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Beyond the Injury: Identifying Abuse in Older Adults in Emergency Departments

Contributors Bharti Khurana, MD, MBA and Maura Kennedy, MD

Brigham investigators are working to identify patterns that may signal abuse in vulnerable populations to connect them with resources and services

Falls, bumps and bruises can send vulnerable, older adults to the emergency department to receive care after an accident. But are these injuries always the result of accidents? Previous research has identified falls and interpersonal violence as reasons why older adults seek care in emergency departments. However, it’s not always clear whether an injury is due to an accidental fall or to acts of abuse or violence. To identify and understand how often older adults present signs of abuse in the medical setting, Bharti Khurana, MD, MBA, founder and director of the Trauma Imaging Research and Innovation Center at Brigham and Women’s Hospital, analyzed injury patterns among older adults who presented to emergency department. The findings from the study are published in the Journal of the American Geriatrics Society.

Q: Are there signs or trends that clinicians can look for to help determine whether an older adult is experiencing abuse or accidentally fell?

BK: As physicians, we do not really realize how often older adults experience abuse because it’s significantly underreported, so it’s not usually on our minds. However, through the research we recently published, we have identified trends that are more common in patients who experience abuse. For example, injuries to the face or head, fingers, toes and ribs are more common among patients who have experienced abuse. We noted that patients who came to the emergency department because of a fall tend to have injuries on their spine, pelvis and legs. In addition, we found cuts and bruises were more common in patients who experienced abuse; whereas patients who fell had fractures in their pelvis or legs. Clinicians who recognize these signs and trends can address the abuse instead of sending the patient back to a violent environment.  

Q: How can medical staff best support older adults they suspect are experiencing abuse?

BK: Our team hopes clinicians can recognize the injury patterns in patients who are experiencing abuse, especially in patients who frequently visit the emergency department with repeat injuries. Oftentimes, because the injuries from violence and abuse are not severe, patients are discharged from the emergency department without the root of the problem being addressed. If clinicians can create a safe space for these patients to disclose abuse, they can introduce social workers and other resources to remove them from the violent environment and improve their quality of life. However, creating that trust with the patient in the emergency department can be difficult since clinicians are unable to spend a large amount of time with these individuals compared to if they were admitted. In addition, some patients are hesitant to report abuse if the perpetrator is someone whom they rely on heavily to help them meet their physical, social and financial needs. Empowering patients and fostering a trusting environment amid the chaos in the emergency department is the key to helping these individuals.

Q: Are there any limitations to your study?

BK: One important limitation of this study was with our dataset since we relied on patients to disclose their abuse. Likely, abuse is occurring, we just don’t have an accurate representation of it due to unreliable and low rates of self-reporting. We had to use a national database because we didn’t have enough local data to work with for this study. In addition, the national database lacks detailed, granular information such as specific data on nursing home facilities, forensic nurse examinations, imaging reports and underlying medical conditions of injured patients.

Q: What is Mass General Brigham doing to support older adults who may be experiencing abuse?

BK: There is a robust support system at Mass General Brigham for suspected cases of older adult abuse, especially because of our experienced and skilled social workers, who are available 24/7. The main challenge in diagnosing abuse is the patient’s reluctance to disclose it. Our publication highlights abuse trends that clinicians can look out for and then use older adult mistreatment screening and response tools to address the abuse and violence. 

Helping Older Adult Patients Who Are Experiencing Abuse

The Mass General Brigham healthcare system has a variety of social service programs to connect older adults experiencing abuse, neglect and financial exploitation. Many hospitals across our system are equipped with dedicated Elder Abuse Consult Teams. However, these services and resources are initiated when Mass General Brigham clinicians recognize abuse and neglect in their patients, emphasizing the importance of new approaches to better identify older adult abuse and neglect in the emergency department. One approach includes screening tools, such as EM-SART, which include both patient-directed questions and observational items. This tool prompts the clinician to consider whether there have been frequent or unexplained injuries.


Maura Kennedy, MD, section chief for Geriatric Emergency Medicine at Massachusetts General Hospital, is also interested in this area and notes research from Dr. Khurana and other Mass General Brigham investigators can help emergency clinicians recognize injury patterns associated with abuse and enhance their use of these screening tools. Furthermore, there is the potential that in the future these findings can be used in artificial intelligence and large language models to assist in identifying abuse in older adults when they come into emergency departments across our system. 

This was originally posted in Brigham Clinical Research News and adapted for the MGB Newsroom.

Bharti Khurana, MD, MBA


Founder and director of the Trauma Imaging Research and Innovation Center at Brigham and Women’s Hospital


Section chief for Geriatric Emergency Medicine at Massachusetts General Hospital