应对虐待老人问题的流行：创伤中心针对虐待老人问题的干预措施存在差异。
Dealing with the elder abuse epidemic: Disparities in interventions against elder abuse in trauma centers.
机构信息
Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA.
Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2023 Jun;71(6):1735-1748. doi: 10.1111/jgs.18286. Epub 2023 Mar 6.
BACKGROUND
Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults.
METHODS
Analysis of the 2017-2018 ACS TQIP. All trauma patients ≥60 years with an abuse report for suspected physical abuse were included. Patients with missing information on abuse interventions were excluded. Outcomes were rates of abuse investigation initiation following an abuse report and change of caregiver at discharge among survivors with an abuse investigation initiated. Multivariable regression analyses were performed.
RESULTS
Of 727,975 patients, 1405 (0.2%) had an abuse report. Patients with an abuse report were younger (mean, 72 vs 75, p < 0.001), and more likely to be females (57% vs 53%, p = 0.007), Hispanic (11% vs 6%, p < 0.001), Black (15% vs 7%, p < 0.001), suffer from dementia (18% vs 11%, p < 0.001), functional disability (19% vs 15%, p < 0.001), have a positive admission drug screen (9% vs 5%, p < 0.001) and had a higher ISS (median [IQR], 9 [4-16] vs 6 [3-10], p < 0.001). Perpetrators were members of the immediate/step/extended family in 91% of cases. Among patients with an abuse report, 1060 (75%) had abuse investigations initiated. Of these, 227 (23%) resulted in a change of caregiver at discharge. On multivariate analysis for abuse investigation initiation, male gender, private insurance, and management at non-level I trauma centers were associated with lower adjusted odds (p < 0.05), while Hispanic ethnicity, positive admission drug screen, and penetrating injury were associated with higher adjusted odds (p < 0.05). On multivariate analysis for change of caregiver, male gender, and private insurance were associated with lower adjusted odds (p < 0.05), while functional disability and dementia were associated with higher adjusted odds (p < 0.05).
CONCLUSIONS
Significant gender, ethnic, and socioeconomic disparities exist in the management of physical abuse of older adults. Further studies are warranted to expand on and address the contributing factors underlying these disparities.
LEVEL OF EVIDENCE
III.
STUDY TYPE
Therapeutic/Care Management.
背景
虐待老人是导致伤害、发病和死亡的一个主要原因。我们旨在确定与对老年人疑似身体虐待的干预措施相关的因素。
方法
对 2017-2018 年 ACS TQIP 的分析。所有年龄≥60 岁且有疑似身体虐待报告的创伤患者均被纳入。排除虐待干预措施缺失信息的患者。结局为在报告虐待后开始虐待调查的比例和幸存者出院时照顾者的变化，其中开始虐待调查的患者。进行多变量回归分析。
结果
在 727975 例患者中，有 1405 例（0.2%）有虐待报告。有虐待报告的患者更年轻（平均年龄 72 岁比 75 岁，p<0.001），更有可能是女性（57%比 53%，p=0.007），西班牙裔（11%比 6%，p<0.001），黑人（15%比 7%，p<0.001），患有痴呆症（18%比 11%，p<0.001），功能障碍（19%比 15%，p<0.001），入院药物筛查阳性（9%比 5%，p<0.001），ISS 较高（中位数[IQR]，9[4-16]比 6[3-10]，p<0.001）。91%的情况下，虐待的施害者是直系亲属/继父母/姻亲。在有虐待报告的患者中，有 1060 例（75%）进行了虐待调查。其中，227 例（23%）导致出院时照顾者发生变化。多变量分析显示，男性、私人保险和非 I 级创伤中心治疗与调整后较低的可能性相关（p<0.05），而西班牙裔、入院药物筛查阳性和穿透性损伤与调整后较高的可能性相关（p<0.05）。多变量分析显示，男性和私人保险与照顾者变化的可能性较低相关（p<0.05），而功能障碍和痴呆与可能性较高相关（p<0.05）。
结论
在老年人身体虐待的管理中存在显著的性别、种族和社会经济差异。需要进一步研究来扩展和解决这些差异背后的促成因素。
证据水平
III。
研究类型
治疗/护理管理。
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