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

Abstract

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.

Methods: We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014.

Results: We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%).

Conclusion: Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.

Figure 1:

Flow diagram showing sources of case and control patients

Figure 2:. Comparison of precise locations of bruises in the maxillofacial/dental/neck region in physical elder abuse victims with visible injuries vs. matched unintentional fallers with visible injuries presenting to an urban, academic emergency department

Note: This figure is a visual representation of how commonly bruises were found in precise locations among case and control patients. Within the figure, we have placed a circle in each precise location where bruise(s) were found. 171 bruises in cases and 61 bruises in controls contributed to this diagram because they were in at least one precise location within the maxillofacial / dental / neck body region. For bruises that covered multiple precise locations, the diagram represents them in all of these precise locations. The size of each circle’s area corresponds directly to the total number of bruises in that precise location among all case or control patients. To ensure visibility of circles, precise locations with 1–3 bruises are shown with circles with the same area.