Ability of Older Adults to Report Elder Abuse: An Emergency Department-Based Cross-Sectional Study.

OBJECTIVES: To characterize assessments of a patient's ability to report elder abuse within the context of an emergency department (ED)-based screen for elder abuse. DESIGN: Cross-sectional study in which participants were screened for elder abuse and neglect. SETTING: Academic ED in the United States. PARTICIPANTS: Patients, aged 65 years and older, presenting to an ED for acute care were assessed by trained research assistants or nurses. MEASUREMENTS: All patients completed the four-item Abbreviated Mental Test 4 (AMT4), then completed a safety interview (using the Emergency Department Senior Abuse Identification tool) designed to detect multiple domains of elder abuse and received a physical examination. Based on the cognitive assessment and safety interview, assessors ranked their confidence in the patient's ability to report abuse as absolutely confident, confident, somewhat confident, or not confident. To assess interrater reliability, two assessors independently rated confidence for a subset of patients. RESULTS: Assessors suspected elder abuse in 18 of 276 patients (6.5%). Assessors were absolutely confident in the patient's ability to report abuse for 95.7% of patients, confident for 2.5%, somewhat confident for 1.5%, and not confident for 0.3%. Among patients with an AMT4 of 4 (n = 249), assessors were confident or absolutely confident in 100% of patients. Among patients with an AMT4 of less than 4 (n = 27), they were confident or absolutely confident in the patient's ability to report abuse for 81% of patients, including 11 of 12 patients with mild cognitive impairment and 7 of 11 patients with severe cognitive impairment. For patients receiving paired evaluations (n = 131), agreement between assessors regarding patient ability to report abuse was 97% (κ = 0.5). CONCLUSIONS: In this sample of older adults receiving care in an ED, research assistants and nurses felt that the vast majority were able to report elder abuse, including many patients with cognitive impairment. J Am Geriatr Soc 68:170-175, 2019.

A clinic-based pilot intervention to enhance diabetes management for elderly Hispanic patients.

BACKGROUND AND OBJECTIVES: Successful diabetes self-management requires behavioral and lifestyle changes. However, low-income patients may face challenges related to poverty that make it difficult to engage in lifestyle changes. We piloted an intervention designed to help older, low-income, Hispanic, patients with diabetes access free or low-cost community resources to enhance diabetes self-management. Results from this pilot intervention are reported. DESIGN AND METHODS: Patients were recruited at baseline to complete surveys assessing diabetes self-care activities, diabetes self-efficacy, and general self-efficacy. Volunteers were trained by a clinic social worker to help patients identify needs and make referrals to local community resources (e.g., housing, transportation, food, clothing, dental and prescription services, employment, or family social services). Identical surveys were administered at 3-month follow-up. RESULTS: 28 patients were recruited at baseline and 18 patients completed the follow-up assessment. No significant changes in diabetes care and self-efficacy were detected. All patients requested at least one referral to a community resource. The most common requests were for low-cost dental clinics, food assistance, and housing support. At follow-up, nine (50%) patients contacted their given referrals. CONCLUSIONS: The need for assistance with basic social services is high in this population. The rate of referral uptake (50%) is high for a relatively low intensity intervention. Since the completion of the pilot, the program has trained 21 volunteers and helped over 220 patients in a primary care clinic. Using a volunteer model and creating connections to existing community resources is a cost-conscious way to deliver needed services to patients.

Elder financial abuse: an evaluation framework and supporting evidence.

OBJECTIVES: To develop a valid and reliable framework for evaluating cases of alleged elder financial abuse. DESIGN: Experienced experts in elder financial abuse rated a framework with eight elements. SETTING: Professionals attending an advanced training course on elder abuse. PARTICIPANTS: Deputy district attorneys (n=44), senior law enforcement detectives (n=59), Adult Protective Service workers, and public guardians and victim advocates (n=56) who had a combined total of 1,985 years of experience and who had investigated a total of 3,225 cases (mean of 13.1 years and 21.2 cases) were included. MEASUREMENTS: These experienced professionals were asked to rate how well an evaluative framework matched their experience with elder financial abuse using a 5-point rating scale ranging from very little to almost entirely. RESULTS: The mean rating for the model was 4.4 out of 5. About 90% of the sample rated it as almost entirely or very much matching their experience. There were no differences between professions. The reliability measure was 0.85. CONCLUSION: These results suggest a reliable and valid framework for evaluating cases of possible elder financial abuse.