Elder Abuse: The Problem

Elder abuse, neglect, and exploitation are common and have serious consequences. As many as 10% of older adults living in the community experience abuse or neglect each year, with rates in nursing homes above 20%. Victimization increases the risk of mortality, nursing-home placement, exacerbations of chronic illnesses, and depression. Unfortunately, elder mistreatment is often under-recognized and underreported, with as few as 1 in 24 cases reported to the authorities.

The Emergency Department and hospital offer an ideal opportunity to identify and intervene. An evaluation for acute injury or illness in a hospital ED may be the only time an isolated, vulnerable, abused older adult ever leaves their home.  In fact, abuse victims are less likely to see a primary-care provider than to present to a hospital ED, where acute injuries and illnesses are managed. In the ED and hospital, ability to identify abuse is increased because providers from various disciplines can observe a patient during an evaluation that typically lasts multiple hours.

Unfortunately, despite its prevalence and severity, ED and hospital providers rarely recognize or report elder mistreatment. Many reasons exist for this, including inadequate training and a lack of time to conduct a thorough evaluation for abuse.

Additionally, in the unlikely event that elder abuse, neglect, or exploitation is identified, EDs and hospitals don’t have clear, standardized processes to ensure that the case is thoroughly investigated, the appropriate authorities are involved, or that the victim is protected. Instead, it is likely that a concerned provider has to make several frantic phone calls and web searches to try to find out what to do. Documentation is forensically inadequate, important steps are missed, services are not offered, and each case is managed differently. In addition, the time taken by the provider to try to figure the management and intervention options for addressing the elder mistreatment causes significant delays in the care they can provide to other patients.

To address this problem, we developed the first-of-its-kind ED/hospital-based, multi-disciplinary Vulnerable Elder Protection Team (VEPT).