11 February 2002
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The biochemistry of aging muscle.
- Carmeli E, Coleman R, Reznick AZ. Exp Gerontol 2002; 37(4):477-489.
Sackler Faculty of Medicine, Department of Physical Therapy, Tel Aviv University, Ramat Aviv, Israel.
Between the ages of 20 and 80, humans lose approximately 20--30% of their skeletal muscle mass. This age-related loss of muscle mass, sometimes described as 'sarcopenia of old age', is the consequence of complicated multifactorial processes and is commonly associated with osteopenia or osteoporosis. Consequences of the aging changes in muscle are declining physiological function and loss of muscle strength, typically associated with reduced physical activities. Consequently, falls and subsequent serious injuries are prevalent in the elderly. Thus, it is imperative to try and understand the processes, leading to age-related muscle loss, in order to develop means to retard this phenomenon leading to improved quality of life in the elderly. It is possible to divide the causes of muscle aging to intrinsic factors, involving changes at the molecular and cellular levels, and to extrinsic or environmental factors. The purpose of this review is to describe some of the biochemical processes and the possible mechanisms of muscle aging and to evaluate the importance of various extrinsic factors such as nutrition, exercise and limb immobilization. Changes in the aging skeletal muscle are reviewed with regard to: (a) enzyme activities, protein turnover and repair capacities (b) mitochondrial functioning and energy reserve systems (c) ion content and regulation (d) oxidative stress and free radicals (e) nutrition and caloric restriction (f) exercise and limb immobilization.
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Fatal occupational injuries in the North Carolina construction industry, 1978-1994.
- Jackson SA, Loomis D. Appl Occup Environ Hyg 2002; 17(1):27-33.
School of Public Health, The University of North Carolina-Chapel Hill, USA.
Occupational injury is a major public health problem and the cause of high rates of fatalities. The construction industry is one of the leading industries for on-the-job fatalities. The North Carolina Medical Examiner's system was used to identify all fatal unintentional injuries that occurred on the job in the state's construction industry between 1978 and 1994. The populations at risk were estimated from the 1980 and 1990 U.S. censuses. There were 525 identified deaths. All except two decedents were male, and the majority were Caucasian (79.2%). The mean age of decedents was 39 years. Death rates were higher among older workers. The crude fatality rate for the overall study period was 15.4 per 100,000 worker-years, with higher rates found among African-Americans (22.9) than among Caucasians (14.5). Occupations within the industry with the highest rates were laborers (49.5), truck drivers (43.2), operating engineers (37.2), roofers (32.8), and electricians (29.0). Falls (26.7%), electrocutions (20.4%), and motor vehicle accidents (18.9%) were found to be the leading causes of death. These findings suggest a need for continued attention to the hazards of heights and electric currents and a need for occupational safety standards for motor vehicles. This study also suggests that the hazards facing construction laborers require further investigation.
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Pedestrian-vehicle crashes and analytical techniques for stratified contingency tables.
- Al-Ghamdi AS. Accid Anal Prev 2002; 34(2):205-214.
College of Engineering, King Saud University, Riyadh, Saudi Arabia. (email: asghamdi@ksu.edu.sa).
In 1999 there were 450 fatalities due to road crashes in Riyadh, the capital of Saudi Arabia, of which 130 were pedestrians. Hence, every forth person killed on the roads is a pedestrian. The aim of this study is to investigate pedestrian-vehicle crashes in this fast-growing city with two objectives in mind: to analyze pedestrian collisions with regard to their causes, characteristics, location of injury on the victim's body, and most common patterns and to determine the potential for use of the odds ratio technique in the analysis of stratified contingency tables. Data from 638 pedestrian-vehicle crashes reported by police, during the period 1997-1999, were used. A systematic sampling technique was followed in which every third record was used. The analysis showed that the pedestrian fatality rate per 10(5) population is 2.8. The rates were relatively high within the childhood (1-9 years) and young adult (10-19 years) groups, and the old-age groups (60 - > 80 years), which indicate that young as well as the elderly people in this city are more likely to be involved in fatal accidents of this type than are those in other age groups. The analysis revealed that 77.1% of pedestrians were probably struck while crossing a roadway either not in a crosswalk or where no crosswalk existed. In addition, the distribution of injuries on the victims' bodies was determined from hospital records. More than one-third of the fatal injuries were located on the head and chest. An attempt was made to conduct an association analysis between crash severity (i.e. injury or fatal) and some of the study variables using chi-square and odds ratio techniques. The categorical nature of the data helped in using these analytical techniques.
Methodological issues in community surveys of suicide ideators and attempters.
- Burless C, De Leo D. Crisis 2001; 22(3):109-124.
Correspondence: Australian Institute for Suicide Research and Prevention, Griffith University, Queensland.
There have been quite a number of community studies in recent years, with surveys being conducted among the general population, in schools, and among the elderly. While all of these studies have greatly contributed to our understanding of suicidal behavior, because of different approaches toward methodology and definitions, they also have some limitations. These limitations spring mainly from the fact that definitions of suicidal ideation and behavior vary widely across studies, which makes comparisons between studies unreliable. The different utilization of methodology is another problem that can impact the comparability of the community studies.
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Childhood injury prevention in Hong Kong Hong.
- Kong Childhood Injury Prevention Research Group. Hong Kong Med J 1998; 4(4):400-404.
Correspondence: C.B. Chow, Department of Pediatrics, Princess Margaret Hospital, Kowloon, Hong Kong.
Injury is a major health problem in Hong Kong children. During the past two decades, injury and poisoning have surpassed infectious diseases as the leading cause of childhood mortality in Hong Kong. These two are also the leading cause of childhood disability. In 1995, injury and poisoning caused approximately 2% of the deaths among children aged 0 to 1 years, 26% of the deaths among children aged 1 to 4 years, and 36% of all deaths of children aged 4 to 14 years. Road traffic accidents, drowning and submersion, and accidental falls accounted for 30%, 20%, and 20%, respectively, of all deaths from unintentional injury in children younger than 15 years of age. Exact morbidity figures for injury and poisoning are not available but injuries are known to account for approximately 30% of paediatric attendances at the accident and emergency departments of regional hospitals, 20% of all hospitalisations among children, and 65% of surgical or orthopaedic admissions. It has been estimated that approximately 2.9% of children will be admitted to hospital for an injury at least once before their fourth birthday. Hong Kong is a small, highly urbanised, and densely populated place that has undergone tremendous socio-economic development in the past three decades. The pattern of injuries has changed and shows some special characteristics. Information on the extent of the problem, the type of injury, and contributing factors are scarce. Preventive measures are reactive in nature, piecemeal, and usually not subject to evaluation. It is recommended that childhood injury prevention be accorded a high priority, child safety be given prime consideration in all policies involving children, and more research be conducted.
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Musical creativity and suicide.
- Preti A, De Biasi F, Miotto P. Psychol Rep 2001; 89(3):719-727.
Correspiondence: Genneruxi Medical Center, Cagliari, Italy. (email: apreti@tin.it).
The different abilities involved in artistic creativity may be mirrored by differences among mental disorders prevalent in each artistic profession, taking poets, painters, and composers as examples. Using suicide rates as a proxy for the prevalence of mental disorders in groups of artists, we investigated the percentage of deaths by suicide in a sample of 4,564 eminent artists who died in the 19th and 20th centuries. Of the sample, 2,259 were primarily involved in activities of a linguistic nature, e.g., poets and writers; 834 were primarily visual artists, such as painters and sculptors; and 1,471 were musicians (composers and instrumentalists). There were 63 suicides in the sample (1.3% of total deaths). Musicians as a group had lower suicide rates than literary and visual artists. Beyond socioeconomic reasons, which might favour interpretations based on effects of health selection, the lower rate of suicides among musicians may reflect some protective effect arising from music.
A comparison of suicidal thinking and reasons for living among younger and older adults.
- Miller JS, Segal DL, Coolidge FL. Death Stud 2001; 25(4):357-365.
Correspondence: University of Colorado at Colorado Springs, Colorado, USA.
A cross-sectional design was used to examine age-related differences in suicidal thinking and reasons for living among younger (n = 82; M age = 21) and older (n = 82; M age = 68) adults. Volunteers anonymously completed the Beck Scale for Suicide Ideation and the Reasons for Living Inventory. Findings indicated that older adults do not manifest suicidal ideation differently than younger adults. However, there does appear to be some age-related differences in reasons for not committing suicide. Compared to the younger group, the older group reported moral objections and child-related concerns as stronger reasons for not committing suicide. An implication is that the identification of specific reasons that deter individuals from committing suicide may be clinically useful and provide some assistance in suicide prevention efforts.
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Evaluating the crash and citation rates of Utah drivers licensed with medical conditions, 1992-1996.
- Vernon DD, Diller EM, Cook LJ, Reading JC, Suruda AJ, Dean JM. Accid Anal Prev 2002; 34(2):237-246.
Correspondence: Don Vernon, University of Utah School of Medicine, Salt Lake City 84108, USA. (email: don.vernon@hsc.utah.edu).
BACKGROUND: Medical problems may affect the ability to drive motor vehicles, and programs that control the issuing of driver licenses to individuals with medical conditions exist in most states. The main activity of these programs is the imposition of restrictions upon the driving privileges of individuals with medical conditions that are deemed to pose some risk to public safety. However, little is known about the effectiveness of these licensing programs.
OBJECTIVE: The objective of this study was to compare the rates of adverse driving events (crash, at-fault crash and citations) experienced by drivers licensed with medical conditions to those of age-, sex- and location-matched controls. Separate comparisons were made for drivers reporting medical conditions licensed with full driving privileges, and those with restricted driving privileges (e.g. speed, area and time of day). DESIGN: Retrospective case-control.
METHODS: The study population was all drivers licensed in the state of Utah who reported a medical condition on their driver license application, over the 5-year period 1992-1996. Drivers enter the program by self-reporting their medical problems. Control drivers were chosen from the entire population of drivers licensed in Utah for the same period. Information on driver license status, participation in the medical conditions program, citations, involvement in crashes, and death certificate data was obtained from the relevant state agencies. Probabilistic linkage methodology was used to link the records in these disparate databases for eventual analysis. Rates of citation, crashes and at-fault crashes, expressed as events per 10000 license days, were calculated separately for program drivers and their corresponding control groups for each medical condition category and restriction status. These data were used to determine an estimate of relative risk (RR) and 95% confidence intervals.
RESULTS: As a group, medical conditions drivers had modestly elevated rates of adverse driving events compared with control drivers (RR 1.09-1.74). Rates in the largest medical category, 'cardiovascular conditions', were not higher than controls. Rates were higher than control for some conditions, such as 'alcohol' and 'learning and memory', for some adverse events (RR 2.2 -5.75). Drivers with more than one medical condition appeared comparable to the general group of medical conditions program drivers.
CONCLUSIONS: Drivers in Utah medical conditions program had modestly elevated rates of adverse driving events compared to matched controls. Possible underreporting of medical conditions and accurate assessment of exposure rates are potential weaknesses in the program.
Wheelchair integrated occupant restraints: feasibility in frontal impact.
- VanRoosmalen L, Bertocci GE, Ha D, Karg P. Med Eng Phys 2001; 23(10):687-698.
Department of Rehabilitation Science and Technology, Injury Risk Assessment and Prevention Laboratory, University of Pittsburgh, 15260, Pittsburgh, PA, USA.
Individuals often use their wheelchair as a motor vehicle seat when traveling in motor vehicles. The current use of fixed vehicle-mounted wheelchair occupant restraint systems (FWORSs) often results in poor belt fit and discomfort. Additionally, satisfaction, usability and usage rate of FWORSs during transit use are often low. The automotive industry has shown improved occupant restraint usage, belt fit and injury protection when integrating the upper torso and pelvic restraint in a motor vehicle seat. This study compared occupant injury measures of a FWORS to a concept wheelchair integrated restraint system (WIRS) using a 20g frontal sled impact test with a 30 mph change in velocity. Neck loads, neck moments, head, pelvis and chest acceleration, sternum compression and knee and head excursion data were recorded from the wheelchair seated 50th percentile male hybrid III anthropomorphic test dummy (ATD). The WIRS resulted in a lower head injury criteria (HIC) value, lower sternum compression and a lower upper-torso restraint load than the FWORS.Compared with the FWORS, increased head, knee and wheelchair excursions and higher neck loads and moments were measured in the WIRS test. Both restraint scenario injury parameters were complied with occupant injury criteria based on General Motors Injury Assessment Reference Values (GM-IARVs) and occupant kinematic requirements defined by the Society of Automotive Engineers (SAE) voluntary standard, J2249. A higher motion criteria index was calculated for the WIRS scenario and a comparable combined injury criteria index was calculated for both restraint scenarios.The sled impact test showed WIRS concept feasibility, facilitating further development by industrial manufacturers who might further want to pursue this restraint principle to increase wheelchair occupant safety and comfort during transport in motor vehicles.
Wheelchairs used as motor vehicle seats: seat loading in frontal impact sled testing.
- Bertocci G, Manary M, Ha D. Med Eng Phys 2001; 23(10):679-685.
University of Pittsburgh, Department of Rehabilitation Science and Technology, Injury Risk Assessment and Prevention Laboratory, 5044 Forbes Tower, Pittsburgh, PA, 15260, USA.
Wheelchairs are not typically designed to function as motor vehicle seats. However, many wheelchair users are unable to transfer to a vehicle seat and instead travel seated in their wheelchair. ANSI/RESNA WC19: Wheelchairs Used as Seats in Motor Vehicles provides design and testing requirements, but does not provide wheelchair manufacturers with design guidance related to expected loads imposed upon wheelchair components during a crash. To provide manufacturers with crashworthy design guidance, our study measured wheelchair seat loading during 20g/48kph frontal impact sled tests with a 50th percentile male test dummy. Loading conditions were assessed using two different rear securement point positions. Results of four sled impact tests revealed downward loads ranging from 17 019 to 18 682 N, depending upon rear securement point configuration. Maximum fore/aft shear loads ranged from 4424 to 6717 N across the tests.
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Are men and women equally violent to intimate partners?
- Taft A, Hegarty K, Flood M. Aust N Z J Public Health 2001; 25(6):498-500.
Correspondence: La Trobe University, Victoria. (email: a.taft@latrobe.edu.au).
Violence against women is a significant public health issue. One form of violence against women, intimate partner abuse or domestic violence, is prevalent in Australia. In this article, we summarise the main theoretical and methodological debates informing prevalence research in this area. We explain why studies finding equivalent victimisation and perpetration rates between the sexes are conceptually and methodologically flawed and why coercion and control are fundamental to the definition and measurement of partner abuse. We conclude that while male victims of partner abuse certainly exist, male victims of other forms of male violence are more prevalent. A focus on gendered risk of violence in public health policy should target male-to-male public violence and male-to-female intimate partner abuse.
The protective influence of parents and peers in violence avoidance among African-American youth.
- Smith P, Flay BR, Bell CC, Weissberg RP. Matern Child Health J 2001 Dec;5(4):245-252
Correspondence: Paula Smith, Department of Family and Consumer Studies, The University of Utah, Salt Lake City 84112, USA. (email: Paula.Smith@fcs.utah.edu).
OBJECTIVES: This study attempted to provide further insight into the roles of parents and peers as they influence youth involvement with violence. Specifically, this paper considers whether parents who are close to their children have children who affiliate with prosocial friends who may in turn serve as a buffer against violence. This study also considers how parent and peer influences may change as youth transition to adolescence.
METHODS: A cross-sectional health behavior survey was administered to 384 low-income, African-American youth aged 10-15 from three Chicago area schools. Structural equation models (SEM) were developed to assess the impact of youth reported prosocial friends and parental closeness on violence involvement. The overall model was tested to examine equivalence across preadolescent and adolescent age-groupings.
RESULTS: Results from the overall model indicated that parental closeness did not have a direct influence on youth violence involvement, but having a close parent-child relationship improved the youth's ability to select prosocial friends, which was directly related to decreased involvement with violence. Differences in the model by age-grouping suggested the presence of prosocial friends was a stronger factor for adolescent violence avoidance when compared to preadolescents.
CONCLUSIONS: Parents can make a difference in the way in which their children choose their friends and therefore get involved with violence by maintaining a closely bonded relationship throughout preadolescence and adolescence. The importance of this closely bonded relationship has even greater effects for decreasing violence involvement for adolescents than preadolescents.
Hopelessness and violence among inner-city youths.
- Bolland JM, McCallum DM, Lian B, Bailey CJ, Rowan P. Matern Child Health J 2001; 5(4):237-244.
Correspondence: J. Bolland, Institute for Social Science Research, University of Alabama, Tuscaloosa 35487-0216, USA. (email: jbolland@bama.ua.edu).
OBJECTIVES: Ethnographic literature on inner-city life argues that adolescents react to their uncertain (and objectively bleak) future by abandoning hope; this, in turn, leads them to engage in risk behaviors, including violence, with considerable frequency. This study empirically measures the pervasiveness of hopelessness and uncertainty about the future among inner-city adolescents and documents the link between hopelessness, uncertainty, and risk behavior.
METHODS: We surveyed a sample of 583 adolescents (aged 9-19) living in public housing in Huntsville, AL; this constitutes 80% of the eligible population. Each participant in the survey received $10. Their responses yielded empirical distributions for hopelessness, uncertainty about the future, and four violent behaviors. Using OLS regression, we examined the effect of hopelessness on these violent behaviors.
RESULTS: Hopelessness about the future was relatively rare, affecting only 20-30% of the respondents. However, it was a strong predictor of fighting and carrying a knife for females, and of carrying a knife, carrying a gun, and pulling a knife or gun on someone else for males. Uncertainty about the future was more prevalent, but unrelated to the violent behaviors.
CONCLUSIONS: These results suggest that the conclusions of the ethnographic literature are only partially valid: While hopelessness is, in fact, strongly related to risk behavior, it is not nearly so prevalent as is generally assumed.
Violent behaviors in early adolescent minority youth: results from a middle school youth risk behavior survey.
- Clubb PA, Browne DC, Humphrey AD, Schoenbach V, Meyer B, Jackson M; RSVPP Steering Committee. Matern Child Health J 2001; 5(4):225-235.
Correspondence: PA Clubb, Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill 27599-7445, USA. (email: paclubb@email.unc.edu).
OBJECTIVES: To describe the prevalence and characteristics of violence and violence-related behaviors among six populations of U.S. minority adolescents in grades 6-8.
METHODS: Six thousand four hundred non-White adolescents were recruited from six sites that were part of a collaborative project. Surveys were administered either during the school day or at community facilities. All students at each site were asked 10 questions about recent violence-related behaviors (including use of threats, fighting, weapon carrying, and weapon use). Prevalence of each violence-related behavior was reported within and across sites, and stratified by race/ethnicity, gender, age, and other characteristics expected to influence the behaviors.
RESULTS: Sixty-six percent (66%) of the middle school students sampled reported being involved in some type of recent fighting and/or weapon-related behaviors. Sixty-one percent (61%) indicated some form of fighting behavior in the past 3 months (threatening to beat someone up, physical fighting, and/or being hurt in a fight). Thirty percent (30%) of participating youth reported one or more weapon-related behaviors (threatening to use a weapon, carrying a weapon, using a weapon, and/or being cut, stabbed or shot at). Reported gun carrying among males varied depending upon site, but was as high as 20%. Grade in school was positively associated with reported violent behaviors. Adolescents who reported living full-time with a parent or parent figure, and those who reported religious observance or beliefs, were less likely to report violence involvement. All violence-related behaviors were more common among male than female adolescents.
CONCLUSIONS: Violence prevention efforts should begin in elementary school and continue throughout adolescence. Programs should be prepared to provide services or referrals to victims of violence, implement programs tailored toward females as well as males, and build partnerships with churches and other community organizations in which youth are involved.
Violent and aggressive behaviors in youth: a mental health and prevention perspective.
- Osofsky HJ, Osofsky JD. Psychiatry 2001; 64(4):285-295.
Correspondence: H. Osofsky, Department of Psychiatry, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA. (email: hosofs@lsuhsc.edu).
Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.
Increasing physician impact on the prevention of domestic violence.
- Thornton JE, Garner CN, Swenson-Britt E, Brackley MH. Tex Med 2002; 98(1):58-61.
Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229-3900, USA.
Physicians in their professional organizations have recognized the tremendous toll of domestic violence on the safety and health of their patients. Effective integration of screening and referral into routine practice has encountered many significant barriers, primarily the syndrome of compassion fatigue. This article describes how physicians can enhance the safety of families. Universal education offers more opportunities for physicians to communicate with survivors and perpetrators of violence. Specific documentation by physicians will enhance patient care and public health surveillance efforts. Safety planning skills offer immediate benefits to patients facing acute dangers. The participation of physicians (individually and collectively) on adult intentional fatality review boards will make available more specific data and tools for the prevention of domestic violence.
Domestic violence: how to ask and how to listen.
- Kramer A. Nurs Clin North Am 2002; 37(1):189-210.
Correspondence: A. Kramer, Clinical Nurse Specialist, Interpersonal Violence, Aurora Sinai Medical Center, Aurora Health Care, Inc., Milwaukee, Wisconsin.
Significant numbers of women experience physical, sexual, and psychological abuse by their partners or family members and come to the emergency department for care. The nurse has a unique opportunity to make a difference in these women's lives by simply asking about the abuse in a caring and confidential manner. Listening and thinking in terms of a stage-based approach to behavioral change with battered women may guide the emergency nurse toward more effective intervention strategies. The goal is not to "fix it" but rather to partner with her and offer options that may help shift her trajectory toward more safety and less isolation.
Partner violence intervention in the busy primary care environment.
- McNutt LA, Carlson BE, Rose IM, Robinson DA. Am J Prev Med 2002; 22(2):84-91.
Correspondence: LA McNutt, Department of Epidemiology (McNutt), University at Albany, State University of New York, Albany, New York, USA.
BACKGROUND: Few studies of intimate partner violence (IPV) interventions have been conducted in primary care settings. Based on recommendations, we implemented a multifaceted IPV intervention that included a sticker placed in medical charts listing screening questions, routine IPV screening by nursing staff, clinician follow-up for women screening positive, and referral to on-site services.
METHODS: A prospective cohort study compared multiple measures collected at the intervention site and a center providing usual care. Measures included self-reported IPV, documented IPV screening and IPV experiences, and quantity of IPV materials taken from the centers.
RESULTS: Of 746 charts reviewed in a random chart review conducted at the intervention site, 36.6% were tagged for IPV screening, and of those tagged, 86.1% had documentation of screening. Approximately 5% (11 of 235) of women screened positive for IPV; about half had documented clinician follow-up and referral to on-site services. Comparison of survey responses and medical record reviews (intervention site) indicated that the screening protocol primarily identified severely abused women (sensitivity 80%, specificity 98%), but rarely identified women experiencing low to moderate levels of abuse. IPV brochures were taken from the intervention site at a rate of 51 per 1000 visits versus 29 per 1000 visits taken from the control site.
CONCLUSIONS: Utilizing screening as the only gateway to on-site services limited access for many IPV victims. The removal of IPV brochures from examination rooms suggests that providing contact information for self-referral to on-site services may improve access.
How geriatricians identify elder abuse and neglect.
- Harrell R, Toronjo CH, McLaughlin J, Pavlik VN, Hyman DJ, Dyer CB. Am J Med Sci 2002; 323(1):34-38.
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
BACKGROUND: Up to 2 million elderly persons are abused or neglected in the United States each year. Although elderly patients see their physicians an average of five times per year, physicians make only a small percentage of reports to Adult Protective Services (APS) agencies.
OBJECTIVES: The purpose of this study was to learn how practicing geriatricians define, diagnose, and address abuse and neglect to provide some guidance to the busy general internist regarding this complex issue.
METHODS: Ten local geriatricians were interviewed with a standardized set of open-ended questions. A team analyzed the verbatim transcriptions using both quantitative and qualitative methods.
RESULTS: The average number of cases diagnosed per year was 8.7 (range, 2-20). The geriatricians were fairly consistent in their definitions of elder abuse and neglect and how they diagnosed it through the history and physical exam. The most common findings in the history were rapport between the patient and caregiver, medical noncompliance, activities of daily living and instrumental activities of daily living assessments, and loss of social activities. The most common findings on the physical exam were bruising/trauma, general appearance/hygiene, malnutrition, and dehydration.
CONCLUSIONS: The geriatricians emphasized keeping the diagnosis of abuse and neglect in mind for every patient. A variety of interventions were employed by physicians and ranged from automatically calling APS on each case to addressing cases through work with an interdisciplinary geriatrics team.
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