Elder abuse and neglect is a growing problem in the United States. As the population of older Americans continues to increase at a historic rate, so do reports of elder abuse and neglect. Although most states have enacted laws specifically aimed at abuse of the elderly, laws only help if acts of elder abuse are reported, and some experts believe that as few as one in every 24 victims of elder abuse ever speak out. Compounding the problem is the fact that many elderly victims live relatively isolated lives, often times dependent on the very people who abuse and neglect them. A new program in the State of New York may be able to help by training Emergency Room staff to recognize the signs of elder abuse and neglect.
As the Baby Boomer generation ages, the number of older Americans in the United States is expected to increase dramatically. By 2050, experts believe the number of older Americans (age 65 and older) will outnumber their younger counterparts (age 21 and younger) for the first time in history. With the increase in the number of seniors has come an increase in elder abuse and neglect. Precise figures relating to elder abuse are difficult to come by, due in large part to the fact that many elderly victims do not report the abuse. Elder victims are often ashamed to be the victim of abuse or find themselves dependent on the perpetrator of the abuse.
For many victims of elder abuse and neglect, a trip to the emergency room may be the only time they leave the house. Consequently, 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.
The VEPT program 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. “Unlike with child abuse victims, where there is a standard protocol in place for screening, there is no equivalent for the elderly, but we have designed and are evaluating one,” said Rosen.
For now, the team focuses on looking for specific injuries, such as radiographic images that show old and new fractures suggesting a pattern of multiple traumatic events. In addition, specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break as a result of holding an arm up to protect a blow to the face.
Sometimes, signs of abuse are present but the elder is not interested in cooperating. When that happens, a psychiatrist is asked to determine if that elder has decision-making capacity. If the elder does have the mental capacity to make decisions, and the team suspects abuse, resources are offered; however, if a patient is not interested there is not much else they can do. Unfortunately, they have to allow the suspected victim to return to the potentially unsafe situation.
Patients who do not have the mental capacity to make their own decisions, and those who are in immediate danger and want help, may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.
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. “It’s difficult to identify and measure appropriate outcomes for elder abuse victims, because each patient may have different care goals,” said Rosen, “but we are working on making a case that detection of elder abuse and intervention in the ER will improve the patients’ lives. We also hope to show that it will save money, because when an elder is in a safe place, expensive, frequent trips to the ER may no longer be needed.”
The ultimate goal of the VEPT program is to optimize acute care for vulnerable victims and ensure their safety. Once all of the kinks are ironed out, the goal is to help other emergency departments set up similar programs throughout the rest of the country.
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Saul Kobrick
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