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European Journal of Applied Sciences – Vol. 12, No. 6
Publication Date: December 25, 2024
DOI:10.14738/aivp.126.17965.
Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What
Competencies are Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
Services for Science and Education – United Kingdom
Identification of Elder Abuse at Emergency Departments: What
Competencies are Required from Staff?
Mari Salminen-Tuomaala
Seinäjoki University of Applied Sciences,
Seinäjoki, Finland
Juha Tiainen
YTHS, Oulu, Finland
Eija Paavilainen
Tampere University, Tampere & Etelä-Pohjanmaa
Wellbeing Services County, Seinäjoki, Finland
ABSTRACT
The purpose of this mixed method study was to describe emergency department
nursing staff’s ratings and experiences of their competencies in identifying elder
abuse. The target group consisted of nursing staff in emergency departments of
one university hospital and four central hospitals in Finland. The staff were
Registered Nurses, Paramedic Nurses and Practical Nurses. The study is part of a
larger research project on the identification of abuse, carried out with staff in
prehospital and emergency department care. The data was collected using an
electronic Webropol survey in autumn 2022 and spring-summer 2023. The
quantitative data was analyzed using IBM Statistics for Windows 28 and the
qualitative data using inductive content analysis. In the experience of emergency
department nursing staff, it was easier to identify physical abuse, compared to
psychological or social abuse or neglect of care in their older patients. The staff
were well aware of risk factors associated with elder abuse, but their detection
was not easy in short care contexts. According to the study results, elder abuse
identification competencies in emergency departments include detection of the
signs of abuse; assessment of the seriousness of the situation; interaction skills;
emotional intelligence and situational awareness, and ethical competencies. In
addition, the results highlight the importance of multiprofessional expertise in
ensuring the patient’s safe follow-up care and coping at home. The identification of
elder abuse is challenging in emergency departments and requires the
development of multiple competencies and knowledge, especially regarding the
detection of the signs of abuse, assessing the seriousness of the situation and
interaction skills.
Keywords: elder, abuse, nursing staff, emergency department.
BACKGROUND
Elder abuse is a global problem that has continued to increase alarmingly in recent years [1,
2]. According to the World Health Organization [3], one in six (15.7 %) over 60-year-olds
experiences abuse yearly. Earlier research has shown that abuse is even more common, since
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older people do not always report abuse due to fear or shame [4, 5]. The identification of elder
abuse and effective interventions can be seen as a matter of human dignity, which makes the
development of nursing staff competencies in this area ethically important [6-8].
Elder abuse is defined as an act or lack of appropriate action in a trusting relationship, which
jeopardizes the older (over 65-year-old) person’s health, safety or wellbeing. The abuse can
include physical or psychological violence, sexual abuse, financial abuse, neglect of care and
help or limitation of rights, or other behaviour that violates human dignity or is experienced
as insulting. Abuse can occur in the form domestic violence, in a couple relationship or in any
close relationship, or as unethical treatment in a caring relationship [2]. Increased
dependence on the help of others can increase the risk of abuse [9]. As pointed out by
Tiilikallio and Säles [10], older people may also become subjected to structural abuse in
society, which may involve age-based discrimination and lack or denial of appropriate
services.
Women in old age experience violence in their couple relationships or other close
relationships more commonly, compared to men. In Finland, there has been an increase in
reported abuse experienced by under 75-year-old women in their close relationships [11]. In
the Healthy Finland Survey, conducted in 2023 by the Finnish Institute for Health and Welfare
[12], 6 % of 65-74-year-old women and 2.1 % of the men reported having experienced
physical or psychological abuse in their close relationships during the previous 12 months. In
a study conducted in Australia it was estimated that 14.8% of community-living over 65-year- old people had experienced abuse. Psychological abuse was found to be the most common
form of abuse (11.7), followed by neglect (2.9%), financial abuse (2.1%), physical abuse
(1.8%) and sexual abuse (1%) [13]. Similarly, Yılmaz et al. [14] found psychological abuse to
be the most common form of abuse in older people. The next most common abuse subtypes
were physical abuse, neglect and financial abuse. Research has shown that elders’ physical
and psychological vulnerability and loneliness make them more susceptible to abuse [15, 16].
In addition, poor health, lack of social contacts and social support, as well low socioeconomic
status are associated with an elevated risk of abuse, especially financial, psychological and
sexual abuse. The perpetrators are usually the elders’ grown-up children, spouses or partners.
Abuse from adult children is mostly financial, physical or psychological, whereas abuse
committed by a spouse or partner is most commonly physical, psychological or sexual [13].
Abuse can lead to long-term illness and depression and increase the use of emergency
services [17-19].
According to Qu et al. [13], abused older people seek help for physical, psychological and
financial abuse more commonly, compared to sexual abuse or neglect. Help is mostly sought
from family members and friends. Nursing professionals have a central role in the
identification of elder abuse, so developing their expertise is imperative [8]. Emergency
departments are frequently visited by abused elders, but the abuse often remains undetected
[18, 20]. As declared by Åberg [21], elder abuse and violence in close relationships are
difficult to detect; they are typically hidden crimes, not reported to authorities. Is has been
estimated that only one out of twenty-four cases of abuse are reported to authorities [21, 22].
Earlier research on the identification of elder abuse in nursing has involved the perspectives
of residential and nursing homes [24-29]; home care and nursing [30-34]; prehospital
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Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
emergency services [35-37], and hospital emergency departments [38-42]. Furthermore, a
few studies have dealt with educational interventions designed for nurses on the
identification of elder abuse [43-45], including training on screening and assessment tools
[46-52].
The identification of elder abuse has been found to be hampered by the relatively short
duration of the contacts at the emergency department [39]. Secondly, emergency departments
focus on acute health problems and do not routinely seek to detect psychological or financial
problems [53]. The assessment of the situation is further complicated by ethical and family
dynamic factors [54]. As noted by Andermann [55], social risks factors underlying health
problems should also be looked at when encountering suspected abuse. Some interventions
have already been developed to identify, prevent and intervene with elder abuse. They
involve education, multiprofessional collaboration and various counselling and support
interventions [56]. It has been proposed that training arranged to help professionals detect
elder abuse should be complemented by interventions that improve the safety of the elders
and respect their autonomy and privacy [57]. When developing interventions, it is also
important to assess in which environments they could be most useful [58, 59]. Especially
creating screening tools for nursing staff at emergency department should be a priority [56,
60, 61]. Elder abuse protocols could also be developed to support nursing staff [62] and to
increase nursing students’ awareness of the scope of the problem [63]. Systematic screening
with help of checklists has proven to be effective in the detection of abuse at emergency
departments [22]. Checklists can help staff identify signs of abuse and people subjected to
abuse [64]. Earlier studies have shown that health care professionals feel that they have not
received adequate training on how to identify elder abuse [59, 65]. Increasing elder abuse
training is justifiable, as it has been shown to promote professionals’ interview skills,
assessment of the situation, organization of further care and documentation [66]. The
identification of elder abuse, the appropriate interventions and documentation call for ethical
competencies [67]. In addition, health care professionals would benefit from cultural
sensitivity [68] and training on the risk factors of abuse [55]. More information is required
about the health care professionals’ experiences of identifying elder abuse and neglect [1, 69].
Nurses working at emergency departments and caring for older clients in acute situations
have a critical role in the detection of elder abuse [22, 23].
STUDY PURPOSE AND RESEARCH PROBLEMS
The purpose of this mixed method study was to describe emergency department nursing
staff’s ratings and experiences of their competencies in identifying elder abuse. The study
aimed at producing information that can be used to promote emergency department staff’s
theoretical and practical competencies, or knowledge and skills, in the identification of elder
abuse.
The research questions were:
1. How do staff at emergency departments rate their knowledge and skills in working
with older abused clients?
2. What knowledge and skills do emergency department staff, in their own experience,
need to identify and intervene with elder abuse?
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THE STUDY
Target Group and Data Collection:
The target group consisted of Registered Nurses, Paramedic Nurses and Practical Nurses at
emergency departments of one university hospital and four central hospitals in Finland. The
study is part of a larger research project on the identification of abuse, carried out with staff in
prehospital and emergency department services. The data was collected using an electronic
Webropol survey in autumn 2022 and spring-summer 2023. The research team used a
questionnaire they had developed earlier based on an integrated literature review [70], pre- tested with emergency care providers and piloted in a survey with prehospital emergency
care providers, contacted through the Finnish Association of Paramedics and A & E nursing
professionals.
All Registered Nurses, Paramedic Nurses and Practical Nurses at the emergency departments
received a link to the questionnaire via e-mail through their respective hospitals’ research
coordinators. The respondents could choose between a Finnish and Swedish language version
of the questionnaire. They responded anonymously. The background questions (n=7) in the
questionnaire concerned respondents’ age, gender, professional education, occupation,
workplace and work experience in years. Second, the questionnaire included 12 Likert scale
questions on respondents’ knowledge of what constituted abuse, its risk factors, the affected
persons’ need for support and indicators of physical, psychological and social abuse in elders.
A further purpose of the questions was to examine respondents’ knowledge of action to be
taken when encountering abused clients at the emergency department. They were asked to
rate how skilled they felt in taking up the topic of abuse, in referring clients to further care
and in supporting abused clients. Last, the questionnaire involved four open questions. The
respondents were asked to describe situations at the emergency department, in which they
had come to suspect abuse of elders, children or youth. They were also requested to describe
competencies needed in the identification of abuse and to list their educational needs.
This article reports results from the viewpoint of theoretical and practical competencies, or
knowledge and skills, required in the identification of elder abuse. The focus is on the
identification of abuse, which is a prerequisite for any interventions. The two are often
seamlessly intertwined. The same questionnaire was used to collect information on the
identification of child and youth abuse. The results for this material are to be reported in
another article.
Data Analysis
The quantitative data related to the first research question was analyzed using IBM Statistics
for Windows 28 [71] and the qualitative data pertaining to the second research question
using inductive content analysis [72]. Percentages and frequencies were used to report
quantitative data. The purpose of the qualitative data was to bring out previously unknown
aspects of the topic under study. Phrases, clauses and sentences representing a coherent idea
as a response to the second research question constituted the unit of analysis [73]. After
reading the data for several times, expressions that represented a response to the research
question were picked out and reduced by removing “empty” filler words, but retaining the
original core idea. The reduced expressions were then grouped based on similarities. These
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Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
categories were named using titles characteristic of the content, compared, and collapsed into
a higher-level category, and named using a descriptive label [74].
Ethics and Reliability
Permission to conduct research was obtained from each hospital separately. Ethical approval
was not required, since the study did not involve patients. Voluntary completion of the
Webropol survey was considered consent to participation. Good scientific practice was
followed throughout the study [75]. The cover letter contained detailed information about the
study, participation and use of data [72]. Participation was voluntary. As the topic can be
considered ethically sensitive, the voluntary nature of participation ensured that
professionals could decline if they found the topic too stressful [76]. Respondents were also
informed of the possibility to withdraw at any stage of the research process [75]. The
research data was handled with confidentiality and stored safely, and data analysis
undertaken with care.
The reliability and validity of the quantitative research questions can be considered good. The
survey questions brought responses as planned [77, 78] and the questionnaire was consistent
and clearly structured [78]. The reliability of the study was increased by the fact that the
questionnaire had been pre-tested with both prehospital and emergency department staff and
used in a survey with prehospital emergency care providers. As regards external validity, the
study measures what it was intended to measure, and the results can be generalized to a
larger population. Internal validity of the study is good; the results reflect the phenomenon
and its potential cause-and-effect relationships [71]. Reliability is a key quality attribute in
research, determining how trustworthy and consistent the results obtained are. This study
can be considered reliable, as it produced similar results under similar circumstances in the
various locations [79].
As regards the qualitative data, the research rigour of the analysis and report can be evaluated
from the perspectives of credibility, conformability, reflexivity and transferability [72]. The
credibility of the study was increased by the fact that the respondents described their
personal experiences of the phenomenon under study. To enhance the conformability of the
study, the analytical process was described carefully, but without compromising participants’
anonymity. The researchers practiced reflexivity, or were aware of their potential
preconceptions, as they had encountered abused clients in their previous work in nursing. To
facilitate the evaluation of transferability, the background of the study participants was
described briefly. The findings are transferable and useful in the Finnish nursing context and
potentially useful internationally.
RESULTS
Quantitative Results
Demographic Respondent Data:
The respondents were 76 members of nursing staff; 69 Registered Nurses, 3 Paramedic
Nurses and 4 Practical Nurses. There were 62 (81.5%) women and 14 (18.5%) men. The
respondents’ age range was 24-66 years, with the means of 36.8 years and median of 35
years. The majority of them (n=63; 82.9%) held a Bachelor-level degree from a University of
Applied Sciences. Six respondents (7.9%) had a Master-level degree from a University of
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Applied Sciences, four had a vocational qualification (5.3) and three (3.9%) a University
degree. The length of the respondents’ work experience varied between 2 and 40 years
(means 12.8 years; median 10.5 years).
Most respondents, 92.1%, had encountered suspected cases of abuse at their work at the
hospital emergency department. For 32.1% of the respondents, this occurred on a monthly
basis; for 35.7% every week, and for 5.4% daily. However, 23.2% of the respondents reported
that they suspected abuse of their clients 1-3 times per year; and 3.6% said they suspected
abuse more often than 3 times a year.
Respondents’ Self-Rated Knowledge Related to the Identification of Elder Abuse:
Table 1: Emergency department staff’s self-rated theoretical and practical
competencies in identifying and intervening with suspected abuse.
Theoretical or
practical competency
Very
poor
Rather
poor
Neither
poor nor
good
Rather
good
Very
good
Means Median
My knowledge of what
kind of things constitute
abuse
0 % 10 % 14 % 70 % 6 % 3.7 4.0
My knowledge of what
kind of support an
abused client needs
2 % 18 % 40 % 36 % 4 % 3.2 3.0
My knowledge of what
signs and things indicate
physical abuse
0 % 4 % 18 % 68 % 10 % 3.8 4.0
My knowledge of what
signs and things indicate
psychological abuse
2 % 28 % 28 % 36 % 6 % 3.2 3.0
My knowledge of what
signs and things indicate
social abuse
6 % 34 % 24 % 30 % 6 % 3.0 3.0
My knowledge of action
to be taken when
encountering an abused
client at the emergency
department
2 % 16 % 30 % 46 % 6 % 3.4 4.0
My knowledge of the
risk factors related to
abuse
4 % 24 % 20 % 46 % 6 % 3.3 4.0
My skills in taking up
the topic of abuse with a
client
6 % 18 % 30 % 40 % 6 % 3.2 3.0
My skills in referring an
abused client to further
care
6 % 34 % 24 % 30 % 6 % 3.0 3.0
My skills in supporting
an abused client
2 % 22 % 36 % 32 % 8 % 3.2 3.0
My skills in attending to
an abused client’s family
4 % 38 % 32 % 24 % 2 % 2.8 3.0
My skills in
documenting elder
abuse
2 % 22 % 16 % 52 % 8 % 3.4 4.0
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Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
Table 1 shows the respondents’ self-ratings for their knowledge and skills in identifying and
intervening with abused clients. Although the majority (76%) of the respondents rated their
knowledge of what constituted abuse as rather good or very good, there was great variation in
their knowledge of different forms of abuse. Most respondents (78%) found that they had
rather good or very good knowledge related to the identification of physical abuse, but they
were less confident about the indicators of psychological or social abuse. For these forms of
abuse, the responses were more evenly distributed across the three central options on the
Likert scale (rather poor/neither poor nor good/rather good knowledge).
More than half of the respondents (52%) reported having rather good or very good
knowledge of the risk factors related to abuse, and also knowing rather well or very well what
action to take when encountering potentially abused clients. The respondents’ ratings were
lower for their knowledge of what kind of support the abused clients might need; the largest
group of respondents (40%) chose the option “neither poor nor good knowledge”, and the
second largest group (36%) assessed their knowledge to be rather good.
Respondents’ Self-Rated Intervention Skills:
As Table 1 shows, of the various intervention skills required when encountering potentially
abused clients, the respondents trusted their documentation skills best. More than half of
them rated their documentation skills as rather good. The respondents felt less confident
about their skills in taking up the topic of abuse with clients, in supporting them or in
referring them to further care. For these interventions, the responses were relatively evenly
distributed across the three central options on the Likert scale (rather poor/neither poor nor
good/rather good skills). Attending to the client's family seemed to be the most challenging
intervention; the greatest group of respondents (38%) found that they had rather poor skills
in this respect, 32% felt that their skills were neither poor, nor good and 24% reported rather
good skills.
Qualitative Findings: Competencies Required and Educational Needs
Table 2: Competencies Required in Identifying and Intervening with Suspected Abuse
and Educational Needs as Experienced by Respondents
Category Reduced expression
Detection of the signs of
abuse
Knowledge about typical injuries
Knowledge about the mechanisms of injury
Detecting injuries caused by abuse
Comprehensive examination
Detecting signs of violence
Assessing the seriousness
of the situation
Good cognitive skills when interviewing clients
Reasoning skills
Comparing the narrative to injuries
Detecting signs of crisis or trauma
Interpretation of clients’ description
Assessing clients’ ability to cope
Interaction skills Listening and presence
Ability to take up sensitive topics
Creating an atmosphere of trust
Authenticity, calm and privacy in encountering
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Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
experienced by old people may be so severe that the person is at risk of suicide”. According to
the respondents, it became important to assess the situation by asking oneself questions like
“Does the abuse old person play down the severity of their situation to protect the abuser?
What kind of words do they use of the abuser?” (r43).
Interaction Skills:
Interaction skills were among the competencies listed by the respondents as necessary when
working with potentially abused clients. Genuine presence and concentration on the client
were mentioned, as were “authentic encounters and interest in each case” (r50). According to
the respondents, listening, calm and empathy were required to gain the client’s trust. In the
words of one respondent, professionals needed to possess “long feelers, presence, ability to
build an atmosphere of trust” (r50). Another respondent wrote: “In addition, you need enough
social skills, so that you can build a trusting relationship with the client and discuss sensitive
issues” (r25). Further attributes mentioned involved “courage to take up the topic” (r31) and
“a clinical eye. Courage to ask questions” (r45). Good interaction skills were also required in
multiprofessional collaboration and in the creation of networks to support clients’ coping.
Emotional Intelligence and Situational Awareness:
In the experience of the respondents, discretion and emotional intelligence were helpful in
interaction with older clients, who often hesitated to report their experiences or complex
family dynamics. Nurses needed to be able to read non-verbal cues, understand emotions and
feel compassion. At times, genuine presence involved having to face unpleasant emotions. In
addition, the respondents observed that taking up the topic of potential abuse called for
situational awareness and understanding of the relationship between the client and the
abuser. The professionals needed to assess in which situations, and in which words to ask
about the client’s background. To quote two respondents, “the skill to detect signs of abuse,
like hiding emotions, playing down things” (r21); “Dealing with the feelings of transference
and the emotions that arise in yourself, situational awareness, game sense” (r33).
Furthermore, the respondents mentioned the assessment of the client’s emotional intelligence
skills. They thought it was important to explore how the older clients experienced the abuse,
and what emotions and reactions the situation evoked in them.
Ethical Competencies:
The respondents pointed out that ethical competencies were needed when dealing with
suspected abuse. This involved assuming responsibility and an advocacy role, and informing
clients of their rights in a neutral and comprehensible manner. In the respondents’ own
words, “The old person’s rights as a client, listing them, talking about them openly” (r45); “We
must remember that as nurses, we are the voices and advocates for the old people. We must
have courage to deal with the issue. We must not hide our moral competency but bring it
forward with courage” (r47). Discretion and a respectful way of addressing the sensitive topic
were also necessary, as clients often experienced shame, guilt, loss of dignity and feelings of
inferiority. The respondents emphasized “sensitivity and courage to ask questions, giving
space, from one human being to another” (r7); and “a respectful and appreciative approach to
the work, no guilt-tripping” (r5).
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DISCUSSION
Health care professionals working at emergency departments require theoretical
competencies in order to identify elder abuse. In this study, the majority of the respondents
rated their knowledge of elder abuse as rather good, but they need further knowledge about
detecting the signs of abuse and about supporting their older clients. They might benefit from
training on the identification of elder abuse [45] and on the use of screening checklists and
assessment tools [49-52].
According to the nurses working at emergency departments, it is easier to detect physical
abuse of elders, compared to psychological or social abuse or neglect. Although the
professionals are well aware of the risk factors related to elder abuse, the identification of
abuse is challenging in the short care context. Previous research confirms that the short
duration of the contacts at emergency departments obstruct the identification of abuse and
related risks [39, 53]. The fact that a visit to the emergency department may be the only time
vulnerable, isolated elders ashamed of the way they have been treated leave their home to
seek help, makes it all the more important that the theoretical and practical competencies of
emergency department staff are developed [22, 23, 80].
A great variety of competencies is required from professionals at emergency departments in
order to identify elder abuse and to take appropriate action. According to this study, these
competencies include the detection of the signs of abuse; assessing the seriousness of the
situation; interaction skills; emotional intelligence and situational awareness, and ethical
competencies. The results are similar to earlier results [56, 60, 61]. Different from earlier
research, emotional intelligence, situational awareness and ethical competencies were
brought into focus more strongly in this study. Interventions to suspected abuse should be
conducted with discretion, as elder abuse is frequently associated with complex family
dynamics. An examination of the respondents’ contributions in this study revealed that ethical
skills were strongly represented in the responses to open questions, although they were not
included in the quantitative questions. This indicates that the professionals working at
emergency departments are well aware of the ethical challenges associated with elder abuse.
Since the identification of elder abuse and the development of nursing interventions for those
experiencing abuse require solid emotional intelligence, situational awareness, interaction
skills and ethical competencies, it is proposed that further education combining these themes
should be offered to emergency department staff. Simulation-based education is a viable
option that, according to Cunningham et al. [81], enables learning about the recognition of
elder abuse and appropriate interventions in concrete terms, increasing participants’
understanding of the assessment of abuse and fostering communication with the team to help
provide wholistic care. Furthermore, a combination of lectures and simulation-based learning
has been found effective in learning to recognize elder abuse, assess the seriousness of the
situation and advocate for older clients [44].
The role of multiprofessional collaboration is another important finding in this study. The
effectiveness of teamwork in helping vulnerable older clients at the emergency department
and in ensuring safe further care and coping at home has also been described by Rosen et al.
[82].
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Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
CONCLUSION
The identification of elder abuse and appropriate action at emergency departments call for
theoretical and practical competencies. According to this study, these competencies include
the detection of the signs of abuse; assessing the seriousness of the situation; interaction
skills; emotional intelligence and situational awareness, and ethical competencies. It is
advisable that these areas are more strongly integrated into nursing curricula. In addition,
multiprofessional collaboration is recommended to ensure safety and care continuity for
abused older clients.
ACKNOWLEDGEMENTS
We wish to thank all nurses at emergency departments who contributed to our study.
References
[1] Storey, J.E., & Prashad, A.A. (2018). Recognizing, reporting, and responding to abuse, neglect and self- neglect of vulnerable adults: an evaluation of there: act adult protection worker basic curriculum. Journal
of Elder abuse & neglect 30(1), 42–63. https://doi.org/10.1080/08946566.2017.1371092
[2] WHO. (2020). COVID-19 and violence against older people.
https://www.who.int/publications/m/item/covid-19-and-violence-against-older-people
[3] WHO. (2024). Abuse of older people. https://www.who.int/news-room/fact-sheets/detail/abuse-of- older-people
[4] Dow, B., Gahan, L., Gaff, Y.E., Joosten, M., Vrantsidis, F., & Jarred, M. (2020). Barriers to disclosing elder
abuse and taking action in Australia. Journal of Family Violence, 35(8), 853–861.
https://doi.org/10.1007/s10896-019-00084-w
[5] WHO. (2021). Elder abuse. https://www.who.int/news-room/fact-sheets/detail/elder-abuse
[6] Pillemer, K., Burnes, D., Riffi, N.C., & Lachs, M.S. (2016). Elder abuse: Global situation, risk factors, and
prevention strategies. The Gerontologist, 56(Suppl. 2), S194–S205.
https://doi.org/10.1093/geront/gnw004
[7] Burnett, J., Dyer, C.B., & Heisler, C.J. (2021). Enhancing and evaluating the capacity of elder abuse fatality
review teams to assist victim services. Journal of Elder Abuse & Neglect, 33(2), 107–122.
https://doi.org/10.1080/08946566.2021.1929640
[8] Hirst, S.P., & Majowski, K. (2022). Elder Abuse: A Global Challenge and Canada’s Response. Journal of
Gerontological Nursing 48(4), 21-25. 10.3928/00989134-20220307-01
[9] Eslami, B., Di Rosa, M., Barros, H., Torres-Gonzalez, F., Stankunas, M., Ioannidi-Kapolou, E., Lindert, J.,
Soares, J.J.F., Lamura, G., & Mel-Chiorre, M.G. (2019). Lifetime abuse and somatic symptoms among older
women and men in Europe. PLoS One 14(8), e0220741. https://doi.org/10.1371/journal.pone.0220741
[10] Tiilikallio, P., & Säles, E. (2018). Täällä on lupa puhua väkivallasta: käsikirja ikääntyneisiin kohdistuvan
kaltoinkohtelun ja väkivallan vastaiseen työhön. Turvallisen vanhuuden puolesta - Suvanto ry. Helsinki.
[11] Parikka, S., Koskela, T., Ikonen, J., Kilpeläinen, H., Hedman, L., Koskinen, S., & Lounamaa, A. (2020).
Kansallisen terveys-, hyvinvointi- ja palvelututkimus FinSoten perustulokset 2020.
https://www.terveytemme.fi/finsote/2020/index.html
[12] Finnish Institute for Health and Welfare THL. (2023). Väkivaltakokemukset. Terve Suomi-tutkimus.
[Experiences of violence. Healthy Finland Survey.
https://www.thl.fi/tervesuomi_verkkoraportit/ilmioraportit_2023/vakivaltakokemukset.html
Page 12 of 16
Services for Science and Education – United Kingdom 466
European Journal of Applied Sciences (EJAS) Vol. 12, Issue 6, December-2024
[13] Qu, L., Kaspiew, R., Carson, R., Roopani, D., De Maio, J., Harvey, J., & Horsfall, B. (2021). National Elder
Abuse Prevalence Study: Final Report. Melbourne: Australian Institute of Family Studies.
https://static.aifs.gov.au/files/BtfhlRWam/2021_national_elder_abuse_prevalence_study_final_report.pdf
[14] Yılmaz, M., Durmaz, A., & Arıkan, I. (2022). Elderly abuse, affecting factors and evaluation of life
satisfaction: a cross-sectional study. Psychogeriatrics 22(5), 612-620.
https://doi.org/10.1111/psyg.12862
[15] Burnes, D., Pillemer, K., Rosen, T., Lachs, M.S., & McDonald, L. (2022). Elder abuse prevalence and risk
factors: findings from the Canadian Longitudinal Study on Aging. Nature aging, 2(9), 784–795.
https://doi.org/10.1038/s43587-022-00280-2
[16] Hubatková, B., & Vidovićová, L. (2024). Outcomes of elder abuse and neglect in Central Europe: exploring
the link between EAN and well-being among non-institutionalized older adults. Journal of Elder Abuse &
Neglect 36(3), 265–290. https://doi.org/10.1080/08946566.2024.2346846
[17] Sultanoğlu, H., Demir, M.C., & Boğan, M. (2022). Trends in Geriatric Trauma Emergency Department
Admissions During COVID-19. Journal of Trauma Nursing 29(3), 125-130. DOI:
10.1097/JTN.0000000000000652
[18] Baek, D., Elman, A., Gottesman, E., Shaw, A., Makaroun, L.K., Stern, M.E., Mulcare, M.R., Sullivan, M., Pino, C.,
McAuley, J., LoFaso, V.M., Chang, E., Hancock, D., Bloemen, E.M., Tietz, S., Lindberg, D.M., Sharma, R., Clark,
S., Lachs, M.S., Pillemer, K., & Rosen, T. (2023). Initial steps in addressing the challenges of elder
mistreatment evaluation: Protocol for evaluation the vulnerable elder protection team. BMJ Open 13(10),
e071694. https://doi.org/10.1136/bmjopen-2023-071694
[19] Gottesman, E., Elman, A., & Rosen, T. (2023). Elder mistreatment: Emergency department recognition and
management. Clinics in Geriatric Medicine 39(4), 553-573. DOI: 10.1016/j.cger.2023.05.007
[20] Dash, K., Breckman, R., Lees-Haggerty, K., Elman, A., Lachs, M., Stoeckle, R.J., Fulmer, T., & Rosen, T. (2021).
Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital
emergency departments. Journal of Elder Abuse & Neglect 33(4), 311-326. doi:
10.1080/08946566.2021.1965930
[21] Åberg, L-K. (2017). Sanasto. Rikoksen uhrin käsikirja. Jyväskylä: PS-kustannus.
[22] Rosen, T., Platts-Mills, T.F., & Fulmer, T. (2020). Screening for elder mistreatment in emergency
departments: Current progress and recommendations for next steps. Journal of Elder Abuse and Neglect
32(3), 295-315. DOI: 10.1080/08946566.2020.1768997
[23] Rosen, T., Zhang, H., & Wen, K. (2023). Emergency department and hospital utilization among older adults
before and after identification of elder mistreatment. JAMA 6(2), E2255853. doi:
10.1001/jamanetworkopen.2022.55853
[24] Stevens, M., Biggs, S., Dixon, J., Tinker, A., & Manthorpe, J. (2013). Interactional perspectives on the
mistreatment of older and vulnerable people in long-term care settings. British Journal of Sociology 64(2),
267-286. DOI: 10.1111/1468-4446.12017
[25] Marsland, D., Oakes, P., & White, C. (2015). Abuse in care? A research project to identify early indicators of
concern in residential and nursing homes for older people. The journal of adult protection 17(2), 111-125.
10.1108/JAP-08-2014-0027
[26] Mileski, M., Lee, K., Bourquard, C., Cavazos, B., Dusek, K., Kimbrough, K., Sweeney, L., & McClay, R. (2019).
Preventing the Abuse of Residents with Dementia or Alzheimer's Disease in The Long-Term Care Setting: A
Systematic Review. Clinical interventions in aging 14, 1797-1815. 10.2147/CIA.S216678
Page 13 of 16
467
Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
[27] Myhre, J., Saga, S., Malmedal, W., Ostaszkiewicz, J., & Nakrem, S. (2020). Elder abuse and neglect: an
overlooked patient safety issue. A focus group study of nursing home leaders' perceptions of elder abuse
and neglect. BMC health services research 20(1), 199-199, Article 199, 1-14.
https://doi.org/10.1186/s12913-020-5047-4
[28] Botngård, A., Eide, A.H., Mosqueda, L., Blekken, L., & Malmedal, W. (2021). Factors associated with staff-to- resident abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC health services
research 21(1), 244-244, Article 244. 10.1186/s12913-021-06227-4.
[29] Neuberg, M., Pudmej Ešegović, V., Križaj, M., Cikač, T., & Meštrović, T. (2022). Abuse and neglect of older
people in health facilities from the perspective of nursing professionals: A cross‐sectional study from
Croatia. International journal of older people nursing 17(6), e12484-n/a, 1-13. 10.1111/opn.12484
[30] Friedman, B., Santos, E.J., Liebel, D.V., Russ, A.J., & Conwell, Y. (2015). Longitudinal Prevalence and
Correlates of Elder Mistreatment Among Older Adults Receiving Home Visiting Nursing. Journal of elder
abuse & neglect 27(1), 34-64. 10.1080/08946566.2014.946193
[31] Yi, Q., & Hohashi, N. (2018). Comparison of perceptions of domestic elder abuse among healthcare workers
based on the Knowledge-Attitude-Behavior (KAB) model. PloS one 13(11), e0206640-e0206640, 1-14.
https://doi.org/10.1371/journal.pone.0206640
[32] Van Royen, K., Van Royen, P., De Donder, L., & Gobbens, R.J. (2020). Elder Abuse Assessment Tools and
Interventions for use in the Home Environment: a Scoping Review. Clinical interventions in aging 15,
1793-1807. 10.2147/CIA.S261877
[33] Fang, J-H., Chen, I-H., Lai, H-R., Lee, P-I., Miao, N-F., Peters, K., & Lee, P-H. (2022). Factors associated with
nurses' willingness to handle abuse of older people. Nurse education in practice 65, 103497-103497,
Article 103497. 10.1016/j.nepr.2022.103497.
[34] Paek, M-S., Lee, M.J., & Chon, Y. (2024). Comparison Between Initial Elder Abuse and Re-abuse Cases of
Korean Elder Protective Service Agencies. Journal of family violence 39(3), 497–508. 10.1007/s10896-
022-00484-5
[35] Namboodri, B.L., Rosen, T., Dayaa, J.A., Bischof, J.J., Ramadan, N., Patel, M.D., Grover, J., Brice, J.H., & Platts- Mills, T.F. (2018). Elder Abuse Identification in the Prehospital Setting: An Examination of State
Emergency Medical Services Protocols. Journal of the American Geriatrics Society 66(5), 962-968.
10.1111/jgs.15329
[36] Nowak, K., Ouellette, L., Chassee, T., Seamon, J.P., & Jones, J. (2018). Emergency services response to elder
abuse and neglect – Then and now. The American journal of emergency medicine 36 (10), 1916-1917.
10.1016/j.ajem.2018.02.036
[37] Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2022). Ensihoitajien kokemuksia ikääntyneiden
kaltoinkohtelusta. (Experiences of elder abuse in out-of-hospital emergency care). Gerontologia 36(1), 49-
69. https://doi.org/10.23989/gerontologia.108078
[38] Rosen, T., Bloemen, E.M., LoFaso ,V.M., Clark, S., Flomenbaum, N.E., & Lachs, M.S. (2016). Emergency
Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse.
The Journal of emergency medicine 50(3), 518-526. 10.1016/j.jemermed.2015.10.037
[39] Evans, C.S., Hunold, K.M., Rosen, T., & Platts-Mills, T.F. (2017). Diagnosis of elder abuse in U. S. emergency
departments. Journal of the American Geriatrics Society 65(1), 91-97.
[40] Dash, K., Rosen, T., Biese, K., Platts-Mills, T.F., & Hwang, U. (2020). The Power of Data Can Support Effective
Response to Elder Mistreatment in Hospital Emergency Departments. Generations 44 (1), 38-43.
Page 14 of 16
Services for Science and Education – United Kingdom 468
European Journal of Applied Sciences (EJAS) Vol. 12, Issue 6, December-2024
[41] Khurana, B., & Loder, R.T. (2022). Injury Patterns and Associated Demographics of Intimate Partner
Violence in Older Adults Presenting to U.S. Emergency Departments. Journal of interpersonal violence
37(17-18), 1-23. NP16107-NP16129. 10.1177/08862605211022060
[42] Yip, S.H., O'Connor, D., Shakeri Shemirani, F., Brown, A., & Hyman, J. (2022). Emergency assistance in
situations of abuse, neglect, and self-neglect: exploring the complexity and challenges. Journal of elder
abuse & neglect 34(2), 124-151. 10.1080/08946566.2022.2070317
[43] Ellis, J.M., Ayala, Q., Beatriz, P., Ward, L., & Campbell, F. (2019). Implementation and evaluation of an
education programme for nursing staff on recognising, reporting and managing resident‐to‐resident elder
mistreatment in aged care facilities. Journal of advanced nursing 75(1), 187-196. 10.1111/jan.13819
[44] Ross, M.E.T., Bryan, J.L., Thomas, K.L., Asghar-Ali, A.A., & Pickens, S.L. (2020). Elder Abuse Education Using
Standardized Patient Simulation in an Undergraduate Nursing Program. Journal of Nursing Education
59(6), 331–335. 10.3928/01484834-20200520-06
[45] Ranabhat, P., Nikitara, M., Latzourakis, E., & Constantinou, C.S. (2022). Effectiveness of Nurses’ Training in
Identifying, Reporting and Handling Elderly Abuse: A Systematic Literature Review. Geriatrics 7(5), 1-16.
108. 10.3390/geriatrics7050108
[46] Cannell, B., Gonzalez, J.M.R., Livingston, M., Jetelina, K.K., Burnett, J., & Weitlauf, J.C. (2019). Pilot testing the
detection of elder abuse through emergency care technicians (DETECT) screening tool: Results from the
DETECT pilot project. Journal of Elder Abuse & Neglect 31(2), 129-145.
https://doi.org/10.1080/08946566.2018.1564104
[47] Fulmer, T., Paveza, G., Abraham, I., & Fairchild, S. (2000). Elder neglect assessment in the emergency
department. Journal of Emergency Nursing 26(5), 436-443. DOI:
https://doi.org/10.1067/men.2000.110621
[48] Elman, A., Rosselli, S., Burnes, D., Clark, S., Stern, M.E., LoFaso, V.M., Mulcare, M.R., Breckman, R., & Rosen,
T. (2020). Developing the emergency department elder mistreatment assessment tool for social workers
using a modified delphi technique. Health and Social Work 45(2), 110-121. DOI: 10.1093/hsw/hlz040
[49] Platts-Mills, T.F., Sivers-Teixeira, T., Encarnacion, A., Tanksley, B., & Olsen, B. (2020). EMSART: A scalable
elder mistreatment screening and response tool for emergency departments. Generations Journal 44(1),
51-58.
[50] Abujarad, F., Ulrich, D., Edwards, C., Choo, E., Pantalon, M.V., Jubanyik, K., Dziura, J., D’Onofrio, G., & Gill,
T.M. (2021). Development and usability evaluation of VOICES: A digital health tool to identify elder
mistreatment. Journal of the American Geriatrics Society 69(6), 1469-1478. 69(6), 1469-1478. doi:
10.1111/jgs.17068.
[51] Makaroun, L.K., Halaszynski, J.J., Rosen, T., Haggerty, K.L., Blatnik, J.K., Froberg, R., Elman, A., Geary, C.A.,
Hagy, D.M., Rodriguez, C., & McQuown, C.M. (2022). Leveraging VA geriatric emergency department
accreditation to improve elder abuse detection in older veterans using a standardized tool. Academic
Emergency Medicine 30(4), 428-436. doi: 10.1111/acem.14646
[52] McCusker, J., Warburton, R.N., Lambert, S.D., Belzile, E., & De Raad, M. (2022). The revised identification of
seniors at risk screening tool predicts readmission in older hospitalized patients: A cohort study. BMC
Geriatrics 22, 888. doi: 10.1186/s12877-022-03458-w.
[53] Stevens, T.B., Richmond, N.L., Pereira, G.F., Shenvi, C.L., & Platts-Mills, T.F. (2014). Prevalence of
nonmedical problems among older adults presenting to the emergency department. Academic Emergency
Medicine 21(6), 651-658. DOI: 10.1111/acem.12395
[54] Killick, C., & Taylor, B.J. (2009). Professional decision making on elder abuse: systematic narrative review.
Journal of Elder Abuse and Neglect 21(3), 211-38. doi: 10.1080/08946560902997421.
Page 15 of 16
469
Salminen-Tuomaala, M., Tiainen, J., & Paavilainen, E. (2024). Identification of Elder Abuse at Emergency Departments: What Competencies are
Required from Staff? European Journal of Applied Sciences, Vol - 12(6). 455-470.
URL: http://dx.doi.org/10.14738/aivp.126.17965
[55] Andermann, A. (2018). Screening for social determinants of health in clinical care: moving from the
margins to the mainstream. Public Health Reviews 39(19), 1-17. doi: 10.1186/s40985-018-0094-7.
[56] Rosen, T., Elman, A., Dion, S., Delgado, D., Demetres, M., Breckman, R., Lees, K., Dash, K., Lang, D., Bonner, A.,
Burnett, J., Dyer, C.B., Snyder, R., Berman, A., Fulmer, T., Lachs, M.S., & National Collaboratory to Address
Elder Mistreatment Project Team. (2019). Review of Programs to Combat Elder Mistreatment: Focus on
Hospitals and Level of Resources Needed. Journal of the American Geriatrics Society 67(6), 1286-1294.
doi: 10.1111/jgs.15773.
[57] Yan, E., To, L., Wan, D., Xie, X., Wong, F., & Shum, D. (2022). Strategies to build more effective interventions
for elder abuse: a focus group study of nursing and social work professionals in Hong Kong. BMC Geriatrics
22 (1), 978-978. 10.1186/s12877-022-03682-4
[58] Burnes, D., MacNeil, A., Nowaczynski, A., Sheppard, C., Trevors, L., Lenton, E., Lachs, M.S., & Pillemer, K.
(2021). A scoping review of outcomes in elder abuse intervention research: The current landscape and
where to go next. Aggression & Violent Behavior, 57, 1-8. 101476. https://
doi.org/10.1016/j.avb.2020.101476.
[59] Atkinson, E., & Roberto, K.A. (2023). Global approaches to primary, secondary, and tertiary elder abuse
prevention: A scoping review. Trauma, Violence & Abuse 25(1), 150-165.
https://doi.org/10.1177/15248380221145735
[60] Gallione, C., Dal Molin, A., Cristina, F.V.B., Ferns, H., Mattioli, M., & Suardi, B. (2017). Screening tools for
identification of elder abuse: a systematic review. Journal of Clinical Nursing 26(15-16), 2154-2176. doi:
10.1111/jocn.13721.
[61] Cannell, B., Livingston, M., Burnett, J., Parayil, M., & Gonzalez, J. M.R. (2020a). Evaluation of the detection of
elder mistreatment through emergency care technicians project screening tool. JAMA Network Open, 3(5),
e204099. https://doi.org/10.1001/jamanetworkopen.2020.4099
[62] Blundell, B., Warren, A., & Moir, E. (2020). Elder abuse protocols: Identifying key features and establishing
evidence for their use and effectiveness. Journal of Elder Abuse & Neglect, 32(2), 134–151.
https://doi.org/10.1080/08946566.2020.1736225
[63] Kim, H-J., Seo, M-S., & Park, D. (2021). Factors influencing intention to intervene in elder abuse among
nursing students. PeerJ 9: e12079, 1–12. http://doi.org/10.7717/peerj.12079
[64] Cannell, B., Weitlauf, J., Livingston, M.D., Burnett, J., Parayil, M., & Reingle Gonzalez, J. (2020b). Validation of
the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study
protocol. BMJ Open 10;10(9), e037170. doi: 10.1136/bmjopen-2020-037170.
[65] Ahmed, A., Choo, W.Y., Othman, S., Hairi, N.N., Hairi, F.M., Mohd Mydin, F.H., Illiani Jaafar, S.N. (2016).
Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory
survey. Journal of Elder Abuse & Neglect, 28(3), 163–177.
https://doi.org/10.1080/08946566.2016.1185985
[66] Du Mont, J., Kosa, D., Yang, R., Solomon, S., & Macdonald, S. (2017). Determining the effectiveness of an
Elder Abuse Nurse Examiner Curriculum: A pilot study. Nurse Education Today 55, 71-76.
https://doi.org/10.1016/j.nedt.2017.05.002
[67] Hess, S. (2011). The role of health care providers in recognizing and reporting elder abuse. Journal of
Gerontological Nursing, 37(11), 28-34. https://doi.org/10.3928/00989134-20111012-50
[68] Mohd, M., Fadzilah, H., Othman, S., Choo, W.Y., Mohd Hairi, N.N., Mohd Hairi, F., Ali. Z., & Abdul Aziz, S.
(2022). Primary care nurses' challenges, opportunities, and facilitators of elder abuse intervention in
Malaysia. Public Health Nursing 39(1), 3-14. 10.1111/phn.12961
Page 16 of 16
Services for Science and Education – United Kingdom 470
European Journal of Applied Sciences (EJAS) Vol. 12, Issue 6, December-2024
[69] Loh, D.A., Choo, W.Y., Hairi, N.N., Othman, S., Mohd Hairi, F., Mohd, M., Fadzilah, H., Jaafar. S., Nur, I., Tan,
M.P., Mohd, A.Z., Abdul Aziz, S., Ramli, R., Mohamad, R., Lal, M.Z., Hassan, N., Brownell, P., & Bulgiba, A.
(2015). A cluster randomized trial on improving nurses' detection and management of elder abuse and
neglect (I- NEED): study protocol. Journal of Advanced Nursing 71(11), 2661-2672. 10.1111/jan.12699
[70] Fink, A. (2013). Conducting Research Literature Reviews: From the Internet to Paper. SAGE Publications.
[71] Heikkilä, T. (2020). Tilastollinen tutkimus. Edita. Helsinki.
[72] Polit, D.F., & Beck, C.T. (2018). Essentials of nursing research: appraising evidence for nursing practice.
Ninth edition. Wolters Kluwer Health. Philadelphia.
[73] Graneheim, U.H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts,
processes and measures to achieve trustworthiness. Nurse Education Today 56, 29–34.
https://doi.org/10.1016/j.nedt.2003.10.001
[74] Elo, S., Kajula, O., Tohmola, A., & Kääriäinen M. (2022). Laadullisen sisällönanalyysin vaiheet ja
eteneminen. Hoitotiede 34(4), 215-225. Steps and phases of qualitative content analysis process. Journal
of Nursing Science 34(4), 215-225.
[75] TENK. (2023). The Finnish Code of Conduct for Research Integrity and Procedures for Handling Alleged
Violations of Research Integrity in Finland. Guideline of the Finnish National Board on Research Integrity
2023. Publications 4/2023. https://tenk.fi/sites/default/files/2023-11/RI_Guidelines_2023.pdf
[76] Aho, A-L., & Kylmä, J. (2012). Sensitiivinen tutkimus hoitotieteessä – näkökohtia tutkimusprosessin eri
vaiheissa. Sensitive research in nursing science – viewpoints on different phases during research process.
Hoitotiede 24(4), 271-280.
[77] Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence Based Nursing
18(3), 66-67. 10.1136/eb-2015-102129
[78] Watson, R. (2015). Quantitative research. Nursing standard: official newspaper of the Royal College of
Nursing 29(31), 44-48. DOI: 10.7748/ns.29.31.44. e8681
[79] Bryman, A. (2012). Social Research Methods. Oxford University Press.
[80] Mercier, E., Nadeau, A., Brousseau, A., Emond, M., Lowthian, J., Berthelot, S., Costa, A.P., Mowbray, F.,
Melady, D., Yadav, K., Nickel, C., & Cameron, P.A. (2020). Elder abuse in the out-of-hospital and emergency
settings: A scoping review. Annals of Emergency Medicine 75(2), 181-191.
[81] Cunningham, S., Cunningham, C., & Foote, L. (2020). Recognizing Elder Abuse: An Interprofessional
Simulation Experience with Prelicensure Health Care Students. Journal of Geriatric Physical Therapy
43(4), E58-E64. DOI: 10.1519/JPT.0000000000000257
[82] Rosen, T., Elman, A., Clark, S., Gogia, K., Stern, M.E., Mulcare, M.R., Makaroun, L.K., Gottesman, E., Baek, D.,
Pearman, M., Sullivan, M., Brissenden, K., Shaw, A., Bloemen, E.M., LoFaso, V.M., Breckman, R., Pillemer, K.,
Sharma, R., & Lachs, M.S. (2022). Vulnerable Elder Protection Team: Initial experience of an emergency
department-based interdisciplinary elder abuse program. Journal of the American Geriatrics Society 70
(11), 3260, 10.1111/jgs.17967