Mapping the elder mistreatment Iceberg: U.S. hospitalizations with elder abuse and neglect diagnoses

Sue Rovi, Ping Hsin Chen, Marielos Vega, Mark S. Johnson, Charles P. Mouton

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)346-359
Number of pages14
JournalJournal of Elder Abuse and Neglect
Issue number4
StatePublished - Oct 2009
Externally publishedYes


  • Diagnoses
  • Elder abuse and neglect
  • Elder mistreatment
  • Health care costs and utilization

ASJC Scopus subject areas

  • Social Sciences (miscellaneous)
  • Geriatrics and Gerontology


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