National Collaboratory to Address Elder Mistreatment 2022–2023 Projects
The National Collaboratory to Address Elder Mistreatment (NCAEM) has a one-year mentorship program that supports clinicians, service providers, researchers, policymakers, and advocates from multiple disciplines who are focusing on improving care for older adults experiencing or at risk of experiencing elder mistreatment. Learn more about the projects completed by the inaugural cohort of mentees and mentors.
Project Title: Up for the Challenge: Elder Mistreatment Education Requirement for Nurse Licensure Renewal in Pennsylvania
Mentee: Anne Mitchell, PhD, CRNP, FGSA
Mentor: Kathy Greenlee, JD
Summary
Dr. Mitchell’s project focused on the need for mandatory elder mistreatment education for nurse licensure renewal in Pennsylvania. Her initial research highlighted the lack of consistent education on elder mistreatment in nursing programs and the disparity between child abuse and elder abuse education in the state. For the project, she identified the following objectives:
- Understanding the legislative process
- Building relationships with legislators
- Engaging with the Pennsylvania State Board of Nursing
While engaging with the Board of Nursing proved to be challenging, Dr. Mitchell discovered other opportunities for engagement by connecting with experts and stakeholders, including professionals from medical universities, nursing schools, and hospital systems. Dr. Mitchell made many new professional connections through this project including Representative Tarik Khan (D-PA 194), Brian Duke (former secretary of the Pennsylvania Department of Aging), Jennifer Spoeri (executive director of the National Adult Protective Services Association), and Marian Liu (Purdue University). Her next steps include the following:
- Developing her MPH capstone project on implementing the Elder Mistreatment Emergency Department (EMED) Toolkit
- Continuing to work with interest groups such as the Gerontological Advanced Practice Nurses Association and the Pennsylvania State Nurses Association
- Advocating for elder mistreatment education inclusion in the Hartford National Center of Gerontological Nurse Excellence Distinguished Educators Survey
Project Title: Racial/Ethnic Group Differences in Older Adults’ Involvement with Adult Protective Services
Mentee: Kenny Steinman, PhD
Mentor: Jason Burnett, PhD
Summary
Dr. Steinman’s project developed a research protocol for using the National Adult Maltreatment Reporting System to examine racial and ethnic group differences in older adults’ involvement with Adult Protective Services (APS). The primary goal was to describe these differences in APS metrics and determine their persistence across jurisdictions. The project aimed to identify benchmarks for patterns of racial/ethnic group differences and to describe the individual and community characteristics that helped to explain them. Additionally, the protocol established approaches for utilizing APS data in ways that promote collaborative engagement among practitioners, community leaders, and researchers.
Dr. Steinman also developed a pilot study of this project with APS practitioners and data from three Ohio counties, which was published in the Journal of Gerontological Social Work. Outcomes from the study provided valuable insights for addressing health disparities and will guide the development of culturally sensitive APS interventions. The next steps involve finding funding opportunities to support a national study.
Project Title: Development of an Elder Mistreatment Course
Mentee: LaCinda Jones, MSW, LCSW
Mentor: Alyssa Elman, MSW
Summary
Ms. LaCinda Jones’ project aimed to develop an elder mistreatment course for the MSW program at Arizona State University (ASU). The goal was to address the lack of training in elder mistreatment for social workers, despite their significant role in identifying and intervening in such cases. Ms. Jones modified an existing course developed by Dr. David Burnes from the University of Toronto and adapted it for the U.S. context. The course covers various topics related to elder mistreatment, such as risk factors, assessment, interventions, legal implications, and ethical dilemmas.
The next steps will be to finalize the course by having subject matter experts review the curriculum and then to secure funding to implement and promote the course. Ms. Jones has buy-in to move forward with the following:
- Implementing the course at ASU
- Presenting it to the coalition for social work and health
- Publishing it in the next version of the Council on Social Work Education (CSWE) health curriculum
- Advocating for standards in CSWE accreditation policies regarding elder justice issues
Project Title: Office on Aging and Emergency Department Alliance
Mentee: Lauren Southerland, MD
Mentor: Tony Rosen, MD, MPH
Summary
Dr. Southerland’s project focused on developing a program to streamline the assessment process and support provided to vulnerable elderly patients in the emergency department (ED). The program embedded a county Office on Aging case manager in the ED, which allowed them to coordinate in real time with ED staff and screen patients for potential elder mistreatment and the support services needed. Over the course of her project year, Dr. Southerland completed the program design, team building, and coordination between stakeholder partners to implement this plan. She intends to pilot this program for four months and assess elder mistreatment detection and service reach.
Successes of the project to date include (1) enhanced communication between the hospital and Adult Protective Services (APS) to address cases of elder abuse and (2) improved coordination of care for vulnerable patients. The next steps involve the following:
- Further refining the collaboration between the hospital and APS
- Optimizing resource utilization
- Building a database to track patient outcomes
Project Title: Elder Abuse Screening and Assessment in the Veterans Health Administration
Mentee: Lena Makaroun, MD, MS
Mentor: Tony Rosen, MD, MPH
Summary
Dr. Makaroun’s project focused on comprehensively describing the landscape of elder abuse screening practices within the Veterans Health Administration (VHA) health care system. The goals were to (1) understand the presence and characteristics of elder abuse screening, (2) identify any facility-level characteristics associated with the likelihood of screening, and (3) determine opportunities to standardize elder abuse detection approaches.
Dr. Makaroun surveyed 170 VHA sites and analyzed data from the 130 (76%) respondents. From the respondents answers, her findings revealed wide variability in screening practices:
- 4% (5 sites) reported screening older adults for elder abuse using a previously published tool.
- 5% (6 sites) reported screening for elder abuse with an unstudied or locally developed tool.
- 48% (62 sites) reported screening patients of all ages for general abuse and neglect using unstudied questions and tools.
- 44% (57 sites) reported no elder abuse screening at their site.
The project findings highlighted the need for standardization and consensus-building regarding elder abuse detection within the VHA system. Dr. Makaroun plans to build on this work by (1) conducting key informant interviews to explore implementation barriers and (2) continuing to lead an initiative to integrate the Elder Mistreatment Screening and Response Tool into the VHA system.
Project Title: Barriers and Facilitators to Nurses Reporting Elder Abuse in Home Health
Mentee: Meredith Troutman-Jordan, PhD, RN, PMHCNS-BC, FGSA
Mentor: Bonnie Olsen, PhD
Summary
Dr. Troutman-Jordan’s project focused on exploring the barriers and facilitators to nurses reporting elder abuse in the home health setting. Her goals were to (1) identify the factors that influence nurses’ decision-making in reporting elder abuse, (2) discover indicators of elder abuse recognized by nurses, and (3) identify available resources and interdisciplinary collaboration opportunities to overcome barriers and strengthen facilitators for reporting elder abuse. The project used a qualitative research approach, specifically focus group discussions with nurses who worked or had previously worked in home health.
Dr. Troutman-Jordan’s findings revealed that nurses often lacked specific assessment tools to explore risk factors or indicators of elder abuse, and they experienced hesitancy and distress when intervening in abuse cases. Additionally, factors such as family interactions, intuition, insufficient time, and communication challenges were identified as relevant in reporting elder abuse. The outcomes of the project included an internally funded research grant and multiple publications, as well as presentations at the 2023 Southern Gerontological Society Conference.
Dr. Troutman-Jordan’s next steps include using the research findings to inform the development of interventions, strategies, and resources to support nurses in identifying and reporting elder abuse effectively in the home health setting.
Project Title: Social Aspects of “Age-Friendly” Care in a Retirement and Assisted Living Community
Mentee: Tina Kilaberia, PhD, MSW
Mentor: Mark Lachs, MD, MPH
Summary
Dr. Kilaberia’s project compared four cases (four older adults) using the intersectionality lens to reflect divergent experiences in the same retirement and assisted living community (Lifeplan Community). The four older adults reported varied social and intergenerational relationships, which affected what meaning they attached to their experiences of the Lifeplan community as age-friendly. Older adults with visible disability and visible diversity experienced a greater degree of resident-to-resident aggression—social isolation, social exclusion, and prejudice—in comparison to older adults with invisible disability and invisible diversity. Although the setting may meet many environmental and health care needs, it lacks design for meaningful social relationships among older persons.
The four older persons offered their perspectives on the desired aspects of an age-friendly community, reflecting that belonging-based social connections were vital. Two contributions of the study are as follows:
1. Directly asking older persons what “age-friendly” means to them, as older people have not been primary stakeholders in giving this input
2. Identifying resident-to-resident aggression as a form of elder mistreatment in a housing and care community.
Future studies should attend to the social design in similar Lifeplan Communities to maximize positive participation of older persons living in them.