由急诊科/医院主导的老年人虐待应对项目所服务的老年人的长期轨迹。
Long-Term Trajectories of Older Adults Served by an Emergency Department/Hospital-Based Elder Mistreatment Response Program.
作者信息
Baek Daniel, Gottesman Elaine, Makaroun Lena K, Elman Alyssa, Stern Michael E, Shaw Amy, Mulcare Mary R, McAuley Jennine, LoFaso Veronica M, Itzkowitz Jaclyn, Chang E-Shien, Hancock David, Bloemen Elizabeth M, Lindberg Daniel M, Sharma Rahul, Lachs Mark S, Pillemer Karl, Rosen Tony
机构信息
Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA.
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
出版信息
J Am Geriatr Soc. 2025 Jun;73(6):1906-1917. doi: 10.1111/jgs.19351. Epub 2025 Jan 7.
BACKGROUND
An emergency department (ED) visit or hospitalization provides an opportunity to identify elder mistreatment and initiate intervention, but this seldom occurs. To address this, we developed the Vulnerable Elder Protection Team (VEPT), a novel interdisciplinary consultation service. We explored the long-term trajectories of patients receiving VEPT evaluation and intervention.
METHODS
We followed up at multiple intervals for 12 months older adults seen by VEPT from 9/1/2020-3/27/2023 with high or moderate concern for mistreatment who were discharged to the community, an elder abuse shelter, or rehabilitation facilities. We collected information through telephone calls to the older adult and others involved. We also analyzed separately cases in which the patient re-presented to the ED/hospital with VEPT consultation during the follow-up period.
RESULTS
A total of 157 older adults met criteria for follow-up, and 30 of these (16.4%) died within 12 months. At 1 month, elder mistreatment was no longer occurring in 47.5% and still occurring but reduced in 20.3%, with 29.7% having no contact with the perpetrator and 17.8% having reduced contact. At 12 months, elder mistreatment was no longer occurring in 60.9% and still occurring but reduced in 14.5%, with 34.8% having no contact with the perpetrator and 17.4% having reduced contact. During the 12-month follow-up period, 16 (10.2%) patients re-presented to the ED with VEPT consultation, with 12 having persistent concern for ongoing elder mistreatment. Reasons included older adults/caregivers not accepting intervention or being willing to separate as well as VEPT reliance on community-based agencies and programs after discharge.
CONCLUSIONS
We observed improved post-discharge safety for elder mistreatment victims who engaged with the VEPT program, with this increased safety durable over 1 year. Re-presentations highlighted the complexity of elder mistreatment intervention. Overall, these findings demonstrate the potential value of an ED/hospital-based elder mistreatment response team, a promising new geriatric care model.
背景
急诊科就诊或住院为识别老年人受虐情况并启动干预提供了契机，但这种情况很少发生。为解决这一问题，我们组建了弱势老年人保护团队（VEPT），这是一项新型的跨学科咨询服务。我们探究了接受VEPT评估和干预的患者的长期发展轨迹。
方法
我们对2020年9月1日至2023年3月27日期间由VEPT诊治的、存在高度或中度受虐担忧且出院后返回社区、老年虐待庇护所或康复机构的老年人进行了为期12个月的多次随访。我们通过电话向老年人及其他相关人员收集信息。我们还单独分析了随访期间患者在VEPT会诊后再次前往急诊科/医院就诊的病例。
结果
共有157名老年人符合随访标准，其中30人（16.4%）在12个月内死亡。在1个月时，47.5%的老年人受虐情况不再发生，20.3%的受虐情况仍在发生但有所减轻，29.7%的人与施虐者没有接触，17.8%的人与施虐者的接触减少。在12个月时，60.9%的老年人受虐情况不再发生，14.5%的受虐情况仍在发生但有所减轻，34.8%的人与施虐者没有接触，17.4%的人与施虐者的接触减少。在12个月的随访期内，16名（10.2%）患者在VEPT会诊后再次前往急诊科就诊，其中12人仍持续担忧老年人受虐情况仍在发生。原因包括老年人/照顾者不接受干预或不愿意分开，以及VEPT在患者出院后依赖社区机构和项目。
结论
我们观察到，参与VEPT项目的老年受虐受害者出院后的安全性有所改善，且这种安全性的提高可持续1年以上。再次就诊凸显了老年人受虐干预的复杂性。总体而言，这些发现证明了基于急诊科/医院的老年人受虐应对团队的潜在价值，这是一种很有前景的新型老年护理模式。
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