Gagnon Samuel, Nadeau Alexandra, Tanguay Katherine, Archambault Patrick M, Brousseau Audrey-Anne, Carmichael Pierre-Hugues, Emond Marcel, Deshaies Jean-Francois, Benhamed Axel, Blanchard Pierre-Gilles, Mowbray Fabrice I, Mercier Eric
Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada.
VITAM-Centre de recherche en santé durable, Quebec, QC, Canada.
CJEM. 2023 Dec;25(12):953-958. doi: 10.1007/s43678-023-00600-4. Epub 2023 Oct 18.
Elder abuse is associated with impaired physical and psychological health. It is, however, rarely identified in emergency departments (EDs). The objective was to determine the prevalence and the predictors of elder abuse among older adults visiting EDs.
This prospective cohort study was conducted in eight Canadian EDs between May and August 2021. Patients were eligible if they were ≥ 65 years old, oriented to time, and with a Canadian Triage and Acuity Scale score 3, 4 or 5. In a private setting, participants were questioned directly about abuse as part of a larger questionnaire exploring ten non-medical problems. We used multivariable logistic regression to identify predictors of elder abuse.
A total of 1061 participants were recruited (mean age: 77.1 (SD 7.6) years, female sex: 55.7%, lived alone: 42.5%). Patients mostly attended EDs for pain (19.6%), neurologic (11.3%) or cardiovascular (8.4%) symptoms. The most frequent pre-existing comorbidities were hypertension (67.2%), mental health conditions (33.3%) and cardiac insufficiency (29.6%). Mobility issues outside (41.0%) or inside their home (30.7%) and loneliness (29.4%) were also frequent. Fifty-four (5.1%) participants reported elder abuse, of which 34.3% were aware of available community-based resources. Identified predictors of elder abuse were female sex (OR 2.8 [95%CI 1.4; 5.6]), financial difficulties (OR 3.6 [95%CI 1.8; 7.3]), food insecurity (OR 2.7 [95%CI 1.2; 5.6]), need for a caregiver (OR 2.7 [95%CI 1.5; 5.0]) and at least one pre-existing mental health condition (OR 2.6 [95%CI 1.4; 4.9]).
When questioned directly, 5.1% of older adults attending EDs reported experiencing abuse. Female sex, functional impairment, social vulnerability, and mental health comorbidities are associated with elder abuse. Given its importance and relatively high prevalence, ED professionals should have a low threshold to ask directly about elder abuse.
虐待老年人与身心健康受损有关。然而，在急诊科（ED）中这种情况很少被识别出来。目的是确定就诊于急诊科的老年人中虐待老年人行为的患病率及其预测因素。
这项前瞻性队列研究于2021年5月至8月在加拿大的8个急诊科进行。年龄≥65岁、时间定向正常且加拿大分诊和 acuity 量表评分为3、4或5的患者符合入选条件。在一个私密环境中，作为探索十个非医疗问题的更大规模问卷的一部分，直接询问参与者关于虐待的情况。我们使用多变量逻辑回归来确定虐待老年人行为的预测因素。
共招募了1061名参与者（平均年龄：77.1（标准差7.6）岁，女性占55.7%，独居占42.5%）。患者前往急诊科就诊大多是因为疼痛（19.6%）、神经系统症状（11.3%）或心血管系统症状（8.4%）。最常见的既往合并症是高血压（67.2%）、心理健康问题（33.3%）和心脏功能不全（29.6%）。户外（41.0%）或家中（30.7%）的行动不便以及孤独感（29.4%）也很常见。54名（5.1%）参与者报告遭受过虐待老年人行为，其中34.3%知晓可利用的社区资源。确定的虐待老年人行为的预测因素包括女性（比值比2.8 [95%置信区间1.4；±5.6]）、经济困难（比值比3.6 [95%置信区间1.8；7.3]）、粮食不安全（比值比2.7 [95%置信区间1.2；5.6]）、需要照料者（比值比2.7 [95%置信区间1.5；5.0]）以及至少一种既往心理健康问题（比值比2.6 [95%置信区间1.4；4.9]）。
当直接询问时，就诊于急诊科的老年人中有5.1%报告曾遭受虐待。女性、功能障碍、社会脆弱性以及心理健康合并症与虐待老年人行为有关。鉴于其重要性和相对较高的患病率，急诊科专业人员应毫不犹豫地直接询问关于虐待老年人的情况。
