCs) are commonly placed in older adult (aged ≥ 65 years) patients in emergency department (ED) settings, often for inappropriate indications. The aim of our qualitative study was to explore ED provider knowledge, attitudes, and practice patterns surrounding use of IUCs in older adult patients in the ED setting, to better guide development of a clinical protocol.

Methods: We conducted 4 focus groups with 38 participants at a large academic medical center.

Trends in short-stay hospitalizations for older adults from 1990 to 2010: implications for geriatric emergency care.

Introduction: Geriatric patients are more likely than younger patients to be admitted to the hospital when they present to the emergency department (ED). Identifying trends in geriatric short-stay admission may inform the development of interventions designed to improve acute care for the elderly.

Objective: To evaluate trends in US geriatric short-stay hospitalizations from 1990 to 2010.

Improving front-end flow in an urban academic medical center emergency department: the emergency department discharge facilitator team.

Length of stay (LOS) is an important determinant of patient satisfaction and overall emergency department (ED) operational efficiency. In an effort to reduce length of stay for low-acuity "treated and released" patients, our department created a discharge facilitator team (DFT) composed of an attending physician, physician assistant, and registered nurse. The DFT identified patients who could be rapidly treated and released in the low-acuity treatment Adult Urgent Care Center (AUCC) and provided them rapid treatment and discharge.

A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model.

Study Objective: We inform the future development of a new geriatric emergency management practice model. We perform a systematic review of the existing evidence for emergency department (ED)-based case management models designed to improve the health, social, and health service utilization outcomes for noninstitutionalized older patients within the context of an index ED visit.

Methods: This was a systematic review of English-language articles indexed in MEDLINE and CINAHL (1966 to 2010), describing ED-based case management models for older adults.

Emergency department presentation of bilateral carotid artery dissections in a postpartum patient.

Spontaneous unilateral postpartum carotid arterial dissection is a rarely reported event. This is the first reported case of bilateral carotid artery dissection. A 35-year-old gravida 4, para 3 woman presented to our emergency department with complaint of headache for 3 days.