Leveraging Electronic Health Record Data From a Novel Standardized Note Template to Study Elder Abuse in Veterans

TL;DR

A new standardized note template in the Veterans Health Administration helps study elder abuse by improving electronic health record data collection.

Contribution

The paper presents the first system-wide analysis of elder abuse in a national healthcare system using a novel standardized EHR note template.

Findings

Self-neglect was the most frequently reported type of elder abuse (36.3%).

Poly-victimization was common, with financial exploitation and self-neglect often occurring together.

Most abuse occurred in the veteran’s home, and multiple individuals were often suspected as harmers.

Abstract

Though healthcare systems play an important role in identifying and responding to elder abuse (EA), inadequate electronic health record (EHR) data have hindered EA surveillance and research efforts. In 2025, the Veterans Health Administration (VHA) implemented a national standardized EHR note template to document reports of suspected abuse/neglect. In this retrospective descriptive study, we examined VHA EHR data from the 10-site pilot and initial four months of national implementation of the new note template (3/2024 – 6/2025). To focus on EA, we restricted analyses to veterans aged ≥60 years and excluded reports to Child Protective Services. The final analytic sample consisted of 1,982 reports for 1,684 unique veterans. Reported veterans had a median age of 76 years and were 92.8% male, 20.2% non-Hispanic Black, 3.9% Hispanic, and 30.3% married. While most (86.4%) had one report filed over the study period, 11.0% had two, and 2.7% had ≥3. EA occurred most often in the veteran’s home (78.5%). The most frequent abuse types were self-neglect (36.3%), multiple abuse types (24.2%), and financial exploitation (17.6%). Among poly-victimization reports, the most frequent combination was financial exploitation and self-neglect. Among non-self-neglect cases (N = 1,253), the most commonly reported suspected harmers were multiple individuals (23.7%) or adult children (19.2%). This first system-wide description of EA in a national healthcare system, enabled by standardized documentation, highlights prevalent self-neglect, poly-victimization, and multiple suspected harmers, underscoring the complexity of EA identified in healthcare settings. Future efforts using data from structured EHR tools may improve EA detection and prevention efforts.