Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, NY, USA.
J Gen Intern Med. 2019 Apr;34(4):567-574. doi: 10.1007/s11606-019-04844-8. Epub 2019 Feb 13.
Standardization in tools and documentation of child abuse and intimate partner violence have proven helpful in completely documenting injuries and suspected abuse among these populations. Similar tools do not yet exist for older adults and elder abuse.
To (1) use insights from experts to develop a tool to assist clinicians in appropriately and completely documenting physical findings in injured older adults for potential future forensic investigation of abuse or neglect and (2) to assess the feasibility of incorporating this tool into clinical practice.
Two-phase, exploratory qualitative study. Phase 1: individual interviews with elder abuse experts from various specialties in medicine and criminal justice. Phase 2: focus groups with anticipated end users of the tool.
Phase 1 telephone-based key informant interviews were conducted with 11 elder abuse experts (2 detectives, 3 prosecutors, 1 forensic pathologist, 2 geriatricians, and 3 emergency medicine physicians). Phase 2 focus groups were conducted among emergency medicine (n = 10) and primary care (n = 8) providers.
Key informant interviews were conducted telephonically while the two focus groups were held in-person at an emergency medicine site in New York, NY, and a primary care site in Los Angeles, CA.
Experts agreed that medical providers' documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records.
A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome.
在儿童虐待和亲密伴侣暴力的工具和文件记录方面的标准化已经被证明有助于全面记录这些人群中的伤害和疑似虐待情况。类似的工具在老年人和老年虐待方面还不存在。
（1）利用专家的见解开发一种工具，帮助临床医生适当地、完整地记录受伤老年人的身体发现，以便将来对虐待或忽视进行法医调查；（2）评估将该工具纳入临床实践的可行性。
两阶段、探索性定性研究。第 1 阶段：与来自医学和刑事司法各专业领域的老年虐待专家进行个人访谈。第 2 阶段：对预期的工具最终用户进行焦点小组讨论。
第 1 阶段通过电话进行了 11 名老年虐待专家（2 名侦探、3 名检察官、1 名法医病理学家、2 名老年病学家和 3 名急诊医学医生）的关键信息员访谈。第 2 阶段的焦点小组在急诊医学（n=10）和初级保健（n=8）提供者中进行。
关键信息员访谈通过电话进行，而两个焦点小组则在纽约州纽约市的一个急诊医学地点和加利福尼亚州洛杉矶市的一个初级保健地点现场进行。
专家们一致认为，医疗服务提供者对老年伤害的记录通常不足以调查涉嫌的老年虐待/忽视。他们强调了法医调查所需的要素：在开始治疗之前的初始外观、从头到脚的全面评估、记录所有伤害（即使是轻微伤害）以及记录所有相关的否定因素。有几位专家指出照片对补充书面记录的价值。最终用户确定了使用工具的实际挑战，包括在繁忙的临床环境中额外或并行记录的负担，以及如何将其整合到现有的电子病历中。
一个实用的工具，可以改善潜在法医使用的老年伤害的医疗记录，这将是有价值的。必须克服利用该工具的实际挑战。
