Detection of Elder Mistreatment in the Aging Services Network

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DESCRIPTION (provided by applicant): Despite its significant public health and policy implications, elder mistreatment (EM) has received little attention from the research community. In order for progress to be made in our understanding of its pathogenesis and, therefore, in developing strategies for prevention, a basic foundation for epidemiological research must first be laid by creating psychometrically robust tools (or adapting existing ones where appropriate) for EM case detection. The long-term goal of this Elder Mistreatment Project is to reduce the prevalence of EM and its associated morbidity and mortality by developing preventive interventions for use by aging services providers. Our premise is that the aging services network is an ideal setting in which to access older adults who are at risk for, or victims of, EM and to intervene. We will build on an established academic/community partnership, the Senior Health and Research (SHARE) Alliance, to address the partners' shared objective of developing a set of tools for the detection of EM that are specifically designed for use in the aging services setting. Aim 1 is to construct a preliminary case management-based screening tool and process to identify EM with input from a panel of content experts as well as from providers, older adult consumers, and their caregivers using qualitative research methods. Our focus will be on the three types of EM most frequently encountered in social service settings: emotional abuse, financial exploitation, and neglect. Aim 2 is to administer the preliminary measure to a random sample of 40 subjects, and on that basis to refine it for more definitive testing. In Aim 3 we will establish the performance characteristics of the scale by comparison with "gold standard" expert consensus assessments in 160 subjects recruited from an aging service agency's care management and Elder Abuse Prevention programs. Analyses will examine the measure's reliability, factor structure for detecting EM and each of its three subtypes, and the scale's validity. Finally, a formative evaluation with clients and case managers on the acceptability of the instrument will lay the groundwork for an ensuing R01 application designed to establish the epidemiology and correlates of EM and related adverse outcomes as detected by professionals in aging services agencies. Experts estimate that <5% of cases of elder mistreatment are recognized or reported. Improving detection is the necessary first step in the scientific process that leads to development of effective preventive interventions. This project will create the tools necessary to identify older people who are victims of elder mistreatment and who present for care to the aging services network.