Vulnerable Elder Protection Team: Initial experience of an emergency department‐based interdisciplinary elder abuse program

Abstract

Background An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED‐based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. Methods We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. Results During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty‐two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy‐five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety‐four percent reported believing that there is merit in establishing a VEPT Program in other EDs. Conclusion VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer‐term outcomes.

Expanding the role of interdisciplinary teams in the emergency department: Using a consultative model to serve older adults who are abused

“…This adds to a growing number of EDs that present creative, comprehensive, and person-centered responses to common problems that cross medical, psychosocial, and traditional health system boundaries. [6][7][8] The authors of this study recognized the difficulty in diagnosing elder mistreatment and the challenge of devoting the necessary time for assessment and care planning in an emergency room setting. They realized that barriers exist in several areas.…”

“…Their ED is described as "a large, urban, academic medical center". 6 The authors categorized reasons for requesting VEPT consults, the results of the VEPT assessment (including likelihood of abuse), and recommendations made by the team. Using a carefully designed combination of quantitative and qualitative strategies for evaluation, they examined if this intervention resulted in greater identification of potential victims and decreased burden on ED providers as well as improved identification of moderateand high-risk situations.…”

“…With the emergence of Geriatric Emergency Departments, the Age Friendly Health System movement, and the significant growth of interdisciplinary teams that assess and address elder mistreatment in local communities, the article by Rosen et al (Vulnerable Elder Protection Team: Initial Experience of an Emergency Department‐Based Interdisciplinary Elder Abuse Program) describes a novel approach based on that used in the child abuse arena and adapted to address the special needs of older adults and emergency room providers. This adds to a growing number of EDs that present creative, comprehensive, and person‐centered responses to common problems that cross medical, psychosocial, and traditional health system boundaries 6–8 …”

“…Implementation involved training more than 400 providers in their healthcare system through in‐person presentations and online modules. Their ED is described as “a large, urban, academic medical center” 6 . The authors categorized reasons for requesting VEPT consults, the results of the VEPT assessment (including likelihood of abuse), and recommendations made by the team.…”

First steps in family‐centered care for family violence

“…Child abuse pediatrics is now a recognized subspecialty, and child protection teams are required for all pediatric trauma centers 1 . Multidisciplinary elder protection teams are beginning to spring up in a few leading centers 2,3 . Sexual assault nurse examiners are expanding their services and the scope of their practice as forensic nurse evaluators 4 .…”