Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults
Standardization in tools and documentation of child abuse and intimate partner violence have proven helpful in completely documenting injuries and suspected abuse among these populations. Similar tools do not yet exist for older adults and elder abuse.
To (1) use insights from experts to develop a tool to assist clinicians in appropriately and completely documenting physical findings in injured older adults for potential future forensic investigation of abuse or neglect and (2) to assess the feasibility of incorporating this tool into clinical practice.
Two-phase, exploratory qualitative study. Phase 1: individual interviews with elder abuse experts from various specialties in medicine and criminal justice. Phase 2: focus groups with anticipated end users of the tool.
Phase 1 telephone-based key informant interviews were conducted with 11 elder abuse experts (2 detectives, 3 prosecutors, 1 forensic pathologist, 2 geriatricians, and 3 emergency medicine physicians). Phase 2 focus groups were conducted among emergency medicine (n = 10) and primary care (n = 8) providers.
Key informant interviews were conducted telephonically while the two focus groups were held in-person at an emergency medicine site in New York, NY, and a primary care site in Los Angeles, CA.
Experts agreed that medical providers’ documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records.
A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome.
KEY WORDSdocumentation tool older adults medical documentation physical injury
The authors would like to thank all of the key informant interviewees and focus group participants that generously gave their time.
This study was funded by the Department of Justice (DOJ) and in part by the National Institute on Aging of the National Institutes of Health under award numbers 5 K99AG052647-02 and 4 R00AG052647-03 for ACK’s time. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Justice or National Institutes of Health.
This study was presented as a poster at the American Geriatrics Society (AGS) annual meeting in San Antonio, TX, in May 2017.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Lifespan of Greater Rochester Inc., Weill Cornell Medical Center of Cornell University, New York City Department for the Aging. Under the radar: New York state elder abuse prevalence study: self-reported prevalence and documented case surveys. 2012. http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf. Accessed 12 December 2018.
- 2.Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the united states: the national elder mistreatment study. Am J Public Health. 2010;100:292–7.Google Scholar
- 3.Lachs MS, Pillemer KA. Elder abuse. N Engl J Med. 2015;373:1947–56.Google Scholar
- 4.Dubowitz H, Bross DC. The pediatrician's documentation of child maltreatment. Am J Dis Child. 1992;146:596–9.Google Scholar
- 5.Jackson AM, Rucker A, Hinds T, Wright JL. Let the record speak: medicolegal documentation in cases of child maltreatment. Clin Pediatr Emerg Med. 2006;7:181–5.Google Scholar
- 6.Boyce MC, Melhorn KJ, Vargo G. Pediatric trauma documentation: adequacy for assessment of child abuse. Arch Pediatr Adolesc Med. 1996;150:730–2.Google Scholar
- 7.Guenther E, Olsen C, Keenan H, Newberry C, Dean JM, Olson LM. Randomized prospective study to evaluate child abuse documentation in the emergency department. Acad Emerg Med. 2009;16:249–57.Google Scholar
- 8.Limbos MA, Berkowitz CD. Documentation of child physical abuse: how far have we come? Pediatrics. 1998;102:53–8.Google Scholar
- 9.Bloemen EM, Rosen T, Cline Schiroo JA, et al. Photographing injuries in the acute care setting: development and evaluation of a standardized protocol for research, forensics, and clinical practice. Acad Emerg Med. 2016;23:653–9.Google Scholar
- 10.Pasqualone GA. Forensic RNs as photographers: documentation in the ED. J Psychosoc Nurs Ment Health Serv. 1996;34:47–51.Google Scholar
- 11.Bar-on ME, Zanga JR. Child abuse: a model for the use of structured clinical forms. Pediatrics. 1996;98:429–33.Google Scholar
- 12.Newton AS, Zou B, Hamm MP, et al. Improving child protection in the emergency department: a systematic review of professional interventions for health care providers. Acad Emerg Med. 2010;17:117–25.Google Scholar
- 13.Ansari S, Boyle A. Emergency department-based interventions for women suffering domestic abuse: a critical literature review. Eur J Emerg Med. 2017;24:13–8.Google Scholar
- 14.Ritchie M, Nelson K, Wills R, Jones L. Does training and documentation improve emergency department assessments of domestic violence victims? J Fam Violence. 2013;28:471–7.Google Scholar
- 15.Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 30-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357.Google Scholar
- 16.National Resource Council. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington DC: The National Academies Press; 2003. https://www.ncbi.nlm.nih.gov/books/n/nap10406/pdf/. Accessed 12 December 2018.
- 17.Basile KC, Hertz MF, Back SE.Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings: Version 1. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2007. https://www.cdc.gov/violenceprevention/pdf/ipv/ipvandsvscreening.pdf Accessed 12 December 2018Google Scholar
- 18.Koin D. A forensic medical examination form for improved documentation and prosecution of elder abuse. J Elder Abuse Negl. 2003;15:109–19.Google Scholar
- 19.Rosen T, Reisig C, LoFaso VM, et al. Describing visible acute injuries: development of a comprehensive taxonomy for research and practice. Inj Prev. 2017;23(5):340–345.Google Scholar
- 20.Glaser BG, Straus AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine; 1967.Google Scholar
- 21.Strauss, A. & Corbin, J. Basics of Qualitative Research: Grounded Theory, Procedures and Techniques. Newbury Park, CA: Sage; 1998.Google Scholar
- 22.Miles MB, Huberman AM, Saldaña J. Qualitative Data Analysis: a Methods Sourcebook. 3rd ed. Thousand Oaks, CA: Sage Publishers; 2013.Google Scholar
- 23.Saldaña J. The Coding Manual for Qualitative Researchers. 2nd ed. Thousand Oaks, CA: Sage Publications; 2012.Google Scholar
- 24.May AN, Flude GW, Duflou J, Mengersen KL, Read-Allsopp C. External injury documentation in major trauma victims is inadequate: grounds for routine photography in the emergency department? Emerg Med Australas. 2008;20:500–7.Google Scholar
- 25.Ahmad A, Lachs MS. Elder abuse and neglect: what physicians can and should do. Cleve Clin J Med. 2002;69(10):801–808.Google Scholar
- 26.Gironda MW, Nguyen AL, Mosqueda LM. Is this broken bone because of abuse? Characteristics and comorbid diagnoses in older adults with fractures. J Am Geriatr Soc. 2016;64:1651–5.Google Scholar
- 27.Murphy K, Waa S, Jaffer H, Sauter A, Chan A. A literature review of findings in physical elder abuse. Can Assoc Radiol J. 2013;64:10–4.Google Scholar
- 28.Rosen T, Bloemen EM, LoFaso VM, Clark S, Flomenbaum NE, Lachs MS. Emergency department presentations for injuries in older adults independently known to be victims of elder abuse. J Emerg Med. 2016;50:518–26.Google Scholar
- 29.Wiglesworth A, Austin R, Corona M, et al. Bruising as a marker of physical elder abuse. J Am Geriatr Soc. 2009;57:1191–6.Google Scholar
- 30.Ziminaki CE, Wiglesworth A, Austin R, Phillips LR, Mosqueda L. Injury patterns and causal mechanisms of bruising in physical elder abuse. J Forensic Nurs. 2013;9:84–91; quiz E1–2.Google Scholar
- 31.Ziminski CE, Phillips LR, Woods DL. Raising the index of suspicion for elder abuse: cognitive impairment, falls, and injury patterns in the emergency department. Geriatr Nurs. 2012;33:105–12.Google Scholar
- 32.Bryson D. Current issues: consent for clinical photography. J Vis Commun Med. 2013;36(1–2):62–3.Google Scholar
- 33.Burns K, Belton S. Clinicians and their cameras: policy, ethics and practice in an Australian tertiary hospital. Aust Health Rev. 2013;37(4):437–41.Google Scholar
- 34.Hill K. Consent, confidentiality and record keeping for the recording and usage of medical images. J Vis Commun Med. 2006;29(2):76–9.Google Scholar
- 35.Payne KF, Tahim A, Goodson AM, Delaney M, Fan K. A review of the current clinical photography guidelines in relation to smartphone publishing of medical images. J Vis Commun Med. 2012;35(4):188–92.Google Scholar
- 36.Paryavi E, Schwartz BS, Meyer CL, Herman MJ, Abzug JM. Reliability and effectiveness of smartphone technology for the diagnosis and treatment planning of pediatric elbow trauma. J Pediatr Orthop. 2016;36(5):483–7.Google Scholar
- 37.Nagvi GA, Daly M, Dawood A, Kurkuri A, Kutty S. Smart consultation for musculoskeletal trauma: accuracy of using smart phones for fracture diagnosis. Surgeon. 2014;12(1):32–4.Google Scholar
- 38.Bullard TB, Rosenberg MS, Ladde J, Razack N, Villalobos HJ, Papa L. Digital images taken with a mobile phone can assist in the triage of neurosurgical patients to a level 1 trauma centre. J Telemed Telecare. 2013;19(2):80–3.Google Scholar
- 39.Fernandes-Taylor S, Gunter RL, Bennett KM, et al. Feasibility of implementing a patient-centered postoperative wound monitoring program using smartphone images: a pilot protocol. JMIR Res Protoc. 2017;6(2):e26.Google Scholar
- 40.Gunter R, Fernandes-Taylor S, Mahnke A, et al. Evaluating patient usability of an image-based mobile health platform for postoperative wound monitoring. JMIR Mhealth Uhealth. 2016;4(3):e133.Google Scholar
- 41.Kunde L, McMeniman E, Parker M. Clinical photography in dermatology: ethical and medico-legal considerations in the age of digital and smartphone technology. Australas J Dermatol. 2013;54(3):192–7.Google Scholar
- 42.Capterra. The top 20 most popular ERM softward solutions. http://www.capterra.com/infographics/top-emr-software. Published January 25, 2012. Updated 2017. Accessed 12 December 2018.