Abstract
Elder mistreatment is underdetected and underreported. The more than 800 000 medics providing services in every county in the United States represent an important and underused surveillance system. To investigate the association between the Detection of Elder Mistreatment Through Emergency Care Technician (DETECT) screening tool use and the number of medic reports made to Adult Protective Services (APS) over a period of approximately 3 years. This quality improvement study used a difference in difference in differences design and included adults aged 65 years and older who were reported to Texas APS in the study region (246 cities in Denton, Johnson, and Tarrant Counties) between December 31, 2014, and February 28, 2018. The DETECT screening tool. Reports to APS. The mean (SD) age of the 11 178 older adults included in this study was 76 (8) years (range, 65-105 years); there was no reported data on patient sex. A total of 18 080 reports of elder mistreatment were recorded. Medics within the study region reported more cases of elder mistreatment during the implementation of the screening tool (relative risk [RR], 4.14; 95% CI, 3.25-5.27). After adjusting for changes in the number of elder mistreatment reports in the comparison groups (ie, underlying changes in reporting trends), the number of reports to APS increased (RR, 3.03; 95% CI, 2.06-4.46). The occurrence of elder mistreatment was validated in 83% (95% CI, 75%-91%) of the reports investigated by APS during the periods when medics did not have access to the screening tool compared with 82% (95% CI, 77%-87%) during the periods when medics had access to the screening tool, indicating that there were no differences in the proportion of reports that resulted in a validated APS investigation. The findings suggest that incorporating the DETECT screening tool into the routine practices of medics is associated with substantial increases in the frequency with which clinicians report potential cases of elder mistreatment to APS.
Highlights
The occurrence of elder mistreatment was validated in 83% of the reports investigated by Adult Protective Services (APS) during the periods when medics did not have access to the screening tool compared with 82% during the periods when medics had access to the screening tool, indicating that there were no differences in the proportion of reports that resulted in a validated APS investigation
The findings suggest that incorporating the DETECT screening tool into the routine practices of medics is associated with substantial increases in the frequency with which clinicians report potential cases of elder mistreatment to APS
Meaning The findings suggest that incorporating the DETECT tool into the routine practices of medics is associated with substantial increases in the frequency with which they report potential cases of elder mistreatment to Adult Protective Services
Summary
The most widely cited estimate of the annual prevalence of elder mistreatment is approximately 11% of cognitively intact adults aged at least 60 years.[9] this statistic is based on self-report of elder mistreatment collected using a random digit dial telephone survey, and the authors of that study cautioned that these were “precisely the types of events that are notoriously underreported in this age group.”9(p.296) Acierno and colleagues[9] found that only a small number of the instances of elder mistreatment that were disclosed to their research team were reported to the authorities (between 7.9% and 31.0% depending on elder mistreatment subtype). Effective and efficient tools that help to identify older adults who are living with abuse or neglect to connect them with services are urgently needed
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