How radiologists can help detect cases of physical elder abuse

Healthcare providers are often tasked with detecting physical abuse of elderly patients and initiating intervention. Emergency radiologists, in particular, may be able to do more in this area, according to an article published July 15 by the Journal of the American College of Radiology.   

Many emergency radiologists and imaging professionals don't know how to screen for and diagnose abuse, wrote lead author Mihan Lee, MD, PhD, and colleagues. 

Lee and colleagues explained that radiologists are often unknowledgeable about evaluating possible elder abuse because of difficulty associated determining an injury’s cause. Many imaging professionals lack training in elder abuse and feel unprepared and unqualified. 

Previous research has suggested a solution to these obstacles can be a "mechanism mismatch”—or an injury pattern inconsistent with the mechanism being described by the patients or their caregivers. 

"First, the corollary of developmental stage in older adults is functional or ambulatory status, which can vary widely between two patients of the same age," Lee et al. wrote. "Without reliable age-related milestones from which to infer it, communication between frontline clinicians and radiologists is the only way to document and pass on this information; unfortunately, this communication commonly does not occur in the ED, leaving radiologists without critical information they need to assess for potential elder abuse."

A radiologist's limited capacity to contribute to an elder abuse evaluation is both a consequence of and potential contributor to the lack of knowledge about imaging findings of abuse, according to the authors. 

To expand and optimize the role of radiologists in these cases, the authors proposed ongoing research to find definitive imaging correlates of elder abuse and other methods for identifying relevant elder abuse cases. Additionally, cultural and practical modifications to ED workflows must enable radiologists to contribute confidently to elder abuse detection, the authors wrote. 

"As radiologists gain experience with elder abuse cases, our hope is that they will be increasingly empowered to build new imaging strategies and tools for elder abuse detection and management," according to the authors.