Radiologists ‘ill-equipped’ to spot physical abuse in elderly patients
Radiologists are poorly equipped to deal with cases of physical elder abuse, researchers wrote in a Journal of the American College of Radiology editorial this month—and that’s likely the product of weak communication and a paucity of research on the subject.
“Elder abuse has severe medical consequences as well as heavy financial costs, and these burdens are only expected to increase in coming years with the imminent growth of the geriatric population,” Mihan Lee, MD, PhD, of Harvard Medical School in Boston, and colleagues wrote. “Yet, despite the urgency of this problem, elder abuse continues to be deeply underdiagnosed, with as few as one in 24 cases of elder abuse in the U.S. ever being reported.”
Those figures are in stark contrast to, say, cases of child abuse, Lee et al. said, which are discussed at length in medical school and training. As with pediatric radiologists, those who work with the older demographic are uniquely positioned to detect abnormalities in a patient’s imaging workup after an acute injury.
In these cases, the authors wrote, physicians are often the only people a patient sees outside of their immediate family, who could be the root of abuse. But even when radiologists are confronted by such a situation, Lee and co-authors said they might not be well-versed in next steps.
“It seems that most radiology programs have omitted the topic altogether,” the authors said. “As a result, radiologists reported feeling even less prepared and qualified to provide meaningful insights on cases with concern for abuse when they did arise and consistently voiced a desire for increased instruction on the topic.”
One of the biggest obstacles to elder abuse education in radiology is a lack of research on the topic, the authors wrote. Identifying pathognomic radiographic findings for elder abuse is difficult, since many symptoms of physical abuse echo common geriatric issues like brittle bones and undernutrition. An injury resulting from abusive trauma could be easily misdiagnosed as an osteoporotic patient losing their balance and falling.
Communication within the hospital—especially in the emergency department, where messages are often rushed and urgent—is another barrier, according to the editorial. It’s not uncommon for radiologists to be passed over in the ED, where, without enough information, they couldn’t know if a patient should be assessed for potential abuse.
“In child abuse, imaging was seen as a critical piece of the assessment,” Lee et al. wrote. “Thus, pediatric radiologists reported open two-way communications with frontline providers on topics including injury mechanism, developmental stage, living situation, family dynamics and degree of suspicion. By contrast, for elder patients, geriatricians and emergency physicians stated that they typically consulted radiologists to confirm or rule out injuries but did not see them as a source of new information or clinical insight.”
In spite of that, the authors said, most radiologists themselves said they’d never been asked to read a scan for possible abuse, and that the communication they did receive from primary providers was largely “minimal and incomplete.”
Lee and the team said there are two building blocks critical to overcoming that divide: ongoing research into the subject of elder abuse and the radiologic parameters that can detect it, and more open, real-time communication within the emergency department. EMTs, social workers, policemen and lawmakers should all be involved in the process, they said—just as in cases of child abuse.
“These strategies are only first steps toward integrating radiologists into a complex and multidisciplinary elder abuse detection effort,” the authors said. “In short, the relegation of radiology to a minor role in elder abuse assessment may constitute a self-fulfilling prophecy: radiologists’ exclusion from critical communications in the ED workflow limits both their immediate and potential contributions to the effort.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.