Recognition and perception of elder abuse by prehospital and hospital-based care providers

The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers suspected the existence of abuse, neglect and domestic violence among the elderly were not rare events. In Maryland, there are a limited number of specific educational programs dealing with abuse and neglect of the elderly. A statewide training program is needed to ensure PCP and HCP can recognize the signs and symptoms of elder abuse and neglect, and to ensure that the providers are aware of their legal requirements for reporting the abuse to the proper state or local agencies.