Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

PURPOSE: This study describes U. S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). METHOD: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. RESULTS: Few hospitalizations (< 0. 02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2. 12, 95% CI = 1. 63-2. 75), significantly more likely to be emergency department admissions (78. 0% vs. 56. 8%, p <. 0001), and, on average, more likely to have longer stays (7. 0 vs. 5. 6 days, p = 0. 01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than "routinely" discharged (i. e. , to home or self-care) (OR = 3. 66, 95% CI = 2. 92-4. 59). Elder mistreatment-coded hospitalizations compared to all other hospitalizations had on average lower total charges (21, 479 vs. 25, 127, p <. 001), with neglect cases having the highest charges in 2003 (29, 389). IMPLICATIONS: Knowledge about EM is often likened to the "tip of the iceberg. " Our study contributes to "mapping the EM iceberg"; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.