Radiologists could do more to help fight elder abuse—and they want to

In a small yet important study at a large and influential hospital, 19 diagnostic radiologists were able to identify injuries suggestive of elder abuse. Only two of the participants had any prior training in this area, and all said they’d like to receive more.  

The findings were published online Oct. 12 in the American Journal of Roentgenology.

Tony Rosen, MD, MPH, of Weill Cornell and colleagues interviewed radiologists at New York-Presbyterian Hospital in a semistructured format, then coded and analyzed data from these sessions to identify themes.

Prior to the interviews, the participants had red-flagged the same kinds of radiographic findings that often indicate child abuse.

These include wounds in multiple stages of healing, injuries that seem inconsistent with causes as described by patients or their guardians, high-energy injuries such as upper rib fractures, and bruises to the ulnar forearm that suggest a defensive posture against an attacker.

In the interviews, all the radiologists said they believed they had missed cases of elder abuse in their practice.

None had ever received a request from a referring physician to assess images for evidence pointing to possible elder abuse.

A participating experienced neuroradiologist told the team, “With child abuse, often the referring physician will let us know they suspect child abuse. I have yet to have anyone tell me [in an 18-year career] that they suspect elder abuse.”

“The ED does not usually provide us with a good history,” an emergency attending radiologist said. “I may just get ‘fall’ or ‘found down.’ I don't know if they were found down in a nursing home, in their own home or in the street.”

In their discussion, Rosen and colleagues express their surprise that no participants had any experience with identifying elder abuse.

Given how widespread the problem of elder abuse is known to be, this observed lack of experience “underscores the importance of training radiologists and raising their awareness,” they write. “[E]lder abuse will not be detected unless it is considered as a differential diagnosis.”

“Though training in detection is currently lacking, providers expressed a desire for increased knowledge,” the authors conclude. “In addition, radiologists were able to identify radiographic findings suggestive of elder abuse. On the basis of these findings, we plan to conduct additional studies to define pathognomonic injury patterns and to explore how to empower radiologists to incorporate detection into their practice.”