Positive predictive value of Dutch Elder Abuse Scale (ERASE): an early warning tool for elder abuse in the emergency department and geriatric outpatient setting.

BACKGROUND: Elder abuse (EA) is a worldwide problem with serious consequences for individuals and society. This study aimed to determine the prevalence of EA and positive predictive value (PPV) of the Dutch Elder Abuse Scale (ERASE), an early warning tool for EA in patients presenting to the emergency department (ED) or geriatric outpatient clinic (GOC) in hospitals in the Netherlands. METHODS: Three general peripheral hospitals in the Netherlands participated. The study population were subsequent patients aged 70 years and older who visited the ED or GOC. Healthcare professionals (nurses/physicians) working at the hospital's ED and GOC administered ERASE. In case of suspected EA, the case was assessed in a standardized manner in the EA multidisciplinary team meeting (EA-MDTM) by independent experts. This assessment was considered the reference test. All data were quantitatively descriptively analyzed. To test ERASE for its performance in clinical practice, the PPV was determined. Also the prevalence of EA in the (acute) hospital setting was determined. RESULTS: In the inclusion period 22924 patients aged 70 years and older visited the ED or GOC. In almost half of these patients ERASE was administered by healthcare professionals of the three hospitals. In total 202 (1.8% (95% CI: [1.5%; 2.0%]) patients had a positive score on ERASE and were subsequently discussed in the EA-MDTM. In total 54 patients were concluded to have been a victim of EA according to the EA-MDTM. The total prevalence of EA in patients aged 70 years and older, visiting the ED or GOC, based on the conclusion of the EA-MDTM of the hospital working group on domestic violence, was 0.5% (95% CI: [0.35%; 0.62%]. The PPV of ERASE was 28% (95% CI: [0.20%; 0.35%]. CONCLUSIONS: Although the PPV of ERASE was not high, the tool may help detect signs of EA in the ED or GOC. Subsequently further investigation is required to substantiate or reject the diagnosis of EA. An EA-MDTM where a case is discussed in a standardized manner can aid in that perspective.