Addressing Elder Mistreatment

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Improving Responses to Elder Abuse

Some jurisdictions have developed innovative approaches to improve their response to elder mistreatment, such as instituting special elder abuse prosecution units, forming elder fatality review teams, and expanding and improving statutes that mandate abuse reporting for vulnerable adults. Although these approaches show promise, they are in the nascent stages of development and have not been rigorously evaluated. Similarly, Adult Protective Services (APS) vary widely across the country, and research related to screening, risk assessment and interventions used by APS is limited.

Computerized Decision Support System for Elder Abuse

NIJ funded a team of researchers to develop a computerized decision support system for elder abuse.[1] The Elder Abuse Decision Support System (EADSS) contains assessments for physical, sexual, and psychological abuse; neglect; and financial exploitation. In Phase 1, the team assessed infrastructure requirements and "end-user criteria" through an environmental and infrastructure scan, holding meetings with key informants from the Illinois Department on Aging, teleconferences with national experts, and focus groups and interviews with practitioners and local experts. In Phase 2, the researchers developed the prototype using computerized adaptive testing methods and other appropriate measurement formats. In Phase 3, they demonstrated the prototype and held a second round of focus groups and interviews with local and national experts to elicit feedback regarding its usefulness, quality and affordability. NIJ is funding a follow-up study to pilot test the EADSS in six Illinois APS agencies.

Constructing and Validating and Elder Abuse Risk Assessment Tool

In another NIJ-funded study, investigators worked with APS in New Hampshire to construct and validate a risk assessment tool.[2] The goal of the study was to determine which APS clients were at high risk for future abuse or neglect so that resources could be targeted efficiently to those clients. In the initial stage of the study, New Hampshire's Bureau of Elderly and Adult Services collected data on theoretical and empirical factors related to risk of future abuse or neglect. Among the sample of 763 clients for whom data was collected in Phase 1, the risk classification significantly corresponded to the outcomes the clients experienced. For example, in the six-month follow-up period, 23.9 percent of clients classified as high risk had a subsequent APS investigation, compared with 9.4 percent of clients classified as moderate risk and 5.2 percent of clients classified as low risk. Proportions for founded allegations of abuse were 14.7percent for high-risk, 4.7 percent for moderate-risk, and 2.0 percent for low-risk clients.

The final phase of the study was a validation of the risk assessment tool with a new set of 1,064 clients, followed for one year. Unfortunately, the risk assessment did not perform as well in the validation sample as it did in the construction sample. In the validation sample, 22.0% of high-risk, 29.0% of moderate-risk and 13.1% of low-risk clients had subsequent APS investigations. The proportions for founded allegations of abuse were 13.6 percent for high-risk, 10.5 percent for moderate-risk and 7.7 percent for low-risk clients. Although the risk assessment tool statistically corresponded to APS outcomes, investigators must further improve the classification abilities of actuarial tools to make them useful in APS practice.

Manual to Help Elder Abuse Fatality Teams

The Office for Victims of Crime teamed with the American Bar Association (ABA) to produce a replication manual to help elder abuse fatality teams review the causes of elder deaths and enhance community agencies' response to elder victims of abuse. NIJ also funded the ABA to assess five court-based initiatives across the United States.[3] Investigators conducted site visits, interviewed key stakeholders and analyzed court records to explore initiatives in Alameda County, Calif., Hillsborough County, Fla., Palm Beach County, Fla., Jefferson County, Ky., and Kings County, N.Y. The findings suggest that the court-sponsored initiatives improve the handling of elder abuse cases, but more empirical evidence is needed.

Notes

[1] Conrad, Kendon J., Madelyn Iris, Barth B. Riley, Edward Mensah, and Jessica Mazza, Developing End-User Criteria and a Prototype for an Elder Abuse Assessment System, Final report to the National Institute of Justice, grant number 2009-IJ-CX-0202, February 2013, NCJ 241390.

[2] Johnson, Kristen, Kathy Park, Andrea Bogie, Shannon Flasch, and Jennifer Cotter, Developing an Actuarial Risk Assessment to Inform Decisions Made by Adult Protective Services Workers, Final report to the National Institute of Justice, grant number 2008-IJ-CX-0025, December 2012, NCJ 240410.

[3] Stiegel, Lori A., and Pamela B. Teaster, A Multi-Site Assessment of Five Court-Focused Elder Abuse Initiatives, Final report to the National Institute of Justice, grant number 2007-IJ-CX-0107, June 2011, NCJ 238287.

Date Modified: May 3, 2013