Multicenter Validation of an Emergency Department–Based Screening Tool to Identify Elder Abuse - 20/08/20
, Karen Hurka-Richardson, NP a, Rayad B. Shams, BS a, Aileen Aylward, MSW, MPH a, Joseph A. Dayaa, BA b, Melinda Manning, JD, MSW c, Laura Mosqueda, MD d, Jason S. Haukoos, MD, MSc e, Mark A. Weaver, PhD f, Philip D. Sloane, MD, MPH g, Debbie Travers, PhD, RN h, Phyllis L. Hendry, MD i, Ashley Norse, MD i, Christopher W. Jones, MD j, Samuel A. McLean, MD, MPH k, Bryce B. Reeve, PhD l, Sheryl Zimmerman, PhD m, Investigators for the ED Senior AID Research Group
Katie Davenport, MD a, Debra Bynum, MD n, Emilia Frederick, RN c, Kim Lassiter-Fisher, MSW o, Amy Stuckey, MSW c, Racquel Daley-Placide, MD p, Mark Hoppens, MD a, Judy Betterton, LCSW c, Samantha Owusu, LCSW c, Cynthia Flemming, LCSW c, Andrew Colligan, RN jAbstract |
Study objective |
Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse.
Methods |
We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool.
Results |
Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%).
Conclusion |
This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.
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| Investigators for the ED Senior AID Research Group: Katie Davenport, MD, Debra Bynum, MD, Emilia Frederick, RN, Kim Lassiter-Fisher, MSW, Amy Stuckey, MSW, Racquel Daley-Placide, MD, Mark Hoppens, MD, Judy Betterton, LCSW, Samantha Owusu, LCSW, Cynthia Flemming, LCSW, Andrew Colligan, RN |
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| Please see page 281 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: David L. Schriger, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: TPM, SZ, PDS, BR, NR, JD, SM, LM, JH, MW, and DT conceived the study, designed the trial, and obtained research funding. TPM, CJ, PH, AN, and MM supervised the conduct of the trial and data collection at each site. KHR, RBS, AA, and AC were responsible for ED data collection through recruitment of participants and administration of the screening tool and the SSBE. LEAD panel data that were used as the reference standard were provided by KD, DB, EF, KLF, AS, RDP, MH, JB, SO, and CF. KHR and RBS performed data management, quality control, and data analysis. MW and JH provided statistical advice on study design and analysis. TPM, KHR, and RBS drafted the manuscript, and all authors contributed substantially to its revision. TPM takes responsibility for the paper as a whole. |
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| All authors attest to meeting the 4 ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was supported by Award No. 2015-IJ-CX-0022 from the National Institute of Justice, US Department of Justice. The opinions, findings, and conclusions expressed in this publication are those of the authors and do not necessarily reflect those of the Department of Justice. |
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Vol 76 - N° 3
P. 280-290 - septembre 2020 Retour au numéro
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