A systematic evaluation of a multidisciplinary social work-lawyer elder mistreatment intervention model

Increasing disclosures of older adult maltreatment: a review of best practices for interviewing older adult eyewitnesses and victims

The current article provides a contemporary review of the best practices for interviewing older adults about crimes they witnessed or experienced. Specifically, we provide a detailed overview of how investigators can use a range of interviewing adaptations and procedures to acquire detailed and accurate maltreatment disclosures from older adults. In addition to discussing well-established investigative interviewing practices (e.g. rapport building, free-recall, cognitive instructions and prompts), this article also summarizes more recent literature on the benefits of multidisciplinary investigations, use of assistive technology and interview accommodations, along with effective practices for working with minority and marginalized older adults. Lastly, several research, professional and policy recommendations are provided for supporting older adults during investigative interviews.

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.

Relationship between emotional elder abuse and developmental function of the family

AIM

This study aimed to assess the relationship between emotional elder abuse and the developmental function of the family.

DESIGN

Community-based correlational cross-sectional study was conducted.

METHODS

Data were collected on 265 older adults from July to October 2019 in Tehran-Iran. The samples were selected by simple random sampling and they completed self-report tools: demographic information, emotional elder abuse developmental function in the family. Data analysis was performed using descriptive and inferential statistics and SPSS software v.16.

RESULTS

Mean score of the developmental function in the family was 67.38 (SD = 3.22, range = 0-129). There was a significant negative correlation between the total score of developmental function in the families and emotional elder abuse. Moreover, there was a relationship between the subscale of care and regulation, being attracted to human relationships, purposeful exchange, and creating representatives and ideas with emotional elder abuse.

Strategies to build more effective interventions for elder abuse: a focus group study of nursing and social work professionals in Hong Kong

BACKGROUND

One in six older adults living in communities experience abuse and neglect. Elder abuse has serious consequences for individuals, families, and society, including mortality, physical and psychological morbidities, and increased care requirements. Timely and effective interventions for elder abuse should therefore be a priority. This study used a qualitative focus group approach to address the following questions: What are the essential elements of elder abuse interventions? What can be done to improve current interventions?

METHOD

The 32 participants in this focus group study included social workers, medical social workers, and nurses from seven organizations who shared their knowledge and insights. All sessions were conducted online, audio-recorded, and transcribed verbatim. Three researchers with backgrounds in social work and psychology independently coded the transcripts and agreed on the themes emerging from the focus groups.

RESULTS

Based on the experiences of frontline helping professionals in Hong Kong, we highlighted the key factors for effective elder abuse intervention: 1) identification and assessment; 2) essential skills and attitudes; 3) elements of effective interventions; 4) collaborative efforts across disciplines and agencies; and 5) raising awareness among professionals and the public.

CONCLUSIONS

Training can equip frontline professionals with the necessary skills to identify elder abuse cases and to assess the risk of abuse. Effective interventions should not only address clients' safety and need for tangible support but also respect their autonomy and privacy. A client-centered, strength-based approach that involves supportive peers and addresses the complex family relationships involved can be useful. Interventions should also involve cross-discipline and cross-agency collaboration.

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

Despite a growing number of elder abuse cases nationwide, response programs such as Adult Protective Services (APS) lack a defined, prolonged intervention phase to address these complex situations. This paper presents RISE, a model of elder abuse 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, goal attainment scaling), the RISE model intervenes at levels of the individual older adult victim, individual harmer, their relationship, and community to address elder abuse 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 elder abuse victims and others in their lives, leading to more sustainable outcomes.

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.

Emergency assistance in situations of abuse, neglect, and self-neglect: exploring the complexity and challenges

Health and social care professionals are often called upon to provide emergency intervention without the adult's consent in situations of abuse, neglect, and self-neglect. Little is known about this process despite implications related to health care costs and individual rights. In this qualitative study, 17 health care professionals with experience enacting emergency legislation in BC were interviewed to better understand what leads to an emergency response and how these professionals carry out their role. Five components emerged in the provision of emergency assistance: assessing intolerable risks, assessing incapability, balancing ethical values, exploring resources, and consulting/collaborating. Attention is drawn to the significance of social location, including age, socio-economic, and Indigenous background for influencing the process, sometimes in unintended ways. The challenges in providing emergency interventions may result in social inequities and delay in providing care at times. The importance of bringing a reflexive and intersectional lens to providing interventions is highlighted.

Service providers' use of harm reduction approaches in working with older adults experiencing abuse: a qualitative study

BACKGROUND

Although abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse.

METHODS

Thematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes.

RESULTS

Our analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers' description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult's autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse.

CONCLUSIONS

Harm reduction approaches are evident in service providers' accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.

Identifying Interventions and Their Efficacy as Used by a Community Agency Managing and Responding to Elder Abuse

Limited research has been conducted to identify how elder abuse (EA) can be managed and prevented. Interventions employed by a community agency multidisciplinary team across 164 EA cases were examined. Results identified the largest number (N = 369) and widest variety of EA interventions to date. Using content analysis, interventions with similar proximal goals were grouped into 30 intervention strategies to evaluate efficacy and 12 higher-order intervention categories to guide practice. Intervention outcomes were rated as positive, negative, neutral, could not implement, or unknown. Positive outcomes were the most common (35%), and also included novel and/or effective interventions aimed at perpetrators such as physical treatment, social support, and communication. Few (1%) interventions had negative outcomes. Many interventions could not be implemented (21%), often due to a lack of funding or victim refusal. Results suggest changes to policy, practice, and research methodology, which could increase positive outcomes through facilitation of intervention implementation and improved data access.

Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known

At least 10% of older adults experience abuse, neglect, or exploitation annually in the United States, and this problem is expected to grow as our population ages. Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors. Veterans who receive their care through the Veterans Health Administration (VHA) have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment, and social isolation than the general population. As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults. The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served. This article outlines the rationale for developing a research agenda for elder abuse in the VHA, as well as potential first steps toward understanding more about this complex problem affecting veterans.

State of the science on prevention of elder abuse and lessons learned from child abuse and domestic violence prevention: Toward a conceptual framework for research

The goal of this review is to discuss the state of the science in elder abuse prevention. Findings from evidence-based programs to reduce elder abuse are discussed, drawing from findings and insights from evidence-based programs for child maltreatment and domestic/intimate partner violence. A conceptual measurement model for the study of elder abuse is presented and linked to possible measures of risk factors and outcomes. Advances in neuroscience in child maltreatment and novel measurement strategies for outcome assessment are presented.

Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies

PURPOSE

Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention.

DESIGN AND METHODS

This article provides a scoping review of key issues in the field from an international perspective.

RESULTS

By drawing primarily on population-based studies, this scoping review provided a more valid and reliable synthesis of current knowledge about prevalence and risk factors than has been available. Despite the lack of scientifically rigorous intervention research on elder abuse, the review also identified 5 promising strategies for prevention.

IMPLICATIONS

The findings highlight a growing consensus across studies regarding the extent and causes of elder mistreatment, as well as the urgent need for efforts to make elder mistreatment prevention programs more effective and evidence based.

Community Elder Mistreatment Intervention With Capable Older Adults: Toward a Conceptual Practice Model

Community-based elder mistreatment response programs (EMRP), such as adult protective services, that are responsible for directly addressing elder abuse and neglect are under increasing pressure with greater reporting/referrals nationwide. Our knowledge and understanding of effective response interventions represents a major gap in the EM literature. At the center of this gap is a lack of theory or conceptual models to help guide EMRP research and practice. This article develops a conceptual practice model for community-based EMRPs that work directly with cognitively intact EM victims. Anchored by core EMRP values of voluntariness, self-determination, and least restrictive path, the practice model is guided by an overarching postmodern, constructivist, eco-systemic practice paradigm that accepts multiple, individually constructed mistreatment realities and solutions. Harm-reduction, client-centered, and multidisciplinary practice models are described toward a common EMRP goal to reduce the risk of continued mistreatment. Finally, the model focuses on client-practitioner relationship-oriented practice skills such as engagement and therapeutic alliance to elicit individual mistreatment realities and client-centered solutions. The practice model helps fill a conceptual gap in the EM intervention literature and carries implications for EMRP training, research, and practice.

Elder Abuse

Because older victims of abuse tend to be isolated, their interactions with physicians are important opportunities to recognize abuse and intervene. This review explores the manifestations of elder abuse and the role of multidisciplinary teams in its assessment and management.

Financial Exploitation of Older Women: A Case Analysis Using the Struggle for Recognition Theory

This article aims to make a theoretical contribution to the field of mistreatment of older adults by introducing Honneth's Struggle for Recognition theory in order to document financial mistreatment of older women. Through a case analysis of an older woman financially exploited by her son, considering self-agency and structure, it shows how financial mistreatment disrespects the three components of Honneth's theory, primary relationships, legal relations, and community of value. Personal integrity, social integrity, and honor and dignity are threatened by mistreatment. This case analysis opens for further theoretical exploration of the Struggle for Recognition theory in the understanding of mistreatment of older adults.