Elizabeth Bloemen’s two grandmothers were named Mildred and Mary Elizabeth. Mary Elizabeth, she says, was a fiery, whip-smart woman, full of spunk and love.
And Mildred, a former English teacher with a college degree—uncommon for women of her generation—was also a smart, lively woman. Mildred was diagnosed with dementia when Bloemen was 6 years old, and for most of Bloemen’s childhood, Mildred lived in an assisted living facility.
“I grew up going to a nursing home every day after school in middle school,” Bloemen says.
Bloemen is now a board-certified geriatrician, an assistant geriatrics professor at the University of Colorado Anschutz School of Medicine, and an Injury and Violence Prevention Center-affiliated researcher. She remembers each of her grandmothers fondly, and credits Mildred’s experience with dementia—and her own experience visiting Mildred in the nursing home—as part of the reason why she became interested in elder care.
“I was very interested in the vulnerability of that patient population and how they often don’t really have a voice," Bloemen says. “Through my undergrad studies and then into my MPH, I realized that what I'm very interested in is elder abuse—true elder abuse.”
According to studies cited by the National Council on Aging, 1 in 5 older adults reported elder abuse during the COVID-19 pandemic, and other researchers estimated that only 1 in 24 cases of abuse are reported to authorities.
“Elder abuse can present in a lot of ways, which is why it’s a little tricky,” Bloemen says. “There are five core types of elder abuse we talk about in our field: Verbal abuse, financial abuse, physical abuse, sexual abuse, and neglect.”
Neglect, she says, is the type of abuse that most often results in the death of her patients.
In her experience, Bloemen says, the majority of elder abuse cases she sees don’t require legal intervention.
“A lot of my cases involve either an impaired caregiver—someone who perhaps has also developed dementia—or a caregiver who is exceptionally overwhelmed and doesn't have any resources,” she says.
From Bloemen’s perspective, ideal solutions to cases like these can include involving social services before law enforcement. She says the best way to prevent—and remedy—elder abuse is through a multifaceted, multidisciplinary approach.
Bloemen is actively working to bring that approach to Denver-area hospitals through a program called the Vulnerable Elder Services, Protection and Advocacy Team, otherwise known as VESPA. One of just two programs of its kind in the country, VESPA is essentially a hospital consulting service for elder abuse and neglect, serving University of Colorado Hospital and Denver Health.
“Any time a provider at one of these hospitals—the bedside nurse, a physical therapist, the doctor—whoever is concerned that there could be elder abuse or neglect going on, they call our team to evaluate,” Bloemen says.
The VESPA team is made up of three geriatricians, including Bloemen, as well as a full-time specialized social worker. When called in to consult, the team begins a wraparound approach to determining if elder abuse has occurred.
“Our goal is to determine the level of concern,” Bloemen says. “We do a lot of injury pattern interpretation, similarly to the child abuse pediatrics team. We ask ourselves, ‘Could this fracture have happened the way they said it happened? Do these bruises make sense? Do these lab abnormalities have another medical cause?’”
Then, the team determines what interventions need to be made; those can range from simply talking to the patient’s family members to involving social services and law enforcement. Then, they work with the patient’s care team to make a warm handoff to whomever is involved with their outpatient care, whether that’s a nursing home or Adult Protective Services.
Bloemen says the VESPA program has uncovered elder abuse cases in Colorado hospitals that otherwise may have gone unnoticed; before the implementation of VESPA, there were around four cases per year that were officially coded as elder abuse. In the first year of VESPA, there were almost 100.
Bloemen has an interesting perspective on what success looks like in elder abuse awareness and prevention efforts: A dignified and comfortable death.
“Working with older adults is different than victims in other stages of life, because for most interventions in public health, we want to avoid death,” she says. “In my field, I don't want to avoid death so much as I want to avoid bad deaths or premature deaths. For me, the biggest success is getting a patient in the setting they want to be in [when they die], living with dignity, and having relationships with those people they love most. That is, I think, what we all want at the end of our lives.”
To learn more about VESPA, visit the VESPA website. For more information about the Injury and Violence Prevention Center, visit the IVPC website.