Development of the Detection of Elder Abuse through Emergency Care Technicians (DETECT) Community Intervention

Introduction

Elder abuse and neglect (EA) is an intentional action or negligence that results in harm, or serious risk of harm, to an older adult, and is caused by a caregiver or person in a position of trust. Community-dwelling older adults in the United States who experience EA have a 200-400% greater odds of mortality than older adults who do not experience EA. Chronic morbidities, including depression or anxiety, chronic pain, high blood pressure and heart problems, are also more common among older adults who are abused or neglected. EA is under-detected and under-reported in the United States. Although about 11% of older adults experience EA each year, it is estimated that as few as 7% of cases are reported. The goal of the current study was to understand barriers to reporting EA for Emergency Medical Technicians (EMTs) and to pilot test an intervention that aimed to address these barriers.

Methods

In April and May of 2015 we conducted a series of five semi-structured focus groups ranging in size from 2 to 8 participants each, including 11 EMTs and 12 APS caseworkers (N = 23). Focus groups were conducted on-site at each agency’s location. Systematic procedures of qualitative data analysis included: intensive reading of the text and group discussion of the transcripts by all members of the research team, coding by two investigators, inductive thematic identification, data reduction, and interpretation. Based on the results of these analyses, an electronic EA screening tool, named “DETECT”, was developed and pilot tested with approximately 180 EMTs during September and October of 2015. We evaluated the introduction of DETECT on the total number of validated monthly APS reports as a brief interrupted time series using standard errors robust to serial autocorrelation.

Results

Five themes related to EA reporting barriers were identified: (1) EMT apprehension towards violating older adults’ personal freedom; (2) EMT moral anxiety about the potential negative consequences (e.g., institutionalization) of an APS investigation; (3) time burden of reporting to APS; (4) perceived inability to accurately recall cases by EMTs, and, (5) low EMT confidence in their ability to correctly identify potential EA. Additionally, EMTs expressed a need for a tool to help identify EA. We created the DETECT tool to address eight general domains indicative of EA from the focus groups, including: (1) exterior home conditions; (2) interior home conditions; (3) the presence/adequacy of social support; (4) medical history and medication use/misuse; (5) caregiving indicators; (6) physical condition of the older adult; (7) the older adult’s behavior; and, (8) EMTs’ instincts. Immediately following the introduction of the DETECT screening tool, there was an increase of 4.7 validated reports per month – roughly a 200% improvement.

Conclusions

EMTs encounter older adults who are living with EA and are frequently able to identify these cases. Our study provides evidence that DETECT is a feasible intervention that may enhance EMT’s ability to identify and report EA in the community. Future research should validate our findings using a randomized controlled trial.