Measuring the diverse characteristics of county adult protective services programs.

Adult protective services (APS) programs vary markedly, yet few studies have quantified this diversity. In 2020, a survey of Ohio's 85 county-administered APS programs incorporated subsequent feedback from staff and described the programs in a systematic manner. This process resulted in a 100% response rate and illustrated an efficient approach to measuring organizational characteristics (e.g., whether any staff are mostly dedicated to APS), resources (e.g., access to multidisciplinary teams), and practices (e.g., how often staff create a plan to meet client goals). The prevalence of many factors differed by the number of older adults the program served. For instance, 75% of programs in large counties had regular opportunities to share complex cases with a multidisciplinary team, compared to 28% of programs in small counties. Understanding the diverse characteristics of APS programs - and how to measure them - can help agencies guide quality improvement efforts and the dissemination of innovations.

The National Elder Mistreatment Study: An 8-year longitudinal study of outcomes.

OBJECTIVES: To conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and poor self-reported health. METHODS: Attempts were made to re-contact, via Computer Assisted Telephone Interview, all 752 NEMS participants who reported mistreatment since age 60 at Wave I, as well as a randomly selected sample of non-mistreated NEMS participants Results: 183 NEMS Wave I elder abuse victims and 591 non-victims provided data. In bivariate analyses, elder mistreatment 8 years earlier increased risk of negative outcomes by 200-700%. However, multivariate analyses revealed that Current (Wave II) social support was highly protective against most negative outcomes (excepting PTSD), and even appeared to nullify effects of mistreatment on GAD and poor self-reported health. CONCLUSIONS: Outcomes of elder mistreatment have not been studied prospectively in a national sample. The NEMS 8-year follow-up findings indicate a strong relationship between elder mistreatment at Wave I and negative emotional and physical health 8 years later. Fortunately, current (Wave II) social support appears to be both consistently and powerfully protective against most negative outcomes.

Conceptual model and map of psychological abuse of older adults.

Psychological abuse of older adults is a hidden and pervasive problem that is not well conceptualized nor well measured. Goals. The goals were to (a) conceptualize psychological abuse using three-dimensional concept maps, and (b) develop theoretical models. Methods. Statements describing the construct were generated by local and national panels. These were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. Results. The concept maps guided development of theoretical hierarchies. Significance. Theoretical models may help to develop measures to estimate prevalence better and may enable more precise screening for triage into appropriate interventions.

Self-report measure of psychological abuse of older adults.

PURPOSE: This study tested key psychometric properties of the Older Adult Psychological Abuse Measure (OAPAM), one self-report scale of the Older Adult Mistreatment Assessment (OAMA). DESIGN AND METHODS: Items and theory were developed in a prior concept mapping study. Subsequently, the measures were administered to 226 substantiated clients by 22 elder abuse staff from 7 agencies in a full-scale field test. The resulting database was used to estimate the psychometric properties of the OAPAM using the Rasch item response theory model and traditional validation techniques. Analyses included tests for dimensionality, model fit, and theoretical construct validation. Results from the OAPAM client report were validated against the adult protective services substantiation decision of abuse and the elder abuse staff assessment of psychological abuse (PA). RESULTS: The client self-report measures met stringent Rasch analysis fit and unidimensionality criteria and had high person (internal consistency) and item reliability. The validity results supported the usefulness of the client measures and led to reconsideration of aspects of the hypothesized theoretical hierarchy. A short form was developed. Cut-points were proposed to distinguish levels of PA. IMPLICATIONS: The measure is now available to aid in the assessment of PA of older adults by both clinicians and researchers. Theoretical refinements developed using the Rasch item hierarchy may help to improve assessment and intervention.

A glass half full: the dubious history of elder abuse policy.

This article highlights the brief 30-year history of major U.S. policies that address elder abuse. The history of elder abuse policy is checkered and incomplete, reflecting a lack of comprehensive federal legislation. We begin our review by discussing the scope of elder abuse policy and, in particular, the Social Security Block Grant, which has become the sole source of federal aid for Adult Protective Services programs. The other source of federal aid, typically for helping efforts by Area Agencies on Aging, is the Older Americans Act. We document the incremental but increasing attention paid to elder abuse by chronicling key initiatives, including early congressional reports and hearings; White House Conferences on Aging; and efforts by pioneers such as Mario Biaggi, Claude Pepper, John Breaux, and Orin Hatch-efforts that we believe have led to the various introductions of the Elder Justice Act.

WorldView Environmental Scan on Elder Abuse.

In response to a growing and worldwide recognition of elder abuse, the WorldView Environmental Scan on Elder Abuse was undertaken. It represented an attempt to collect both information on the nature of the problem of elder abuse and responses to it from a global perspective. The first of its kind, the Scan gathered information about elder abuse as well as on related legislation and policy, services and programs, educational resources and needs, training, and past and ongoing research. A total of 53 countries responded to the survey questionnaire, with 362 respondents representing the six world regions designated by the World Health Organization. Findings revealed that factors contributing to elder abuse include changing social and economic structures, isolation of victims, inadequate knowledge of laws and services, intergenerational conflict, and poverty. Barriers to seeking resources to intervene and protect older adults include the culture of the country, language issues, literacy, stigma, lack of mobility, lack of funding, and insufficient familiarity with and access to the internet. The data serve as a catalyst to take action, both globally and nationally, while emphasizing the changes necessary to protect the rights and dignity of older adults.

Elder abuse awareness and action: the role of state summits.

Increasingly, states are convening summits to identify appropriate local responses to elder abuse. This first-ever nationwide research on state-level elder abuse summits examines what leads to their formation, what they accomplish, and what factors contribute to their success. Study results suggest that two-fifths of the states have held summits, four-fifths of which have been since 2000. Typically the summits were convened by the state department of human services or aging, involved 25-50 participants, and lasted less than 2 years. Nearly 50% of study respondents felt that summit goals had been met, and 60% stated that recommendations were implemented, usually because of committed participants, involvement of the right people, or strong advocacy. State summits can be effective means for galvanizing collective action to address elder abuse as a complex social problem.

Future directions for social policy and elder abuse: through the looking glass of generational characteristics.

The future directions for social policy and elder abuse are forecast using the characteristics of three contiguous generations: Baby Boomers, Gen Xers, and Nexters. The results suggest greater potential victimization for the Boomers than previous generations, particularly neglect and exploitation. Gen Xers may experience more self-neglect. Social policy will continue to emphasize the criminalization of elder abuse, reflecting Boomer self-righteousness and severity. Elder abuse victimization will have a medical hue, given the Boomer obsession with health and wellness. Although Gen Xers are less cynical than Boomers, they will be more concerned about their immediate lives and pass the elder abuse policy torch to the Nexters, who will elevate it in deference to the Boomers and in quest for a higher moral order.

VNA HouseCalls of greater Cleveland, Ohio: development and pilot evaluation of a program for high-risk older adults offering primary medical care in the home.

The need for primary medical care in the home will increase with a growing elderly and disabled population. The effectiveness of the service must be assessed in light of its relatively high costs. The aim of this study was to evaluate VNA HouseCalls of Greater Cleveland, Ohio during its first year of operations. The program targets high-risk older adults using teams of advanced practice nurses and physicians. The pilot evaluation focused on the attainment of identified program goals. Data collection techniques included clinical record review (N = 139), mailed referral source satisfaction survey, and both mailed and telephone interview patient satisfaction surveys. The results showed that the typical patient served by VNA HouseCalls was a homebound woman in advanced old age with regular family contact and both physical and mental disorders. When asked, the typical patient indicated that without the program she would not have received the care that she needed.VNA HouseCalls helped in preventing functional decline and reducing hospitalization. It received high satisfaction ratings from both referral sources and patients. Study findings suggest that primary care in the home bears further examination for addressing community need and affecting positive patient outcomes for high risk older adults.

Community resources to promote successful aging.

Community resources are necessary for the health and well-being of older people. They can be organized with respect to the primary characteristic of successful aging they promote. Resources for avoiding disease and related disability include wellness programs, home health care, and mental health services. Resources that help older people sustain high functioning include senior centers, adult day care, and senior housing. Finally, active engagement with life is facilitated through employment services, learning experiences, and volunteer programs. Community resources for baby boomers in late life may differ from those available for today's elders. They will be no less important for successful aging, however.