New injury documentation tool could provide better evidence of abuse of older adults

It is estimated that 10% of older adults experience some form of violence each year. However, the link between injuries and possible abuse towards older adults can take months or even years, and it is often difficult to investigate because of a lack of documentation during previous medical visits.

Geriatric experts now hope to standardize the process of documenting physical injuries in older patients and make the medical record more thorough with the creation of the Geriatric Injury Documentation Tool (Geri-IDT). The tool is from a new study led by Laura Mosqueda, MD, dean of the USC's Keck School of Medicine and professor of family medicine. The study confirms the need to improve documentation by detailing what experts believe to be the most effective factor in achieving this.

The results of the study were presented today in the Journal of General Internal Medicine. Interviews with elder abuse experts, including physicians, detectives and prosecutors, and focus groups with clinicians working in emergency medicine and primary care centers informed the study .

"Because older people are more vulnerable to injuries such as fractures and bruises, it is often difficult to distinguish whether an injury is due to an accident or abuse," said Mosqueda, also director of the National Center for Disease Control. fight against elder abuse. "This tool includes diagrams and a brief questionnaire that facilitates the documentation of an injury and reminds clinicians what to ask for and how to observe during the examination.We think that this will lead us to more complete documentation of the injury and lead to better medical care. "

Experts confirmed that current documentation of geriatric injuries is generally insufficient to investigate allegations of elder abuse and neglect. As such, they emphasized the need to document:

• History of the patient, from the point of view of the patient and from another reliable source
• Physical appearance of the patient before cleaning or treatment
• An badessment from head to toe for injuries
• All injuries, even minor ones
• Any evidence likely to rebut abuse or neglect (relevant negatives)

"It's imperative to protect our older loved ones against abuse," said Alexis Coulourides Kogan, Ph.D., badistant professor of family medicine at Keck School and co-author of the study. "But focusing solely on the reason for a patient's visit rarely tells the whole story, even if you consult the medical record.If the documentation of physical results is mediocre, we risk missing out on the situation as a whole. "

Study participants also emphasized the usefulness of photographs and body diagrams to supplement written documentation, time-related issues with extensive documentation in a busy clinical setting and the need to integrate the tool in existing electronic medical records.

"Using an injury documentation tool may be more work for a clinician, but we think the value far outweighs the burden on physicians," says Kogan. "If there is suspicion of elder abuse, this information can potentially help prosecutors to obtain justice and protect the elderly or to exonerate people who care for the innocent."

Researchers then plan to seek funding to test the geriatric lesions documentation tool in clinical settings.

Provided by
University of Southern California