Diagnosis of Elder Abuse in US Emergency Departments
Diagnosis of Elder Abuse in US Emergency Departments
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DOI：
10.1111/jgs.14480
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发表时间：
2017-01-01
影响因子：
6.3
通讯作者：
Platts-Mills, Timothy F.
中科院分区：
文献类型：
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作者：
Evans, Christopher S.;Hunold, Katherine M.;Platts-Mills, Timothy F.
目标使用两个具有全国代表性的数据集来估计前往美国急诊室 (ED) 诊断为虐待老年人的就诊比例。设计回顾性横断面分析。 2012 年全国急诊科样本 (NEDS) 或 2011 年全国医院门诊医疗调查 (NHAMCS) 中记录的急诊就诊次数。参与者所有 60 岁及以上的急诊科就诊患者。测量主要结果是根据国际疾病分类第九版临床修改诊断代码定义的虐待老年人行为。使用调查权重估计虐待老年人的就诊比例。计算比值比 (OR) 以确定人口特征和与虐待老年人相关的常见急诊诊断。结果 2012 年，NEDS 包含有关老年人 6,723,667 次急诊就诊的信息，相当于估计 29,056,673 次急诊就诊。估计有 3,846 次就诊被诊断为虐待老人，相当于美国急诊室中虐待老人的加权诊断期患病率为 0.013%（95% 置信区间 (CI) = 0.012-0.015%）。忽视和身体虐待是最常见的诊断类型，分别占病例的 32.9% 和 32.2%。多变量分析显示，女性（比值比 (OR) = 1.95，95% CI = 1.68-2.26）和患有挫伤（OR = 2.91，95% CI = 2.36-3.57）、尿路感染（OR = 2.21，95% CI = 1.84-2.65）和败血症的个体被诊断为虐待老人的加权几率更大（OR = 1.92，95% CI = 1.44-2.55）。在 2011 年 NHAMCS 数据集中，在 5,965 名急诊就诊的老年人中，没有记录到虐待老年人的案例。 结论 在美国，被诊断为虐待老人的老年人在急诊就诊的比例至少比人口中估计患病率低两个数量级。可能有必要努力提高急诊室虐待老年人行为的识别率。
ObjectivesTo 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.DesignRetrospective cross-sectional analysis.SettingU.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS).ParticipantsAll ED visits of individuals aged 60 and older.MeasurementsThe 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.ResultsIn 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.ConclusionThe 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.