Victims of elder abuse often are isolated and a health emergency may trigger the first contact they’ve had with anyone outside the home in a long time. A trip to the ER is an opening for assessment and intervention.
At Baptist Memorial Hospital-Memphis, Laura Brown, a licensed clinical social worker, and Ferrell Moore, a registered nurse and clinical resource nurse, want medical workers to seize and act on that opportunity.
They’ve developed a curriculum to teach emergency department healthcare workers to better identify, assess and respond to elder abuse. So far, they’ve trained 145 emergency department employees at Baptist-Memphis including physicians, nurses, social workers, paramedics, nursing assistants and administrative unit coordinators.
Next they hope to introduce the curriculum into all Baptist facilities and all hospitals in Shelby County.
“When we talked to Baptist, one of the goals in creating this curriculum was to share it among all hospitals in Shelby County,” said Katie Midgley, the Plough Foundation’s director of research and evaluation. The foundation hopes that process will begin early next year.
Baptist Memorial Health Care Foundation earned a $100,195 Plough Foundation Aging Initiative grant to develop the curriculum, procedures and training for medical personnel in 2014. Baptist began training ER staff in 2017.
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Brown and Moore said they hope the curriculum becomes a national model. Demographics in the U.S. are rapidly changing and the country is on the edge of a silver tsunami as baby boomers age into elder status. In Shelby County alone, there are 112,777 adults aged 65 and older. By 2030, the number is expected to increase to 178,248, according to Plough.
Within that demographic shift, the number of seniors at risk for abuse also will grow, Moore said. Elder abuse can include the neglect, or physical, emotional, sexual or financial abuse of an adult aged 60 or older. According to the National Center on Elder Abuse, perpetrators are most likely to be adult children or spouses, but also commonly include friends or neighbors, and home care aides.
Baptist-Memphis is a member of the Coordinated Response to Elder Abuse (CREA), a group of 25 public and nonprofit partners working together to meet the needs of elder abuse victims in Shelby County.
CREA, which was formed in 2014 as part of Plough’s Aging Initiative, provided support and services to more than 690 victims of abuse between 2014 and 2017, including advocacy and legal aid, housing and medical assistance. It also identified the crucial role medical professionals can play in recognizing abuse, Moore said.
“The more I learned about the signs and symptoms, the more evident it became there were likely cases we were missing. It illuminated how important our roles are in the emergency department,” Moore said.
She and Brown consulted with Dr. Laura Mosqueda, director of the National Center on Elder Abuse and dean of the University of Southern California Keck School of Medicine, to develop the evidence-based curriculum.
It covers state law, statistics, red-flag dynamics in the patient-caregiver relationship, how to identify abuse and respond and more. Baptist-Memphis also trains its ER staff to identify domestic violence. In addition, it has case managers who can help identify and assess domestic violence victims anywhere in the hospital, said Ayoka Pond, director of public relations and internal communications for Baptist Memorial Health Care.
“The curriculum teaches principles they can be guided by and statistics that should concern them,” such as the size or location of a bruise, Brown said.
Health care workers are encouraged to use their professional knowledge and knowledge about the patient to determine if there is a basis for concern or a need to for more resources for the elderly person, such as home care or community services, Brown said.
Baptist-Memphis has tracked outcomes related to the curriculum and refined it based on feedback from more than 200 of the hospital’s health care professionals. Brown said those who were trained reported an increase in their confidence and knowledge to assess and respond to elder abuse. Baptist operates six hospitals in Shelby County, including specialized hospitals for women, children, rehabilitation, and restorative care.
They also are investigating how the curriculum could be useful to colleges and universities in the region that are training future healthcare professionals, such as students in nursing and radiology.
“One of our goals is to saturate the local medical community with as much of this information as we can,” Midgley said.
CREA handled 162 new clients intakes in 2017, which is 121 fewer than the year before. But, as the population of Shelby County ages, the risk of abuse also rises. The number of Shelby County residents aged 65 and older is projected to grow by 58 percent by 2030.
According to the National Center on Elder Abuse, people with dementia are at a greater risk of elder abuse. The fastest growing segment of the population is people over 85 years old, and right now, more than half have dementia.
News about the curriculum is already spreading beyond Shelby County. Brown and Moore have presented at conferences in Texas, Washington and California. Earlier this year, they were recognized with the Georgia Anetzberger Award during the University of Southern California Judith C. Tamkin International Symposium on Elder Abuse for increasing awareness and response within the medical community.
“One of the most vulnerable populations is elders with cognitive issues. I was surprised to learn how prevalent it was. It is happening all of the time, every day, and there are so many people who are silently suffering” she said.
Midgley hopes community awareness of elder abuse will continue to grow.
“My wish is that everyone would know about the law and what do about it, especially with our population and demographic changes in Shelby County,” she said. “We need to be aware of how our world is looking and how some older adults could need our help. This is about everyone coming together to make sure justice is happening.”