Protecting Vulnerable Elders | Patient Care (2024)

Like child abuse and domestic violence, elder abuse is vastly under-reported. But there’s a difference. Elder abuse research and infrastructure are less well-developed and less well-funded than other types of interpersonal mistreatment, says Dr. Anthony Rosen, an Associate Attending Physician, Associate Professor of Emergency Medicine and founder of the VEPT at Weill Cornell. His goal, and that of his teammates, is to bring elder abuse out of the shadows and into the full light of day. And to protect our vulnerable elders, save lives and grow the team’s impact, locally and nationally.

Elder mistreatment can take the form of physical, sexual, verbal or emotional abuse; financial exploitation; or outright neglect. Physical abuse in particular can be devilishly difficult to detect, even in the Emergency Department, where the VEPT is housed.

Says Dr. Rosen, “there’s an art to distinguishing between an injury caused by an accident and one caused by intentional violence. Falls in particular are very common among older adults, and they’re the reason given by abusers for injuries caused by their own mistreatment of a vulnerable elder.

“Our research has found that abuse victims tend to have injuries to the face, jaw, teeth or neck but no injuries to their extremities,” he continues. “That makes sense: If you fall down the stairs, you can certainly have facial injuries, but not without injuries to your arms and legs. Elder abuse victims are also more likely to have injuries to the left cheek, which stands to reason, given that most abusers—and most people—are right-handed. We’ve also found that neck injuries are common in physical abuse but almost never occur in falls.”

Why is the VEPT housed in the Emergency Department?

In the Emergency Department (ED), victims of abuse or neglect can receive care and connect with both hospital and citywide resources, Dr. Rosen says. In fact, “a visit to the ED for acute injury may be the only time a victimized elder leaves their home.”

Who are the members of the team?

“Our team consists of 2 physicians and 2 advanced practice providers, meaning that a medical provider is always accessible,” he says. “We also have 2 expert social workers, who are actually at the heart of our program. An inpatient geriatrician is available to provide care throughout a vulnerable elder’s hospitalization. And we also have a program coordinator who manages the day-to-day operations of the program.

“Additionally,” he continues, “we collaborate closely with other departments as needed, including security, ethics, geriatrics, patient services, legal, psychiatry and radiology.”

The VEPT works with several community partners as well, including Adult Protective Services (APS) and the Center for Elder Abuse Solutions (CEAS), housed in the Division of Geriatric and Palliative Medicine at Weill Cornell Medicine.

Dr. Rosen’s mentor, Dr. Mark Lachs, has been a behind-the-scenes VEPT member and leader all along. Passionate about the disenfranchised elderly, Dr. Lachs is the Irene F. and I. Roy Psaty Distinguished Professor of Clinical Medicine and an attending geriatrician at Weill Cornell Medicine, whose contributions to research and clinical practice continue to inform the team’s work, both within and beyond the institution.

Has the VEPT been growing?

The short answer is a resounding “yes.” In 2019, just 2 years after its founding, “we secured funding from the New York State Office of Victim Services (OVS) to expand our program beyond the ED and to respond to inpatient consults,” says Dr. Rosen. “We also launched a telemedicine version of our program. Our funding was renewed in October 2022, and we’re currently piloting an outpatient consultation program with the Cornell Center on Aging. We’re also strengthening our relationship with APS.”

Positive outcomes

Dr. Rosen and his colleagues have been carefully tracking the impact of the VEPT program: “We were encouraged that out of the total number of older patients determined to be at high or moderate risk for mistreatment, 75 percent were discharged with a change in their housing situation or with new or additional home services. These improvements suggest an increase in short-term safety for vulnerable older adults, and we are currently examining longer-term outcomes.”

Additionally, “providers in the ED have reported that the VEPT made them more likely to consider and assess elder mistreatment. They’ve also expressed the view that there’s merit in establishing a VEPT program in EDs at other institutions across the country.”

In January 2021, “our colleagues at the University of Colorado launched the Vulnerable Elder Services, Protection and Advocacy Team, which is partly modeled on our VEPT program. We’re excited at the prospect of supporting and replicating similar programs at other institutions. One critical element is to show how these programs can be funded and sustained.”