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Research Agenda on Abuse
of Older Persons and Disabled Adults

Citizens
 

By Rosalie S. Wolf, PhD
October 1999

Acknowledgement | Introduction |
Agendas | Glossary |

ACKNOWLEDGEMENT

This study was undertaken as a partnership between the National Association of State Adult Protective Services Administrators (NAAPSA) and the National Committee for the Prevention of Elder Abuse INCPEA). We extend our appreciation to Joanne Marlatt Otto, NAAPSA Past President and Kathleen Quinn, NAAPSA President for their assistance and good counsel. We are also indebted to the members of NAAPSA and NCPEA and the Illinois Elder Abuse Projects supervisors who participated in the workshops or responded to our survey.

This study was supported in part by a grant from the National Center on Elder Abuse (NCEA). NCEA was established by a cooperative agreement grant (#90-AP2144) awarded to the National Association of State Units on Aging (NASUA) by the DHHS Administration on Aging. It is operated by a consortium of six organizations: NASUA, University of Delaware, American Bar Association Commission on Problems of the Elderly, National Association of Adult Protective Services Administrators, National Committee for the Prevention of Elder Abuse, and San Francisco Consortium for Elder Abuse Prevention. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging policy.

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INTRODUCTION

As one of their tasks under the new National Center on Elder Abuse, the National Committee for the Prevention of Elder Abuse (NCPEA) and the National Association of Adult Protective Services Administrators (NAAPSA) undertook the development of a Research Agenda on Abuse of Older Persons and Disabled Adults. Four methods were used to collect the information:

  • A letter was mailed to all adult protective services (APS) state administrators asking: What answers do you need to help improve your program, increase understanding of the problem, assist in planning for the future, and support training efforts? Seventeen administrators returned the form listing 76 topics; no one item was exactly like another.
  • A letter and form with similar inquiries were mailed to all NCPEA members. Twenty-seven NCPEA members responded with 80 distinct topics.
  • Elder abuse supervisors attending a workshop sponsored by the Illinois Department on Aging produced a list of 30 items that represented a consensus of each workshop sub-group.
  • A fourth source of information came from a workshop "Identifying a Research Agenda for Elder Abuse" held at the 1998 NAAPSA Conference. The 55 persons in attendance were divided into 8 groups. Each group produced a list of topics, 105 in all. Each participant was then asked to vote for his/her top 5 choices.

A master list of researchable questions from both the surveys and workshops is given in the pages that follow, categorized as: The Nature and Scope of Elder Abuse, Causes and Consequences, Investigation and Assessment, Interventions, Effectiveness/Outcomes, Criminal Justice/Law Enforcement, Program Management, Financial Implications, and Policy.

In the agenda section the 10 topics from the NAAPSA workshop that received the highest number of votes are marked by a *. They are also shown in the table below. The other items in the list either received fewer votes at the NAAPSA workshop, came from the Illinois APS supervisors workshop, or were suggested by individual members of the National Committee for the Prevention of Elder Abuse. A Glossary was also developped.

The future of elder abuse research is hopeful. Interest among established researchers is growing. Federal funding, although very limited, is available to those whose work will meet the highest standards. Some suggested studies will be costly to conduct but others could be investigated with relatively minimal expenditure, such as comparisons among the states with regard to expenditures, laws, procedures, training, etc., and secondary analysis of state data. However, continued advocacy will be needed to generate the support and participation required to respond to the many questions that remain unanswered.

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Highest Ranking Research Topics from the NAAPSA Workshop

# votes Research Topic
24 What are the best practice standards for conducting APS work (potential national guidelines)?
17 What are the characteristics of perpetrators by type? by relationship to victim?
16 What is effective training for new APS employees?
14 What happens to those clients who refuse interventions? What are the outcomes of these cases?
14 What is the monetary impact of abuse, neglect, and exploitation of elders and disabled adults on government resources?
12 What are the issues related to "dignity of risk" vs. legal liability for APS workers?
11 How are outcomes defined and measured?
11 What is the incidence of abuse in MI/DD adult populations?
9 Are there (should there be) differences in investigation techniques/interventions for different populations (older adults, DD, MI) and types of abuse/neglect?
9 What would victims have liked APS to have done differently?

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Research Agendas

The 10 topics from the NAAPSA workshop that received the highest number of votes are marked by a *.

The Nature and Scope of Elder Abuse | Causes and Consequences |
Investigation and Assessment | Self-Neglect | Interventions | Effectiveness/Outcomes | Criminal Justice/Law Enforcement | Program Management | Financial Implications | Policy

THE NATURE AND SCOPE OF ELDER ABUSE

  • What is the incidence of abuse of MI/DD populations 18 years and older?*
  • What are the characteristics of perpetrators by type (e.g., family, non-family, spouse, adult child, etc.)? Profiles by relationship to victim (e.g., mother-son, grandparent-grandson, etc.)?*
  • What is known about victimization over the lifespan (i.e., child, domestic violence, elder abuse)?
  • What is the perspective of the perpetrator?
  • Is abuse related to the personality of the perpetrator (e.g., aggressivity, etc.)?
  • What are the various manifestations of abuse? By type of abuse?
  • What is the trajectory of abuse over time?
  • Are there differences in the types of abuse found in the domestic and institutional settings?
  • What is the relationship between caregiving and abuse?
  • What is the prevalence/incidence of abuse in the MI/DD population?
  • Is there a difference in the rate of abuse in urban, suburban, and rural areas?
  • Does the rate of abuse vary by availability of services?
  • What is the incidence of elder abuse in homes with domestic violence, child abuse, pet abuse?
  • What are the factors that lead to disclosure of abuse by victims?
  • Is there a difference in the rate of abuse by biological and non-biological (foster, adopted, step) adult children?
  • What are the factors that influence case recidivism?

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CAUSES AND CONSEQUENCES

  • What are the risk factors for elder abuse, neglect, and exploitation?
  • What is the relationship of alcoholism and drug abuse to elder abuse?
  • What is the prevalence of substance abuse by abusive caregivers?
  • What is the relationship between undue influence, incompetence, and diminished capacity and elder abuse?
  • What is the relationship between elder abuse and depression?
  • Is there a relationship between suicide and elder abuse?
  • What is the relationship between elder abuse and post traumatic stress disorder?
  • What is the relationship between elder abuse and mortality?
  • Is there a difference in the aftereffects of abuse on elderly and younger victims?
  • What is the consequence of a "substantiated" ruling on the victim?

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INVESTIGATION AND ASSESSMENT

  • What are the issues related to "dignity of risk" vs. legal liability for APS workers?*
  • Is there a difference in the investigative techniques for different populations (e.g., older adults, DD, MI) and types of abuse/neglect?*
  • What are the common characteristics of APS referrals?
  • How are elder abuse case investigations documented? What type of documentation is most effective?
  • What are the differences among the states in documenting cases?
  • What are the criteria and definition of substantiated cases?
  • How does style of documentation affect support for substantiation decisions?
  • How is the lethality of the case assessed?
  • Is level of functional competence assessed rather than dependence?
  • What are the procedures for due process/notification? What works?
  • What is the relationship between assessment of risk and recidivism rate?
  • What are the techniques in determining/substantiating sexual abuse cases?

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SELF-NEGLECT

  • What are effective interventions in cases of self-neglect?
  • What are the risk factors for self-neglect?
  • What are the methods of preventing self-neglect?
  • What are the causes of self-neglect?
  • What is the relationship between self-neglect and OCD?

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INTERVENTIONS

  • What would victims have liked APS to have done differently?*
  • What happens to those victims who refuse interventions? What are the outcomes of these cases?*
  • Are there ways to overcome victims' reluctance to accept services?
  • Can the occurrence of physical abuse be reduced when there is no separation of the victim and perpetrator?
  • Is there a relationship between service availability and institutional placement?
  • What is the effect of using an investigative vs. a social work model on delivery of services?
  • What interventions work with elder spouse abuse?
  • Is "pastoral support" a missing link in our system?
  • What are the most commonly used interventions in APS?
  • Are traditional services offered to older battered women effective for male victims?
  • How useful is respite care?
  • What is the role of the police in augmenting and conducting elder abuse investigations?
  • What interventions with victims are effective?
  • What is the role of the family preservation model in elder abuse?
  • Are there programs that combine APS and MI services? If so, how effective are they?
  • What are the characteristics of the guardianship/conservator programs by state?
  • What are some innovative outreach efforts for rural areas?
  • What is the effect of outreach on number of reports, reduction of risk, and skill building?
  • What are some psychological interventions for abusers? How effective are they?

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CULTURAL ISSUES

  • What is the prevalence of elder abuse in different ethnic backgrounds?
  • What are the culturally and linguistically sensitive approaches to identifying the problem in diverse populations?
  • What strategies are most effective in treatment and prevention of elder abuse in diverse cultures?
  • What type of outreach will motivate reporting of abuse in diverse cultures?

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EFFECTIVENESS/OUTCOMES

  • How are outcomes defined and measured?*
  • What proportion of reports and substantiated cases have successful outcomes?
  • Is there a relationship between the gender of the investigator and client and outcomes?
  • Is there a difference in outcomes between a law enforcement and social work orientation?
  • Is there a difference in outcomes with older battered women using a DV approach vs. a traditional APS approach?
  • What is the impact on grandparents who are raising children of abusers?
  • What is the effect of HMOs on APS system?
  • Does the availability of money management programs make a difference in the incidence of financial exploitation?
  • What is the effectiveness of family systems theory based counseling for elder abuse?
  • What is the effectiveness of public awareness campaigns for different populations?
  • What is the effectiveness of multidisciplinary teams? What constitutes an effective team?
  • What is the victim's interpretation of case outcome?
  • What is the effect of APS intervention on victims over time?

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CRIMINAL JUSTICE/LAW ENFORCEMENT

  • How do the states compare with regard to APS laws? Penalties for abuse?
  • What is the effectiveness of criminal statues in prosecuting perpetrators of elder abuse?
  • Is there case law dealing with cases that are appealed? In legal language compared to vernacular?
  • How do criminal background checks correlate with reducing the risk of abuse?
  • What court procedures are in place to address fear of testifying?
  • What is the effect of criminal checks, enhanced penalties, increased prosecutions on incidence?
  • What is the effectiveness of mandatory abuse arrests, restraining orders, law enforcement intervention?
  • What has been the impact of using the criminal justice system to address elder abuse/neglect?
  • What strategies can be used to get law enforcement interested in investigation and prosecution of financial elder abuse?
  • What is the preferable model for investigation of elder abuse cases? A separate unit or combined family violence unit?
  • How do the penalties for elder abuse compare to those for child abuse?
  • How much cross-reporting takes place between law enforcement and social servies?

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PROGRAM MANAGEMENT

  • What are the best practice standards for APS (e.g., case loads, confirmation rates, etc.) that can result in national guidelines?*
  • What is effective training for new APS employees?*
  • What is the status of APS data systems for providing information on number and types of cases? Program evaluation?
  • What kind of staff support can be provided to prevent burnout?
  • What are the factors that lead to longevity in APS employment?
  • What are the educational standards for APS workers?
  • Is a special APS curriculum in universities needed? If so, what would it look like?
  • Is there a difference between agencies serving adults 18 years and older and those serving elders 60 years and older?
  • Do essential community "gatekeepers" know and understand their role?
  • What are some successful media approaches for raising awareness?

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FINANCIAL IMPLICATIONS

  • What is the monetary impact of abuse, neglect, exploitation on government resources (i.e., medical, long term care, emergency responses, restitution, etc.)?*
  • What is the amount of dollars spent for APS? Source and what used for?
  • What is the impact of MI/DD facility closing/downsizing/understaffing on APS (increase/decrease in MI/DD victims of abuse)?
  • What is the total amount of money taken from elders due to misuse of funds and property?
  • What are the economic barriers facing older victims who elect to live free of abuse?
  • What is the number of elders who have been involuntarily divested of resources and now receive Medicaid?
  • What is the estimation of persons who have been victims of non-consumer financial abuse?
  • What is the fiscal impact of exploitation on victims?
  • What is the impact of welfare reform (e.g., balanced budget, Title XX cuts, Medicare changes)?
  • What states provide funding for foster care, assisted living?

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POLICY

  • Is there a relationship between resource allocation and client outcomes?
  • Is it possible to achieve standardization of APS forms among the states?
  • What will APS look like in the next century? Should it be expanded?
  • How does the following sponsorships effect the APS operating system: state vs. local, aging network vs. social services, county vs. non-profit?
  • What will be the effect on APS referrals and guardianships of the changing older population, baby boomers, and deinsitutionalized persons?
  • Can a common set of definitions be established?
  • What are the pros and cons of mandatory reporting?
  • What can be done to reduce victimization?
  • Is there a difference in number of reports between states with funds for preventive programs (i.e., public awareness, training) and those without the funds?
  • What has been the impact of the change in the Illinois law that added a mandatory reporting amendment (for those who cannot report themselves) to their voluntary reporting system?
  • Does the way a state handles its guardianship cases have an impact on the APS system?
  • What is the relationship between the APS program and the Native American reservation regarding abused elders on the reservation?
  • What are the components of a model APS law?
  • How do the states compare with respect to the impact of HMOs?
  • What strategies can be used to garner support for APS programs?

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GLOSSARY

Acronyms
APS Adult protective services
DD Developmentally disabled persons
DV Domestic violence
HMOs Health maintenance organizations
MI Mentally ill persons
NAAPSA National Association of Adult Protective Services Administrators
NCPEA National Committee for the Prevention of Elder Abuse
OCD Obsessive-Compulsive Disorder

Vocabulary

Best Practice Standards
Mutually agreed upon measures that reflect optimal practice, e.g., case loads, hours to respond to emergencies, etc.

Dignity of Risk
Respect for autonomy of individual-at-risk who refused intervention and elects to remain at-risk.

Diminished Capacity
Reduced ability of individual to understand the consequences of his/her actions.

Incompetence
Adult's inability to understand situation and nature of proposed action (risks and benefits) and to make a rational decision.

Involuntary Intervention Order
Order of the court that permits service providers to hospitalize or provide other necessary care to a client in the absence of that client's consent.

Physical Abuse
Infliction of unnecessary pain or injury, e.g., slapped, bruised, punched, etc.

Psychological Abuse
Infliction of mental anguish, e.g., humiliated, isolated, threatened, frightened

Neglect
Refusal or failure ot fulfill a care-taking obligation, e.g., abandonment, denial of food, clothing, medical care.

Outcomes
Results of intervention on the client, the agency, the community

Respite Care
Relief for caregiver by providing a "temporary caregiver" to recipient, either at home or in a nursing home.

Self-Neglect
Results of an adult's inability, due to physical and/or mental impairments to perform essential self-care tasks.

Undue Influence
Use of power and position of a person(s) to exploit the trust, dependency, and fear of another person

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