ERs learn how to protect a vulnerable population.
ERs learn how to protect a vulnerable population
Abuse often leads to depression and medical problems in older patients — even death within year of an abusive incident. Yet those subjected to emotional, physical or financial abuse too often remain silent.
Identifying victims and intervening poses challenges for doctors and nurses.
Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.
The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others.
According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.
The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.
“We work at making awareness of elder abuse part of the culture in our emergency room by training the entire staff in how to recognize it,” said Rosen.
It’s easy for the ER staff to alert the VEPT team and begin an investigation, he said.
A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse.
The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events.
When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity.
The team offers resources but can do little more if the patient isn’t interested. They would have to allow the patient to return to the potentially unsafe situation.
Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found.
During the first three months of the program, more than 35 elders showed signs of abuse, and a large percentage of them were later confirmed to be victims.
Changes in housing or living situations were made for several of them.