For older patients, the emotional and physical impact of abuse often leads to premature death. Doctors, nurses and others in the ER are on the front lines and could make a difference in identifying elder abuse.
Sadly, many of the elderly or disabled are unable to tell others that they are being abused. This makes it difficult for doctors and nurses in the ER to identify the abuse and intervene, according to an unsettling but important article in USA Today, “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.
Psychiatrists are asked to assess the patient’s ability to make cogent decisions, if there are signs of abuse. However, if the patient is not willing to seek help, the hospital can’t do much. Patients who lack capacity, who are in immediate danger and wish to be helped, can be admitted to the hospital. They are put in the care of a geriatrician, until a workable solution can be devised. Hospitalization has the potential to play a life-saving role in keeping seniors and disabled individuals safe. Adult Protective Services does not come into the picture, until the patient has been discharged.
The goal of the ER team is to provide care and protection for victims. Eventually, they hope to bring the program to other ERs to set up similar programs.
Reference: USA Today (August 27, 2017) “Elder abuse: ERs learn how to protect a vulnerable population”