The specific aims for this project are: (1) to comprehensively examine and describe common injury patterns, physical findings, and forensic biomarkers in a series of highly adjudicated cases of physical elder abuse using a mixed methods approach, (2) to conduct a case-control study comparing these injury patterns to those sustained by older adults after an accidental fall, and (3) to design a clinical decision rule to assist health care providers in identifying abuse victims. We will achieve these aims through a unique collaboration with the Elder Abuse Unit (EAU) of the Brooklyn District Attorney's Office. The Brooklyn EAU successfully prosecutes more than 100 cases of physical elder abuse annually and maintains comprehensive files including photographs of injuries, medical records, description of first responder interactions with victim and perpetrator, and court documents. We will closely examine 200 files to comprehensively describe injury patterns as well as characteristics of victims and abusers. This innovative design, using cases of indisputable physical elder abuse, represents an important methodologic advance, as previous research has suffered from insufficient access to a large number of well-characterized elder abuse cases. Given the challenges associated with differentiating elder abuse from accidental injury, we will compare results from these cases to a control group of geriatric patients presenting to the emergency department with accidental falls to identify injury patterns and biomarkers associated with abuse. Ultimately, we plan to derive a clinical decision rule that will assist health care providers in more effectively screening for elder abuse. The applicant, Dr. Anthony Rosen, is an Emergency Medicine physician who has demonstrated significant research and clinical interest in acute geriatric care. He has a successful track record of collaboration in elder maltreatment research with Dr. Mark Lachs, an established NIH-funded researcher, who serves as Geriatrics mentor and co-investigator. Dr. Stephen Hargarten, his Emergency Medicine mentor and a co-investigator, is a pioneer in academic Emergency Medicine and violence prevention research. Having completed an MPH in epidemiology, Dr. Rosen is already trained in research methods and biostatistics. He is a former recipient of the Medical Student Training in Aging Research (MSTAR) grant and has mentored multiple MSTAR student research projects. In addition to his faculty appointment, Dr. Rosen will pursue a Geriatric Emergency Medicine fellowship during the grant period to increase his expertise in caring for older adults. The study proposed can be feasibly completed in two years with the support provided through this R03, particularly because, through funding from his institution, Dr. Rosen will already have salary support for 75% time protected from clinical responsibilities, and all NIA funds awarded will be allocated exclusively to support this research. The long-term goal of this proposal is to develop, implement, and evaluate comprehensive strategies to improve identification and prevention of elder abuse by health care providers and to launch the academic career of a promising junior investigator.

Public Health Relevance

Elder abuse is common and has serious health consequences and is associated with billions of dollars of health care costs, but it is under-recognized by health care providers and infrequently reported to the authorities. We propose to use comprehensive analysis of the injury patterns and physical findings from a series of highly adjudicated cases of physical elder abuse and a comparison to injuries from accidental falls to improve understanding of the phenomenon and increase the ability of health care providers to identify, report, and intervene.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Study Section
Special Emphasis Panel (ZAG1)
Program Officer
Gerald, Melissa S
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Weill Medical College of Cornell University
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Rosen, Tony; Shah, Manish; Lundebjerg, Nancy E et al. (2018) Impact of Jahnigen/GEMSSTAR Scholarships on Careers of Recipients in Emergency Medicine and on Development of Geriatric Emergency Medicine. Acad Emerg Med :
Rosen, Tony; Mehta-Naik, Nisha; Elman, Alyssa et al. (2018) Improving Quality of Care in Hospitals for Victims of Elder Mistreatment: Development of the Vulnerable Elder Protection Team. Jt Comm J Qual Patient Saf 44:164-171
Makaroun, Lena K; Taylor, Laura; Rosen, Tony (2018) Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known. J Am Geriatr Soc 66:389-393
Namboodri, Brooke L; Rosen, Tony; Dayaa, Joseph A et al. (2018) Elder Abuse Identification in the Prehospital Setting: An Examination of State Emergency Medical Services Protocols. J Am Geriatr Soc 66:962-968
Wong, Natalie Z; Rosen, Tony; Sanchez, Allen M et al. (2017) Imaging Findings in Elder Abuse: A Role for Radiologists in Detection. Can Assoc Radiol J 68:16-20
Hullick, Carolyn; Carpenter, Christopher R; Critchlow, Robert et al. (2017) Abuse of the older person: Is this the case you missed last shift? Emerg Med Australas 29:223-228
Evans, Christopher S; Hunold, Katherine M; Rosen, Tony et al. (2017) Diagnosis of Elder Abuse in U.S. Emergency Departments. J Am Geriatr Soc 65:91-97
Rosen, Tony; Reisig, Christopher; LoFaso, Veronica M et al. (2017) Describing visible acute injuries: development of a comprehensive taxonomy for research and practice. Inj Prev 23:340-345
Rosen, Tony; Lien, Cynthia; Stern, Michael E et al. (2017) Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect. J Emerg Med 53:573-582
Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M et al. (2016) Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases. J Interpers Violence :886260516662305

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