Effect of an elder abuse and self-neglect intervention on repeat investigations by adult protective services: RISE project.

BACKGROUND: Adult Protective Services (APS) is the primary agency responsible for investigating elder abuse and self-neglect (EASN) allegations in the United States. The harms of EASN are well established; however, APS lacks a conceptually derived evidenced-based intervention phase. RISE is a community-based intervention designed to complement APS that provides enhanced services and a longer intervention phase. The objective of this study was to test whether exposure to the RISE/APS collaboration was associated with reducing the case outcome of recurrence (repeat investigations) compared to usual care APS only services. METHODS: A retrospective observational study (n = 1947) of two counties in Maine where RISE was available to provide enhanced services to persons referred from APS. An extended regression endogenous treatment Probit model using APS administrative data was used to predict case recurrence. RESULTS: Between July 2019 and October 2021, 154 cases participated in RISE and 1793 received usual APS only services. 49% of cases in RISE had 2 or more prior substantiated allegations versus 6% for those receiving usual APS care, and 46% of cases in RISE had a recurrence during the observation period versus 6% for usual care group. However, after accounting for the non-random treatment assignment, RISE was associated with a significantly lowered likelihood of recurrence compared to persons receiving usual care provided by APS (probability of recurrence reduced by 0.55 for the Average Treatment Effect on the Treated and 0.26 for the Average Treatment Effect). CONCLUSIONS: A reduction in recurrence carries important implications for APS clients, costs, resources, and workflow. It may also serve as a proxy indicating a reduction in revictimization and harm for EASN victims.

Use of Motivational Interviewing by Advocates in the Context of an Elder Abuse Response Intervention: The RISE Project.

Purpose: Despite the increasing number of elder abuse and self-neglect (EASN) cases, many older adults are reluctant to engage with formal support services, such as Adult Protective Services (APS). This study examined the use of motivational interviewing (MI) by advocates, as a component of a larger EASN intervention, RISE (Repair Harm, Inspire Change, Support Connection, Empower Choice), implemented in partnership with APS. Advocates applied MI as part of RISE to help clients explore and resolve ambivalence around pursuing change and ultimately enhance service engagement. Methods: This study conducted qualitative interviews and a focus group with all RISE advocates (n = 4) to understand how MI is applied in the context of an EASN intervention with older adult clients. A descriptive phenomenological approach involving two independent assessors was used to code verbatim transcripts into themes. Results: Three domains were identified: (1) therapeutic relationship, which describes the importance of foundational relationship building in MI to support older adults who have experienced EASN; (2) techniques, which refers to MI strategies advocates apply and adapt in the context of EASN intervention; and (3) implementation challenges, which reflects the difficulties advocates encounter when using MI in cases of EASN. Conclusions: The experiences of advocates suggest MI is a beneficial and amenable approach to help older adults who have experienced EASN navigate issues of ambivalence and explore their motivation for change. This study represents the first in-depth exploration of MI in the context of EASN intervention.

RISE: A Conceptual Model of Integrated and Restorative Elder Abuse Intervention.

Despite a growing number of elder abuse (EA) cases nationwide, response programs such as adult protective services (APS) lack a defined, prolonged intervention phase to address these complex situations. This article presents RISE, a model of EA intervention that works alongside APS or other systems that interact with at-risk older adults. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields (including motivational interviewing, teaming, restorative justice, and goal attainment scaling), the RISE model intervenes at levels of the individual older adult victim, individual harmer, their relationship, and community to address EA risk and strengthen systems of support surrounding the victim-harmer dyad. The RISE model addresses an intervention gap in existing systems to better meet the needs of EA victims and others in their lives, leading to more sustainable outcomes.

A qualitative evaluation of the "RISE" elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap.

Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.

The Relationship of VO2 Peak and the Blood Lactate Transition Threshold with Metabolic Syndrome and Its Component Disorders.

Background: Improvements in cardiorespiratory fitness attenuate the risk for metabolic syndrome (MetS). However, the determinants of cardiorespiratory fitness measurements such as oxygen consumption (VO2) peak and anaerobic threshold (AT) have not been investigated in persons with MetS. Therefore, the main aim of this study was to compare VO2 peak and AT between subjects with and without MetS and to investigate determinants of cardiorespiratory fitness and its effects on the odds for MetS and its individual components. Methods: Thirty-one males with MetS and 24 healthy male participants each performed a VO2 peak and a blood lactate transition threshold test. Waist circumference, body mass index (BMI), blood pressure, fasting plasma triglyceride, total cholesterol, high-density lipoprotein cholesterol, glucose, and insulin levels were measured. Separate multivariable linear regression models were developed in which VO2 peak, AT, and the components of MetS were used as the dependent variables, while a multivariable logistic regression model was used for MetS. Results: The VO2 peak [median (interquartile range)] was lower in subjects with MetS compared with controls [27.9 (23.0-31.0) vs. 35.0 (32.0-45.0) mL·min-1·kg-1; P < 0.0001]. Multivariable regression analysis demonstrated that there was a bidirectional association between MetS and VO2 peak that was mediated by waist circumference and blood pressure. The VO2 peak was a strong negative determinant of waist circumference (ß = -0.36, P < 0.0001), but not of BMI (ß = -0.13, P = 0.21). Conclusions: A higher VO2 peak is associated with a lower odds ratio for MetS, which is related to greater cardiorespiratory fitness in a cyclical relationship that is mediated by blood pressure and waist circumference. A higher VO2 peak is specifically associated with lower waist circumference, and vice versa, possibly by effects on visceral fat.

Professional quality of life of adult protective service workers.

Adult Protective Services (APS) workers are exposed to substantial occupational hazards and job stress, but these stressors are underdocumented. Therefore, we sought to describe APS workers' work environments and responses to occupational hazards and stressors, including compassion fatigue, burnout, and secondary traumatic stress. Survey data were gathered with closed-ended questionnaires administered to APS workers in an urban setting. Virtually all workers (97%) reported exposure to one or more environmental hazards in their work, and 80% reported hazard exposure in the past month. Workers also reported mixed responses to their work environment and to experiences with supervision. A sizable minority (22.7%) was at high risk for burnout, 24.6% were at risk for secondary traumatic stress, and 19.9% reported low compassion satisfaction. The results document multiple stressors in APS work. The APS partner is committed to ongoing efforts to better support its staff, and these findings can inform future efforts to enhance supervisor support and worker self-care, to minimize burnout and secondary traumatic stress.

Reproducibility and levels of blood lactate transition thresholds in persons with metabolic syndrome.

BACKGROUND: The optimal exercise load/intensity for exercise programs for individuals with metabolic syndrome has not been investigated. One method of determining optimal exercise load is to measure the blood lactate transition threshold (BLTT), referred to as the anaerobic threshold (AT). This study investigated the reproducibility of BLTT testing and the consequent determination of AT via the Mader method and a modified form of the Automatic Data Analysis for Progressive Tests (ADAPT) method in patients with metabolic syndrome. METHODS: Fifteen, male patients diagnosed with metabolic syndrome and 15 healthy, male subjects each performed BLTT measurements on a treadmill at the same daily times on three different days. Peak oxygen consumption was also determined during testing. RESULTS: There was no significant difference in treadmill velocity at AT determined by the Mader method or the modified ADAPT method within both groups (P>0.05). Both methods yielded good coefficients of variation. When combining both groups, the typical error also demonstrated good reproducibility. The mean treadmill velocity at AT was higher in the healthy compared to the metabolic syndrome group using both the Mader and the ADAPT method. Regression analysis and analysis of covariance (ANCOVA) demonstrated that this difference was largely due to a higher oxygen consumption (VO2) peak in the healthy group. The study also found an association between VO2 peak and waist circumference among the metabolic syndrome group. CONCLUSIONS: This study demonstrated that BLTT tests are reproducible in persons with metabolic syndrome. The modified ADAPT method may be the preferred method of determining treadmill velocity at AT because fewer factors are known to influence its determination.

The agreement between reaction-board measurements and kinematic estimation of adult male human whole body centre of mass location during running.

The segmental method for estimating the centre of mass (COM) location of the human body has been widely used since 1889. How closely this method agrees with direct measurements of the location and movement of COM during activity however, remains unclear. To test this, a novel reaction-board utilizing life sized projections of human subjects is designed for measuring COM location. Agreement between the segmental method and the more direct reaction-board measurement method is then assessed. Our data demonstrate that the reaction-board system has a physical maximum error of 1.28 cm and 1.95 cm for locating COM along the vertical (board length) and horizontal (board width) axes respectively, and show that the reaction-board and segmental methods agree to within limits of 6.0 cm for the location of COM and to within 5.6 cm for the movement of COM between two points, in recumbent individuals. Applied to running, the segmental method agrees to within limits of 4.8 cm for oscillation of COM and 5.3 cm for stride median COM height. The segmental method agrees with a more direct technique of known accuracy, the reaction-board method, most closely when measuring averaged oscillation over repeated strides, where it displays a measurement error range of 5.1 cm to 0.1 cm in runners.