Radiologists Find Patterns Indicative of Elder Abuse

CHICAGO - Radiologists can more accurately diagnose abuse of elderly patients thanks to Canadian research that points to a discernible pattern of symptoms, according to a new study presented Tuesday at RSNA 2012.

Kieran J. Murphy, MD, and his colleagues at the University Health Network in Toronto conducted a meta-analysis of existing medical literature to pinpoint radiological evidence which may signal abuse.

A review of more than 1,100 cases detailing patients over the age of 60 found that certain injuries and care environments were often indicative of abuse situations. Social context in particular plays a critical role in abuse diagnosis.

“This isn't stuff that happens in a nursing home or hospital; it happens in a house and the victim is usually demented or depressed, and socially isolated except for contact with the caregiver,” said Murphy. “The signs of neglect are profound; there's often weight loss or bed sores and very poor hygiene. The caregiver is mostly a child, a daughter or a son or a grandchild, is financially or emotionally dependent upon the victim. And the caregiver may have a history of mental illness or depression.”

Radiological signs are another story entirely. Radiologic symptoms of child abuse are, sadly but fortunately, easy to recognize. The typical pattern of injuries can be simple to piece together once scrutinized by X-ray. Elder abuse, however, is much more difficult to pinpoint, with only 2 percent of cases reported, Murphy said.

“With the elderly, the challenge is that people fall,” Murphy said. The challenge is further compounded in a country like Canada, where there might be ice on the ground as many as five months of the year. The main question radiologists must ask themselves is how to identify naturally occurring injuries like slips and falls from those which were caused traumatically, he said.

Researchers found that most physical trauma as a result of abuse occurs on the head, face and neck. Dental injuries and subdural hematoma, bleeding between the outer and middle layers of the brain covering, were particularly common. Injuries to the upper torso and upper extremities were also frequently observed.

Compared to accidental injuries, abused individuals were more likely to have severe, repetitive injuries. Access to prior imaging can also be invaluable when determining abuse and because of this, radiologists can play a critical role as sentinel in identifying evidence to piece the picture together.

“A fragile elderly individual might fall over and get a subdural hemorrhages in their head, but they shouldn't get repeated hemorrhages. They shouldn't get repeated rib fractures, unless they're profoundly osteoporotic,” he said. “If you see someone with normal bone density with multiple rib fractures, you should think hey, this doesn't make sense.”

Awareness of these signs combined with the social context in which they occur should be crucial in raising suspicion, Murphy said.