How Geriatricians Identify Elder Abuse and Neglect
How Geriatricians Identify Elder Abuse and Neglect
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老年病学家如何识别虐待和忽视老年人的行为
DOI：
10.1097/00000441-200201000-00006
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
C. Bitondo Dyer
中科院分区：
文献类型：
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作者：
R. Harrell;C. Toronjo;Jan McLaughlin;V. Pavlik;D. Hyman;C. Bitondo Dyer
背景：在美国，每年有多达200万老年人受到虐待或忽视。虽然老年患者平均每年看医生五次，但医生向成人保护服务机构（APS）报告的比例很小。本研究的目的是了解如何执业老年病学家定义，诊断，并解决虐待和忽视提供一些指导忙碌一般内科医生关于这个复杂的问题。方法：用一组标准化的开放式问题采访了十名当地老年病医生。一个小组用定量和定性的方法分析了逐字翻译。结果：平均每年确诊病例数为8.7例（范围，2-20）。老年病学家对虐待和忽视老人的定义以及他们如何通过病史和体格检查进行诊断是相当一致的。病史中最常见的发现是患者与照顾者之间的融洽关系、医疗不依从、日常生活活动和日常生活评估的工具活动以及社交活动的丧失。体格检查中最常见的结果是瘀伤/创伤、一般外观/卫生状况、营养不良和脱水。结论：老年医学家强调要对每一位病人都要牢记虐待和忽视的诊断。医生采用了各种干预措施，从自动呼叫APS到通过与跨学科老年医学团队合作解决病例。
Background: Up to 2 million elderly persons are abused or neglected in the United States each year. Although elderly patients see their physicians an average of five times per year, physicians make only a small percentage of reports to Adult Protective Services (APS) agencies. The purpose of this study was to learn how practicing geriatricians define, diagnose, and address abuse and neglect to provide some guidance to the busy general internist regarding this complex issue. Methods: Ten local geriatricians were interviewed with a standardized set of open‐ended questions. A team analyzed the verbatim transcriptions using both quantitative and qualitative methods. Results: The average number of cases diagnosed per year was 8.7 (range, 2–20). The geriatricians were fairly consistent in their definitions of elder abuse and neglect and how they diagnosed it through the history and physical exam. The most common findings in the history were rapport between the patient and caregiver, medical noncompliance, activities of daily living and instrumental activities of daily living assessments, and loss of social activities. The most common findings on the physical exam were bruising/trauma, general appearance/hygiene, malnutrition, and dehydration. Conclusions: The geriatricians emphasized keeping the diagnosis of abuse and neglect in mind for every patient. A variety of interventions were employed by physicians and ranged from automatically calling APS on each case to addressing cases through work with an interdisciplinary geriatrics team.