Neglect assessment in urban emergency departments and confirmation by an expert clinical team

Terry Fulmer, Gregory Paveza, Carla VandeWeerd, Lisa Guadagno, Susan Fairchild, Robert Norman, Ivo Abraham, Marguarette Bolton-Blatt

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background. Elder neglect accounts for over 70% of all adull protective services reports in the nation annually, and it has been estimated that there are over 70,000 new cases each year. The purpose of this study was to conduct elder neglect research in the emergency department (ED), using a dyadic vulnerability/risk-profiling framework for elder neglect. Methods. Patients were recruited through four EDs in New York and Tampa from the beginning of February 2001 through the end of September 2003. Demographics, a Mini-Mental Status Examination score, and an initial elder assessment screen were collected. The diagnosis of neglect was then made by a Neglect Assessment Team (NAT) comprising a nurse, physician, and social worker, with extensive clinical experience in elder neglect. Results. Of the 3664 ED screens of adults 70 years and older, 405 (11%) met the inclusion criteria and agreed to participate. Neglect was diagnosed by the NAT in 86 of the 405 cases reviewed. Demographic differences between neglect versus no neglect cases were examined using Fisher's exact test, and differences emerged between the 2 groups. Conclusion. This study documents the underreporting of cases of neglect as evidenced by differences in diagnoses by screeners versus experts. The research assistants screened positive for neglect in 5% (N = 22) of the 405 cases. The NAT made the diagnosis of neglect in 22% (86/389) of the cases. This markedly different rate of neglect may mean that ED screens are important but may underestimate the true number of cases. Conversely, an NAT may make the diagnosis of neglect in an older adult more often given a higher sensitivity and a more robust knowledge base of the problem.

Original languageEnglish (US)
Pages (from-to)1002-1006
Number of pages5
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number8
StatePublished - Aug 2005
Externally publishedYes

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology


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