Those subjected to emotional, physical, or financial abuse often are silent. That makes identifying victims and intervening, a real challenge for doctors and nurses, according to the USA Today’s recent article, “Elder abuse: ERs learn how to protect a vulnerable population.”
ER visits may be the only time that an elderly person leaves his or her home. Therefore, ER staff can be a first line of defense, remarked Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT). It is a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.
The most frequent types of elder abuse are emotional and financial. However, when one form of abuse exists, the others are also present. A recent New York study found that as few as 1 in 24 cases of abuse against residents ages 60 and older were reported to authorities.
The VEPT program includes several Presbyterian Hospital emergency physicians. The three doctors and two social workers rotate being on call to respond to signs of elder abuse. They also have access to psychiatrists, attorneys, 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 to begin an investigation, he said.
As part of the program, a doctor will interview the patient and conduct a thorough physical exam. They look for bruises, lacerations, abrasions, areas of pain and tenderness. More tests are ordered if the doctor suspects abuse. The team is trained to look for specific injuries, like radiographic images that show old and new fractures. This may suggest a pattern of multiple traumatic events, and specific types of fractures may indicate abuse, such as mid-shaft fractures in the ulna, when a person holds his arm in front of his face for protection.
If signs of abuse are found, but the patient won’t cooperate in getting help, a psychiatrist is asked to judge the senior’s decision-making capacity. They offer resources, but can’t do much if the patient isn’t interested. Patients in immediate danger and who want help, or who don’t have capacity, may be admitted to the hospital and placed in the care of a geriatrician, until a solution is found. Adult Protective Services won’t get involved, until a patient has been discharged. Therefore, hospitalization can play a vital role in keeping older adults safe.
The team’s goal is to optimize acute care for these vulnerable victims and to ensure their safety.
Reference: USA Today (August 27, 2017) “Elder abuse: ERs learn how to protect a vulnerable population”