An analysis of the National Emergency Medical Services Information System database

Elder abuse (EM), including maltreatment and neglect, is a significant public health problem affecting up to 10% of community-dwelling older adults each year. Elder abuse is a growing problem with higher prevalence in institutional settings and significant associated health care costs. Prehospital clinicians (PHCs) such as emergency department staff and paramedics are uniquely positioned to detect and report EM during their interactions with older adults in their homes. The objective of this study is to describe the extent and characteristics of EM documented by PHCs using the National Emergency Medical Services Information System (NEMSIS) database.

This study analyzed data from NEMSIS, which contains standardized information on PHC emergency response encounters in the United States. In 2018, 22,532,890 activations were recorded from 9,599 agencies in 43 states and U.S. territories. Elder abuse was identified using specific International Classification of Diseases (ICD) codes related to EM. Demographics, location of injuries, and associated physical findings were also examined.

Of the 9,605,522 EMS encounters for patients ≥60 years of age, EM was coded in 1,765 encounters (0.02%). Most EM events were reported as the cause of injury (64%), followed by the clinician’s initial impression (25.4%). Physical abuse was the most common type of maltreatment reported (20.8%), followed by sexual abuse (18.2%), neglect (9.7%), and psychological/emotional abuse (0.34%). The median age of patients with documented EM was 72, and 62.3% were female. The most common anatomic sites of injury were the lower extremities, head, and upper extremities.

Despite the high prevalence of EM, PHCs rarely document EM in their encounters with older adults. Additional training and comprehensive protocols are needed to improve the identification and reporting of EM, particularly elder neglect. Empowering PHCs through education and protocol development can have a significant impact on the detection and intervention of EM.