Bird P E, Harrington D T, Barillo D J, McSweeney A, Shirani K Z, Goodwin C W
US Army Institute of Surgical Research, Fort Sam Houston, Tex. 78234, USA.
J Burn Care Rehabil. 1998 Nov-Dec;19(6):522-7. doi: 10.1097/00004630-199811000-00011.
An estimated 2 million people a year are victims of elder abuse, which ranges from neglect and mistreatment to physical abuse. By the year 2020, a full 22% of the population will be aged 65 or older. This demographic explosion demands that we identify and protect those at risk. To investigate the incidence of elder abuse or neglect (EAN) and to determine clinician awareness of associated risk factors, we conducted a 1-year retrospective review of thermally injured patients aged 60 or older. Data included age, total body surface area burned, mechanism of injury, length of hospital stay, mortality, abuse or neglect risk factors, and referral to the appropriate social agency. We found that our elderly patients (n = 28) were poorly screened for EAN. While 64% to 96% of patients were screened for cognitive impairment, overall health, and financial resources, none were screened for risk factors of emotional isolation. None of the patient's caregivers, including any spouses, roommates, or guardians, were screened for risk factors of substance abuse, familial violence, dependency needs, or external stresses. With the use of available data, we were able to place 11 patients on the following levels of abuse or neglect: 1) low risk for abuse; 2) self-neglect; 3) neglect; and 4) abuse. By this scale, 7 patients (64%) were victims of self-neglect, 3 patients (27%) were victims of neglect, and 1 patient (9%) was a victim of abuse. Adult Protective Services intervened in 2 cases. Recognizing that all cases of EAN should be preventable, we cannot accept the socioeconomic impact of this entity. The 11 patients identified as victims of neglect, self-neglect, or abuse accounted for 135 hospital days and 8 fatalities. Before we can address EAN, health care personnel must be made aware of the problem and routine screening for risk factors must be implemented. The true incidence of EAN is likely underestimated because health care providers have difficulty recognizing its features. A standard assessment tool to screen for neglect or abuse should be used for each older adult admission.
据估计，每年有200万人成为虐待老年人行为的受害者，这种行为涵盖了从忽视、虐待到身体伤害等各个方面。到2020年，整整22%的人口将年满65岁或以上。这种人口结构的爆炸式增长要求我们识别并保护那些处于风险中的人。为了调查虐待或忽视老年人（EAN）的发生率，并确定临床医生对相关风险因素的认知，我们对60岁及以上的热烧伤患者进行了为期1年的回顾性研究。数据包括年龄、烧伤总面积、受伤机制、住院时间、死亡率、虐待或忽视风险因素，以及转介至适当的社会机构。我们发现，我们的老年患者（n = 28）在EAN筛查方面做得很差。虽然64%至96%的患者接受了认知障碍、整体健康状况和财务资源的筛查，但没有一人接受情感孤立风险因素的筛查。没有对患者的任何护理人员，包括配偶、室友或监护人进行药物滥用、家庭暴力、依赖需求或外部压力等风险因素的筛查。利用现有数据，我们能够将11名患者归为以下虐待或忽视级别：1）低虐待风险；2）自我忽视；3）忽视；4）虐待。按照这个标准，7名患者（64%）是自我忽视的受害者，3名患者（27%）是忽视的受害者，1名患者（9%）是虐待的受害者。成人保护服务机构介入了2起案件。认识到所有EAN病例都应该是可以预防的，我们不能接受这个问题所带来的社会经济影响。被确定为忽视、自我忽视或虐待受害者的11名患者占用了135个住院日，导致8人死亡。在我们能够解决EAN问题之前，必须让医护人员意识到这个问题，并实施风险因素的常规筛查。EAN的实际发生率可能被低估了，因为医护人员很难识别其特征。对于每一位老年患者入院时，都应使用标准评估工具来筛查忽视或虐待情况。
