Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments.

Hospital emergency departments (EDs) lack the tools and processes required to facilitate consistent screening and intervention in cases of elder abuse and neglect. To address this need, the National Collaboratory to Address Elder Mistreatment has developed a clinical care model that ED's can implement to improve screening, referral, and linkage to coordinated care and support services for older adults who are at risk of mistreatment. To gauge ED readiness to change and facilitate adoption of the care model, we developed an organizational assessment tool, the Elder Mistreatment Emergency Department Assessment Profile (EM-EDAP). Development included a phased approach in which we reviewed evidence on best practice; consulted with multidisciplinary experts; and sought input from ED staff. Based on this formative research, we developed a tool that can be used to guide EDs in focusing on practice improvements for addressing elder mistreatment that are most responsive to local needs and opportunities.

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.

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.

The Interview for Decisional Abilities (IDA): a tool to assess the decisional capacity of abused and neglected older adults.

We present the Interview for Decisional Abilities (IDA), a semi-structured tool for use by adult protective services (APS) workers as part of their comprehensive assessments of clients. The IDA was created in response to a Federal mandate to standardize the procedures and competencies of APS agencies with a view to improving client assessments and facilitating cross-jurisdictional research on adult mistreatment. The proximal aim of the IDA is to guide workers in gathering information on the ability of suspected victims of adult mistreatment to make decisions about the risks they face.

Improving Quality of Care in Hospitals for Victims of Elder Mistreatment: Development of the Vulnerable Elder Protection Team.

PROBLEM DEFINITION: Hospitals have an opportunity to improve the quality of care provided to a particularly vulnerable population: victims of elder mistreatment. Despite this, no programs to prevent or stop elder abuse in the acute care hospital have been reported. An innovative, multidisciplinary emergency department (ED)-based intervention for elder abuse victims, the Vulnerable Elder Protection Team (VEPT), was developed at NewYork-Presbyterian / Weill Cornell Medical Center (New York City). APPROACH: The VEPT is a consultation service available 24 hours a day/7 days a week to improve identification, comprehensive assessment, and treatment for potential victims of elder abuse or neglect. All ED providers have been trained on how to recognize signs of elder mistreatment. Any provider can activate the VEPT via a single page/telephone call, which triggers the VEPT's often time-consuming, complex assessment of the potential mistreatment victim. First, the ED social worker on duty performs the initial bedside assessment and separately interviews the potential perpetrator and/or caregiver. He or she then contacts the on-call VEPT medical provider to discuss next steps and other team members' potential involvement. For patients admitted to the hospital, the VEPT connects with the inpatient social workers and medical team to ensure appropriate follow-up and care planning. NEXT STEPS/PLANNED EVALUATION: The VEPT program was launched in April 2017 after comprehensive training. Its impact will be measured by tracking the short-term and long-term mistreatment-related outcomes, as well as medical, mental health, functional, psychosocial, and legal outcomes of the vulnerable ED patients for whom the team provides care.

Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team.

BACKGROUND: An ED visit provides a unique opportunity to identify elder abuse, which is common and has serious medical consequences. Despite this, emergency providers rarely recognise or report it. We have begun the design of an ED-based multidisciplinary consultation service to improve identification and provide comprehensive medical and forensic assessment and treatment for potential victims. METHODS: We qualitatively explored provider perspectives to inform intervention development. We conducted 15 semistructured focus groups with 101 providers, including emergency physicians, social workers, nurses, technologists, security, radiologists and psychiatrists at a large, urban academic medical centre. Focus groups were transcribed, and data were analysed to identify themes. RESULTS: Providers reported not routinely assessing for elder mistreatment and believed that they commonly missed it. They reported 10 reasons for this, including lack of knowledge or training, no time to conduct an evaluation, concern that identifying elder abuse would lead to additional work, and absence of a standardised response. Providers believed an ED-based consultation service would be frequently used and would increase identification, improve care and help ensure safety. They made 21 recommendations for a multidisciplinary team, including the importance of 24/7 availability, the value of a positive attitude in a consulting service and the importance of feedback to referring ED providers. Participants also highlighted that geriatric nurse practitioners may have ideal clinical and personal care training to contribute to the team. CONCLUSIONS: An ED-based multidisciplinary consultation service has potential to impact care for elder abuse victims. Insights from providers will inform intervention development.

Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program.

BACKGROUND: An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED-based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. METHODS: We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. RESULTS: During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty-two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy-five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety-four percent reported believing that there is merit in establishing a VEPT Program in other EDs. CONCLUSION: VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer-term outcomes.

Practitioners' views on elder mistreatment research priorities: recommendations from a Research-to-Practice Consensus conference.

This article presents recommendations from expert practitioners and researchers regarding future directions for research on elder abuse prevention. Using the Research-to-Practice Consensus Workshop model, participants critiqued academic research on the prevention of elder mistreatment and identified practice-based suggestions for a research agenda on this topic. The practitioners' critique resulted in 10 key recommendations for future research that include the following priority areas: defining elder abuse, providing researchers with access to victims and abusers, determining the best approaches in treating abusers, exploiting existing data sets, identifying risk factors, understanding the impact of cultural factors, improving program evaluation, establishing how cognitive impairment affects legal investigations, promoting studies of financial and medical forensics, and improving professional reporting and training. It is hoped that these recommendations will help guide future research in such a way as to make it more applicable to community practice.

Building psychosocial programming in geriatrics fellowships: a consortium model.

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.

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.

Effects of the COVID-19 Outbreak on Elder Mistreatment and Response in New York City: Initial Lessons.

New York City is currently experiencing an outbreak of COVID-19, a highly contagious and potentially deadly virus, which is particularly dangerous for older adults. This pandemic has led to public health policies including social distancing and stay-at-home orders. We explore here the impact of this unique crisis on victims of elder mistreatment and people at risk of victimization. The COVID-19 outbreak has also had a profound impact on the organizations from many sectors that typically respond to protect and serve victims of elder mistreatment. We examine this impact and describe creative solutions developed by these organizations and initial lessons learned in New York City to help inform other communities facing this pandemic and provide guidance for future crises.

Utilization of Formal Support Services for Elder Abuse: Do Informal Supporters Make a Difference?

BACKGROUND AND OBJECTIVES: Few elder abuse (EA) victims ever seek or receive assistance from formal support services designed to mitigate risk and harm of revictimization. This study examined whether the presence of third-party "concerned persons" in victims' personal social networks plays a role in enabling formal support service utilization. RESEARCH DESIGN AND METHODS: A representative population-based survey administered to adults (n = 800) in New York State identified 83 EA cases from the past year. Penalized likelihood logistic regression was used to examine the relationship between availability of a concerned person and victim formal support services usage. RESULTS: EA victims who had a concerned person in their personal life were significantly more likely to use formal EA support services than victims without a concerned person. EA victims who lived with their perpetrator were significantly less likely to use formal services. DISCUSSION AND IMPLICATIONS: Third-party concerned persons represent a critical population to target in efforts designed to promote EA victim help-seeking.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney's office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser's substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.

Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed.

BACKGROUND: Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones. OBJECTIVE: To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation. DESIGN: Systematic review. SETTING: Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL. MEASUREMENTS: We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available. RESULTS: We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute-care hospital, 43% had high potential to work in low-resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high-quality study design. CONCLUSION: Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high-quality study design. Many have the potential to work in low-resource environments. Acute-care hospitals were infrequently integrated into programs.

Self-management strategies to reduce pain and improve function among older adults in community settings: a review of the evidence.

CONTEXT: Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined. OBJECTIVE: To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults. DESIGN: We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present. RESULTS: Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above. CONCLUSIONS: Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.

When Helping Hurts: Nonabusing Family, Friends, and Neighbors in the Lives of Elder Mistreatment Victims.

Purpose of the Study: Elder mistreatment is an epidemic with significant consequences to victims. Little is known, however, about another affected group: nonabusing family members, friends, and neighbors in the lives of the older victim or "concerned persons." This study aimed to identify (a) the prevalence of adults aged 18 and older who have encountered an elder mistreatment situation, (b) the proportion of these who helped the elder victim, and (c) the subjective levels of distress experienced by respondents who helped the victim versus those who did not. Design and Methods: Data were collected from a nationally representative telephone survey of 1,000 adults (18+). Multiple linear regression was used to test the relationship between "helping status" and personal distress attributed to an elder mistreatment, defined as someone aged 60 and older experiencing violence, psychological abuse, financial exploitation, or neglect by a caregiver. Results: Nearly 30% of adults knew a relative, friend, or neighbor who experienced elder mistreatment. Of these, 67% reported personal distress resulting from the mistreatment at a level of 8 or more out of 10. Assuming a helping role was associated with significantly higher levels of personal distress. Greater distress was also associated with being a woman, increasing age, and lower household income. Implications: Knowing about an elder mistreatment situation is highly distressing for millions of adults in the United States, particularly for those assuming a helping role. We suggest intervention approaches and future research to better understand the role and needs of concerned persons.

The CITRA pilot studies program: mentoring translational research.

PURPOSE: We developed an innovative pilot studies program to foster partnerships between university researchers and agencies serving older people in New York City. The development of researchers willing to collaborate with frontline service agencies and service agencies ready to partner with researchers is critical for translating scientific research into evidence-based practice that benefits community-dwelling older adults. DESIGN AND METHODS: We adapted the traditional academic pilot studies model to include key features of community-based participatory research. RESULTS: In partnership with a network of 265 senior centers and service agencies, we built a multistep program to recruit and educate scientific investigators and agencies in the principles of community-based research and to fund research partnerships that fulfilled essential elements of research translation from university to community: scientific rigor, sensitivity to community needs, and applicability to frontline practice. We also developed an educational and monitoring infrastructure to support projects. IMPLICATIONS: Pilot studies programs developing community-based participatory research require an infrastructure that can supplement individual pilot investigator efforts with centralized resources to ensure proper implementation and dissemination of the research. The financial and time investment required to maintain programs such as those at the Cornell Institute for Translational Research on Aging, or CITRA, may be a barrier to establishing similar programs.

Reflections of medical students on visiting chronically ill older patients in the home.

The expanding number of Americans living with chronic illness necessitates educating future physicians about chronic illness care. Weill Cornell Medical College's Chronic Illness Care in the Home Setting Program (CIC-HSP), a mandatory part of the primary care clerkship, exposes medical students to persons with chronic illness via a half day of house calls with a geriatrics team. The investigators sought to qualitatively assess the effect of the CIC-HSP on medical students and recent medical graduates. Fifty-two prospective participants were approached, and 50 (96%) with varying training levels and time since completing the program were interviewed. Most respondents (63%) found that the home visits taught them important approaches to caring for the chronically ill, such as individualizing care to meet patients' individual needs and improving quality of life as a goal of care. Students remarked that the experience enhanced their empathy (18%) and sensitivity (20%) toward chronically ill patients and increased their appreciation for chronic illness care (35%). Many participants reported that patients were more empowered in the home (55%) and perceived greater rapport and warmth between the doctor and patient (57%) in the home (vs office) setting. The vast majority of recent medical graduates (84%) related that this educational exposure continued to positively influence their approach to patient care. A home visit experience with a geriatrics team can help foster medical students' understanding of the psychosocial and medical aspects of chronic illness, teach relevant approaches to patient care, and improve students' attitudes toward caring for the chronically ill.

The CITRA research-practice consensus-workshop model: exploring a new method of research translation in aging.

PURPOSE: On the basis of the experience of an extensive community-based research partnership in New York City, we developed an innovative process for bridging the gap between aging-related research and practice, using a consensus-workshop model. DESIGN AND METHODS: We adapted the traditional scientific consensus-workshop model to include translation of the research into nontechnical language and the involvement of practitioners in the process. We then applied the model to the specific issue of falls prevention among community-dwelling older adults. RESULTS: The dialogue and interaction among researchers and practitioners provided new insights beyond a traditional research review. Practitioners offered astute guidance for future research based on their day-to-day field experience. IMPLICATIONS: The recommendations that emerged from the workshop demonstrated the value of close interaction between the aging-related research and practice communities. The consensus-conference model has significant potential to establish a bridge between the worlds of research and practice in a variety of settings.

Elder mistreatment: priorities for consideration by the white house conference on aging.

Elder mistreatment is recognized internationally as a prevalent and growing problem, meriting the attention of policymakers, practitioners, and the general public. Studies have demonstrated that elder mistreatment is sufficiently widespread to be a major public health concern and that it leads to a range of negative physical, psychological, and financial outcomes. This article provides an overview of key issues related to the prevention and treatment of elder mistreatment, focusing on initiatives that can be addressed by the White House Conference on Aging. We review research on the extent of mistreatment and its consequences. We then propose 3 challenges in preventing and treating elder mistreatment that relate to improving research knowledge, creating a comprehensive service system, and developing effective policy. Under each challenge, examples are provided of promising initiatives that can be taken to eliminate mistreatment. To inform the recommendations, we employed recent data from the Elder Justice Roadmap Project, in which 750 stakeholders in the field of elder mistreatment were surveyed regarding research and policy priorities.