Identifying Radiographic Patterns of Injury in Physical Elder Abuse

Purpose: Elder abuse, defined as “harm inflicted on an older person... in a relationship where there is an expectation of trust, and/or when the person is targeted based on age,” is a significant danger to the safety of older adults. When older adults present to the emergency department (ED) after a trauma, radiologists are in a key position to identify potential elder abuse. This study characterizes common radiographic injury patterns seen in physical elder abuse, and explores its specific features in comparison to stranger assault.

Methods/Materials: We conducted a case series of patients aged ≥60 who presented to 3 urban, academic medical center EDs following a reported assault. For each case, patient demographics and details of the assault were abstracted from the chart, including a categorization as to whether or not the incident met criteria for physical elder abuse. All imaging studies ordered for the patients were then tabulated by body part and modality, and reviewed by a radiologist for acute traumatic findings.

Results: 288 cases of geriatric assault were identified, with 38% meeting criteria for physical elder abuse. Elder abuse victims were older (median age 70 vs. 65) and more likely to be female (55% vs. 24%). Rates of ordering of head CTs, cervical spine CTs, and chest radiographs did not vary significantly between the two groups; however, stranger assault victims were more likely to undergo facial CTs (p < 0.05). The most common traumatic findings in elder abuse were rib fractures (24%), followed by subdural hematomas and nasal fractures (both 12%), while the most common traumatic findings in stranger assault were nasal fractures (30%), maxillary fractures (24%) and subdural hematomas (23%). Elder abuse victims were more likely to sustain rib fractures (p=.07) and less likely to sustain nasal fractures (p=0.05).

Conclusions: While victims of physical elder abuse and stranger assault are demographically similar and sustain similar injuries, our findings add to an emerging body of knowledge that can help radiologists recognize and raise appropriate suspicion for physical elder abuse. This recognition is critical to ensuring older patients’ safety in an undifferentiated trauma presentation.