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.

Psychometric Properties of The Five-Item Victimization of Exploitation (FIVE) Scale: A Measure of Financial Abuse of Older Adults.

BACKGROUND AND OBJECTIVES: Elder mistreatment affects at least 1 in 10 older adults. Financial abuse, or exploitation, of older adults is among the most commonly reported forms of abuse. Few validated measures exist to measure this construct. We aim to present a new psychometrically validated measure of financial abuse of older adults. RESEARCH DESIGN AND METHODS: Classical test theory and item response theory (IRT) methodologies were used to examine a five-item measure of financial abuse of older adults, administered as part of the New York State Elder Mistreatment Survey. RESULTS: Factor analysis revealed a single factor best fits the data, which we labeled as financial abuse. Moreover, IRT analyses revealed that these items discriminated well between abused and nonabused persons and provided information at high levels of the latent trait θ, as is expected in cases of abuse. DISCUSSION AND IMPLICATIONS: The Five-Item Victimization of Exploitation Scale has acceptable psychometric properties and has been used successfully in large-scale survey research. We recommend this measure as an indicator of financial abuse in elder abuse, or mistreatment prevalence research studies.

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.

Successful Aging among Immigrant and Canadian-Born Older Adults: Findings from the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: Few studies in Canada have focused on the relationship between immigrant status and successful aging. The concept of successful aging used in this study includes the ability to accomplish both activities of daily living (ADLs) and instrumental activities of daily living (IADLs), freedom from mental illness, memory problems and disabling chronic pain, adequate social support and older adults' self-reported happiness and subjective perception of their physical health, mental health and aging process as good. METHODS: The present study analyzed the first two waves of data from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). The sample includes 7651 respondents aged 60+ at time 2, of whom 1446 respondents were immigrants. Bivariate and multivariable binary logistic regression analyses were conducted. RESULTS: Canadian-born older adults had a slightly higher prevalence and age-sex adjusted odds of achieving successful aging than their immigrant counterparts (aOR = 1.18, 95% CI: 1.04, 1.34, p < 0.001). After adjusting for 18 additional factors, immigrant status remained statistically significant (aOR = 1.24, 95% CI: 1.09, 1.41, p < 0.001). Significant baseline factors associated with successful aging among immigrants included being younger, having higher income, being married, not being obese, never smoking, engaging in moderate or strenuous physical activities, not having sleeping problems and being free of heart disease or arthritis. CONCLUSIONS: Immigrant older adults had a lower prevalence of successful aging than their Canadian-born peers. Further research could investigate whether policies and interventions supporting older immigrants and promoting a healthy lifestyle enhance older adults achieve successful aging in later life.

PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions.

This is the protocol for a Campbell systematic review. The objectives are as follows: to produce a mega-map which identifies, maps and provides a visual interactive display, based on systematic reviews on all the main aspects of elder abuse in both the community and in institutions, such as residential and long-term care institutions.

Elder abuse prevalence and risk factors: findings from the Canadian Longitudinal Study on Aging.

Elder abuse (EA) is a pervasive problem with serious consequences. Previous population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims, which threatens external validity. Based on a national, prospective, population-based cohort sample of older adults (n = 23,468) over a 3-year period from the Canadian Longitudinal Study on Aging, the current study sought to estimate the prevalence of EA and identify risk and protective factors. Past-year prevalence of any EA was 10.0%. Older adults with greater vulnerability related to physical, cognitive and mental health, childhood maltreatment and shared living were at higher EA risk, while social support was protective against EA. Older adults identifying as Black or reporting financial need were at heightened EA risk. This longitudinal, population-based study advances our understanding of EA risk/protective factors across several domains and informs the development of EA prevention strategies.

Lack of Association of Elder Mistreatment With Mortality.

BACKGROUND: Prior research is limited and inconsistent on the degree to which elder mistreatment (EM) is associated with mortality. This study uses data from a 10-year, prospective, population-based study of EM to determine the adjusted effects of EM on older adult mortality, after controlling for other health and socioeconomic covariates. METHODS: The New York State Elder Mistreatment Prevalence Study conducted a random-sample telephone survey of older adults (n = 4 156) in 2009 (Wave 1). The current study employs EM and covariate data from Wave 1 and data on mortality status through Wave 2 (2019). EM was operationalized both as experiencing EM and as severity of EM. The survey measured overall EM and separate subtypes (emotional, physical, and financial abuse, and neglect). RESULTS: The hypothesis was not supported that abused and neglected older people would have higher rates of death over the study. Individuals who were victims of EM were no more likely to die over the following 10 years, compared with those who were not mistreated, after controlling for covariates. Furthermore, the severity of EM, as measured by the frequency of mistreatment behaviors, also was not associated with mortality risk. CONCLUSIONS: The finding that self-reported EM did not raise the risk of earlier death in this sample is encouraging. Future research should work to identify factors that may moderate the relationship between EM and mortality, such as social support/isolation, quality of family relationships, or involvement with formal support service systems.

Bridging the Gap between Homelessness in Older Adulthood and Elder Abuse: Considerations for an Age-Friendly Shelter System.

Homelessness and elder abuse are two major public health issues affecting older adults that are increasing in scope due to global population aging. While these issues have typically been examined separately, this commentary considers the often overlooked intersection between homeless older people and victims of elder abuse through two pathways: (1) the systemic abuse of older adults in the shelter system; and (2) the role of elder abuse as a possible risk factor for homelessness in later life. Strategies for the development of shelter systems that support the diverse needs of an aging population are proposed.

Estimated Incidence and Factors Associated With Risk of Elder Mistreatment in New York State.

Importance: Elder mistreatment is associated with major health and psychosocial consequences and is recognized by clinicians, policy makers, and researchers as a pervasive problem affecting a rapidly aging global population. Objective: To estimate the incidence of elder mistreatment and identify factors associated with the risk of new cases. Design, Setting, and Participants: This research is a 10-year, longitudinal, population-based, cohort study of the incidence of elder mistreatment in New York State households conducted between 2009 (wave 1) and 2019 (wave 2). At wave 1, random digit-dial (landline and cellular telephones) stratified sampling was done to recruit English-speaking and/or Spanish-speaking, cognitively intact, community-dwelling older adults (aged ≥60 years) across New York State. The current study conducted computer-assisted telephone interviews with older adults who participated in wave 1 and gave permission to be contacted again for wave 2 interviews (response rate, 60.7%). Data analysis was performed from October 2020 to January 2021. Exposures: Physical factors (health status, functional capacity, and age), living arrangement (coresidence), and sociocultural characteristics (sex, race/ethnicity, geocultural context, and household income). Main Outcomes and Measures: Ten-year incidence for overall elder mistreatment and subtypes (financial abuse, emotional or psychological abuse, physical abuse, and neglect) were measured using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale, and the New York State Elder Mistreatment Prevalence Study financial abuse tool. Results: The analytical sample included 628 older adults (mean [SD] age at wave 1, 69.20 [6.95] years; age at wave 2, 79.40 [6.93] years; 504 non-Hispanic White individuals [80.9%]; 406 women [64.6%]). Ten-year incidence rates were 11.4% (95% CI, 8.8%-14.3%) for overall elder mistreatment, 8.5% (95% CI, 6.3%-10.9%) for financial abuse, 4.1% (95% CI, 2.6%-5.7%) for emotional abuse, 2.3% (95% CI, 1.2%-3.6%) for physical abuse, and 1.0% (95% CI, 0.3%-1.8%) for neglect. Poor self-rated health at wave 1 was associated with increased risk at wave 2 of new overall mistreatment (odds ratio [OR], 2.86; 95% CI, 1.35-5.84), emotional abuse (OR, 3.67; 95% CI, 1.15-11.15), physical abuse (OR, 4.21; 95% CI, 1.14-13.70), and financial abuse (OR, 2.80; 95% CI, 1.16-6.38). Compared with non-Hispanic White participants, Black participants were at heightened risk of overall mistreatment (OR, 2.61; 95% CI, 1.16-5.70) and financial abuse (OR, 2.80; 95% CI, 1.09-6.91). A change from coresidence to living alone was associated with increased risk of financial abuse (OR, 2.74; 95% CI, 1.01-7.21). Conclusions and Relevance: These findings suggest that health care visits may be important opportunities to detect older adults who are at risk of mistreatment. Race is highlighted as an important social determinant for elder mistreatment requiring urgent attention.

Investigating the connection between ageism and elder mistreatment.

Elder mistreatment is recognized as a pervasive public health problem with detrimental consequences for older adults and society. Although considerable research has examined elder mistreatment risk factors at the individual level, there is a growing call for the field to move beyond proximal causes and consider underlying structural factors that influence elder mistreatment. Illustrating this shift, organizations, advocacy groups and researchers have proposed a connection between ageism and elder mistreatment. However, despite the assertion that ageism is a causal factor for elder mistreatment, there is a scarcity of research to demonstrate this relationship. In this Perspective, we examine the proposed conceptual pathways and limited empirical research connecting ageism and elder mistreatment. After identifying critical gaps in current knowledge, we propose a model that links ageism and elder mistreatment and a research agenda to bring conceptual clarity and empirical evidence to the study of this topic.

The Financial and Psychological Impact of Identity Theft Among Older Adults.

BACKGROUND AND OBJECTIVES: Society's growing reliance on technology to transfer private information has created more opportunities for identity thieves to access and misuse personal data. Research on identity theft specifically among adults aged 65 and older is virtually nonexistent, yet research focusing on victims of all ages indicates a positive association between age, minority status, and more severe economic and psychological consequences. RESEARCH DESIGN AND METHODS: Identity theft measures come from a sample of more than 2,000 self-reported victims aged 65 and older from the nationally representative National Crime Victimization Survey Identity Theft Supplements administered in 2014 and 2016. Regression was used to examine how socioeconomic status, demographic characteristics, and incident-specific factors relate to how much money is stolen, the likelihood of experiencing out-of-pocket costs, and emotional distress among older identity theft victims. RESULTS: Older Black identity theft victims were more likely to have greater amounts of money stolen and were more likely to feel distressed by the incident than older White victims. The most disadvantaged older adults living at or below the federal poverty level were significantly more likely to suffer out-of-pocket costs. The length of time information was misused, experiencing subsequent financial problems and problems with friends/family, and the hours spent resolving identity theft were positively associated with emotional distress. Among those aged 65 and older, age was not significantly associated with losses or emotional distress. DISCUSSION AND IMPLICATIONS: Older adults living in poverty need more resources to assist with recovery and reporting identity theft to law enforcement. Limiting the extent of losses from identity theft and reducing the length of time information is misused may reduce the emotional toll of identity theft on older victims.

Process Models to Understand Resident-to-Resident Aggression Among Residents With Dementia in Long-Term Care.

BACKGROUND/OBJECTIVES: Resident-to-resident aggression (RRA) is a prevalent form of interpersonal violence in long-term care (LTC) settings. Research to guide preventive interventions is limited. Using social-ecological and need-driven dementia-compromised behavior perspectives, we sought to generate process models representing common RRA pathways in dementia-specific LTC units. RESEARCH METHODS: We used qualitative focus group methodology involving staff (n = 36) exposed to everyday resident interactions at two urban LTC facilities in Toronto, Canada. Semistructured interviews were audio-recorded and transcribed. Two independent raters coded the transcripts using iterative, constant comparison analytic processes. RESULTS: Two distinct RRA process models in dementia-specific LTC units were developed. Models reflect sequential pathways driven by residents' benign or responsive behaviors and cognitive processing limitations, with escalation points within resident dyads or groups. IMPLICATIONS: This study furthers RRA conceptualization as a process rather than an aggressive event. Models capture unique RRA manifestations in dementia-specific LTC units and entrypoints for prevention or management.

Exploring Risk of Elder Abuse Revictimization: Development of a Model to Inform Community Response Interventions.

A focus of community-based elder abuse response programs (EARP), such as Adult Protective Services, is to reduce the risk of revictimization among substantiated victims. While elder abuse (EA) risk factor research has predominantly focused on understanding the risk of initial EA onset among the general older adult population, understanding of revictimization risk among substantiated victims is weak. This study sought to identify conditions that perpetuate EA among substantiated victims. Data were collected from multiple sources: focus groups with multidisciplinary teams (n = 35), multidisciplinary team case revictimization risk evaluations (n = 10), and reviewing a random sample of case records (n = 250) from a large EARP in New York City. Sixty-two indicators of EA revictimization risk were identified across several ecosystemic levels: individual victim or perpetrator, victim-perpetrator relationship, and surrounding family, home, community, and sociocultural contexts. Findings carry implications for EARP practices to reduce EA recurrence and the development of measures to evaluate EARP intervention.

Developing standard data for elder abuse multidisciplinary teams: A critical objective.

Multidisciplinary teams (MDTs) represent a prominent and growing form of elder abuse intervention in communities across the U.S. and around the world. Despite the proliferation and promise of MDTs as a model of elder abuse intervention, the field lacks infrastructure, including a standardized data collection strategy, to facilitate a coordinated and informed MDT effort. This commentary presents an exploratory study, which sought to examine existing strategies of case-level electronic data collection implemented by MDTs across the U.S. Using a snowball sampling strategy, we identified 11 MDTs using an electronic data collection strategy. Our analysis found a tremendous range in both the extent and nature of data collection across MDTs, yet it identified common domains of data. A standardized MDT data collection strategy would benefit several MDT stakeholders, including coordinators tracking everyday operations, funders requiring reporting, and researchers conducting large-scale comparative research to identify best MDT practices.

Risk and protective factors of identity theft victimization in the United States.

Identity theft victimization is associated with serious physical and mental health morbidities. The problem is expanding as society becomes increasingly reliant on technology to store and transfer personally identifying information. Guided by lifestyle-routine activity theory, this study sought to identify risk and protective factors associated with identity theft victimization and determine whether individual-level behaviors, including frequency of online purchasing and data protection practices, are determinative of victimization. Data from sequential administrations of the U.S. National Crime Victimization Survey-Identity Theft Supplement (ITS) in 2012 and 2014 were combined (N = 128,419). Using multivariable logistic regression, risk and protective factors were examined for three subtypes: 1) unauthorized use of existing credit card/bank accounts, and unauthorized use of personal information to 2) open new accounts, or 3) engage in instrumental activities (e.g., applying for government benefits, receiving medical care, filing false tax returns). Existing credit card/bank accounts and new accounts identity theft victimization were associated with higher levels of online purchasing activity and prior identity theft victimization. All identity theft subtypes were associated with government/corporate data breaches and other crime victimization experiences. Routine individual-level preventive behaviors such as changing online passwords and shredding/destroying documents were protective. Identity theft subtypes showed divergent socio-demographic risk/protective profiles, with those of higher socioeconomic status more likely to be victims of existing credit card/bank account identity theft. Identity theft is a pervasive, growing problem with serious health and psychosocial consequences, yet individuals can engage in specific protective behaviors to mitigate victimization risk.

Developing the Emergency Department Elder Mistreatment Assessment Tool for Social Workers Using a Modified Delphi Technique.

Elder mistreatment is common and has serious consequences. The emergency department (ED) may provide a unique opportunity to detect this mistreatment, with social workers often asked to take the lead in assessment and intervention. Despite this, social workers may feel ill-equipped to conduct assessments for potential mistreatment, due in part to a lack of education and training. As a result, the authors created the Emergency Department Elder Mistreatment Assessment Tool for Social Workers (ED-EMATS) using a multiphase, modified Delphi technique with a national group of experts. This tool consists of both an initial and comprehensive component, with 11 and 17 items, respectively. To our knowledge, this represents the first elder abuse assessment tool for social workers designed specifically for use in the ED. The hope is that the ED-EMATS will increase the confidence of ED social workers in assessing for elder mistreatment and help ensure standardization between professionals.