Study Reveals Low VA Screening Rates for Elder Abuse

BACKGROUND:
Every year, around 10% of older U.S. adults experience elder abuse (EA), with higher rates among those with dementia and for residents in skilled nursing facilities. Experiencing EA can lead to increased mortality and use of healthcare services, including nursing home placement. Yet, as few as 1 in 24 cases are identified and reported in the U.S. EA screening tools exist, but little is known about if and how these tools are implemented in clinical settings, particularly given the absence of national guidelines on EA screening in the U.S. In 2020, VA’s Office of Care Management and Social Work Services (CMSW) established the National Social Work Elder Abuse “Tiger Team” to focus on EA-specific priorities and strategies. This study sought to evaluate VA healthcare sites nationally to describe the landscape of EA screening practices – and to provide a foundation for future program development to improve EA detection in VA and other healthcare settings. Investigators used data from a national survey conducted by the Tiger Team, which was sent via email from the CMSW National Director to the Social Work Chiefs and Executives at 139 VA medical centers across the country on February 1, 2021. Social work leaders were chosen as respondents because social work is the clinical service primarily responsible for interpersonal violence detection and response programs in VA. The survey assessed the presence and characteristics of EA-specific screening practices, as well as general abuse/neglect screening conducted with patients of all ages. Follow-up emails were sent to sites that reported screening, requesting additional details not included in the initial survey.

FINDINGS:

• Very few sites specifically screened for elder abuse in older Veterans and even fewer used a previously published tool to do so. Further, of the five sites using a published tool, four different EA screening tools were used.
  • These findings are consistent with low and inconsistent uptake of EA screening in non-VHA healthcare settings in the context of no national guidelines recommending screening.
• Overall, 130 sites (94%) responded to the survey. Of these sites, 5 (4%) reported EA screening using published tools; 6 (5%) reported EA screening using unpublished questions; 53 (41%) reported no screening; and 62 (48%) reported general abuse/neglect screening for all patients.

IMPLICATIONS:

• This study represents an important first step towards understanding the landscape and variability in EA screening practices in a national integrated health system – and identifying opportunities to implement standardized EA screening approaches that can be studied and improved upon.

LIMITATIONS:

• The survey asked about site-wide practices but was only directed to the site’s Chief or Executive of Social Work. While instructions encouraged soliciting input from others to complete the survey, it is likely respondents had incomplete knowledge of all practices at their site.

AUTHOR/FUNDING INFORMATION:
Dr. Makaroun is part of HSR’s Center for Health Equity Research and Promotion (CHERP) and the VA Pittsburgh Healthcare System. Dr. Makaroun is supported by an HSR Career Development Award.

Makaroun L, Halaszynski J, Smith K, et al. Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System. Journal of General Internal Medicine. January 8, 2024. Online ahead of print.