Screening and interventions for elder mistreatment: Geriatric emergency department guidelines 2.0 systematic review

BACKGROUND: Elder mistreatment is common, underreported, and associated with significant morbidity and mortality. Emergency department (ED) visits provide an important opportunity to identify elder mistreatment and initiate intervention, but the evidence for the impact of screening or intervention strategies in this clinical setting is not well characterized. Our goal was to conduct systematic literature reviews to describe the impact of ED-based screening tools and ED-initiated interventions for elder mistreatment. 

METHODS: We conducted two systematic reviews following PRISMA 2020 guidelines using predefined Patient Intervention Comparator Outcome (PICO) frameworks. PICO 1 evaluated ED based screening tools for patients aged 60 years and older. PICO 2 evaluated ED initiated interventions for patients with known or suspected elder mistreatment. Searches were performed in MEDLINE, Embase, Web of Science, and Cochrane CENTRAL from December 2018 through December 2024 and supplemented by prior scoping reviews. 

RESULTS: For PICO 1 (ED screening) the prior scoping review identified 5 studies and the updated search identified 208 additional articles, of which 5 studies underwent full-text review. For PICO 2 (ED intervention), the prior scoping review identified 5 studies and the updated search identified 191 additional articles, of which 2 studies underwent full-text review. No studies were identified that met full inclusion criteria for either PICO. Existing studies described multiple screening tools and multidisciplinary intervention models, but lacked comparator groups, standardized reference standards, or clinically meaningful outcome measures required for inclusion. 

CONCLUSIONS: These empty systematic reviews emphasize the large existing knowledge gaps about ED elder mistreatment screening and intervention. These gaps affect the ability to make practice recommendations and highlight opportunities for future rigorous research to inform guideline development.