cases, so why shouldn’t they be a core part of the team in elder abuse?”
Child Abuse Versus Elder Abuse
It started in the 1960s. The 1962 publication of the article,
“The Battered Child Syndrome,” by pediatrician C. Henry
Kempe and his colleagues raised awareness about child abuse
and how it might be identified in a health care setting. Since
then, more than 1000 peer-reviewed articles have been written
on the subject, with many focusing on injury patterns suggestive or diagnostic of abuse and imaging correlates. Evaluation
for potential child abuse has become a cornerstone of radiology
training and practice.
“In comparison,” Rosen said, “very few articles have examined injury patterns or imaging correlates in elder abuse.”
Additionally, for various reasons including age-related osteope-nia, use of anticoagulant medications, and the frequency of accidental injuries from falls, elder abuse is often not easy to spot.
Also, while patient age is often very helpful to radiologists assessing images for potential child abuse, it is not as useful in
older adults, because one 81-year-old may be running marathons while another is bed-bound in a nursing home.
Two-thirds of injuries that occur in elder abuse are to the
upper extremity and maxillofacial region, according to a study
published in the Canadian Association of Radiologists Journal,
also co-authored by Murphy. The social context in which the
injuries take place remains crucial to accurate identification of abuse, including violence in the family; a demented, debilitated,
or depressed and socially isolated victim;
and a perpetrator profile of mental illness,
alcohol or drug abuse, or emotional and/or
financial dependence on the victim. [ 1]
Recognizing Elder Abuse
Between 2014 and 2060, the United
States will experience considerable growth
in its older population as baby boomers age,
according to the U.S. Department of Health
and Human Service’s Administration on
Aging. In 2014, the population of people 65
years and older numbered 46.2 million (the
latest data available). By 2060, there will be
about 98 million older people, more than
twice the number in 2014.
Radiologists Positioned to Identify
Potential Elder Abuse
Radiologists may be uniquely positioned to identify elder abuse, but they don’t have training or experience in detect- ing it, according to a study recently published in the
American Journal of Roentgenology (AJR). To gain a better understanding of why elder abuse isn’t viewed with the same intensity
as child abuse in the reading room, a group of radiology attendings and residents, medical students, and emergency physicians
collaborated to study the attitudes and knowledge of radiologists
who are on the front lines of health care.
Of the 19 diagnostic radiologists interviewed as part of the
study, only two reported any formal or informal training in elder
abuse detection, and all participants believed they had missed cases of elder abuse. The study, titled “Radiologists’ Training,
Experience, and Attitudes About Elder Abuse Detection,” was published in the December 2016 issue of AJR.
“All study participants expressed a desire for additional elder
abuse training,” Kieran Murphy, study co-author and radiology
professor at the University of Toronto, Ontario, said.
“I’ve wanted to do this type of study for 20 years. When I was a
resident in the emergency room, I remember seeing things that I
thought were strange. But, radiologists are not trained to look for
elder abuse and referring physicians usually do not ask us to assess
an image for elder abuse.”
In agreement, Tony Rosen, study co-author and emergency
physician at Weill Cornell Medical College, New York, said,
“Radiologists are a core part of the medical team in child abuse
Study Illustrates That Radiologists Are Interested in Additional Elder Abuse Training
Elder Abuse continues on p. 18