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The article describes the development of a cross-sector collaboration between health, social and academic research systems to meet the needs of vulnerable homebound older adults during the COVID-19 pandemic. Topics discussed include pre-pandemic example of successful collaboration, integrated health and community-based care, and adverse impact of the pandemic on the Meals on Wheels national nutritional and social services program.

Background: Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones. Objective: To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation. Design: Systematic review. Setting: Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL. Measurements: We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available. Results: We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute‐care hospital, 43% had high potential to work in low‐resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high‐quality study design. Conclusion: Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high‐quality study design. Many have the potential to work in low‐resource environments. Acute‐care hospitals were infrequently integrated into programs. See related editorial by Kathleen Wilber in this issue. [ABSTRACT FROM AUTHOR]

Objectives: To describe the Texas Elder Abuse and Mistreatment Institute Forensic Assessment Center Network (TEAM‐FACN), a novel statewide elder mistreatment (EM) virtual assessment program using low‐cost videophone technology and innovative web‐based coordination to connect an Adult Protective Services (APS) agency and its clients, rural and urban, to a centralized geriatric and EM expert medical team for virtual in‐home assessments. Design: Descriptive. Setting: Community. Participants: APS clients aged 18 and older. Intervention: Virtual and in‐home assessments. Measurements: Program use and type of services provided. Results: In the first 8 months, 300 APS clients from all regions of the state were referred for assessment. Outcomes realized include a quadrupling in number of client assessments. TEAM‐FACN physicians provided an average of 2 services, which included 216 mental health assessments, with 123 conducted virtually; 42 medical assessments; 45 guardianship filings; 5 employee misconduct registry reviews; and more than 230 interdisciplinary team meetings to discuss case findings, safety plans, and medical and social interventions. Conclusion: TEAM‐FACN provides an innovative and viable way to increase access of urban and rural older and adults who are being mistreated to expert geriatric and EM protective service assessments. J Am Geriatr Soc 67:151–155, 2019. [ABSTRACT FROM AUTHOR]

Objectives To determine whether there are subtypes of elder self-neglect ( SN) with different risk factors that can be targeted using medical and social interventions. Design Cohort study using archived data of Adult Protective Services ( APS) substantiated cases of elder SN between January 1, 2004, and December 31, 2008. Setting Houston, Harris County, Texas. Participants Adults aged 65 and older with APS region VI substantiated SN between January 1, 2004, and December 31, 2008 (N = 5,686). Measurements Adult Protective Services caseworkers used the Client Assessment and Risk Evaluation ( CARE) tool during home investigations, assessing risk of harm in the domains of living conditions, financial status, physical and medical status, mental health, and social connectedness. Latent class analysis was used to identify unique subtypes of elder SN. Results Four unique subtypes of elder SN were identified, with approximately 50% of individuals manifesting physical and medical neglect problems. Other subtypes included environmental neglect (22%), global neglect (21%), and financial neglect (9%). Older age, Caucasian descent, and mental status problems were more strongly associated with global neglect behaviors. African Americans were more likely to experience financial and environmental neglect than Caucasians and non-white Hispanics. Conclusion Elder SN consists of unique subtypes that may be amenable to customized multidisciplinary interventions. Future studies are needed to determine whether these subtypes impose differential mortality risks and whether multidisciplinary tailored interventions can reduce SN and prevent early mortality. [ABSTRACT FROM AUTHOR]

A recent Institute of Medicine report on geriatric work force issues recommends training residents in settings with geriatric patients and increasing certification requirements to include competence in the care of older adults. Although the number of internal medicine programs with a geriatric curriculum has increased, the scope and effectiveness of these programs vary. The purpose of this study was to evaluate the effect of a new academic geriatric and palliative medicine curriculum on the knowledge and attitudes of third-year internal medicine and fourth-year medicine and pediatrics residents. The study was conducted at The University of Texas Medical School at Houston. A new Division of Geriatric and Palliative medicine was created that offered inpatient, consultation, ambulatory, and home visit experiences in addition to didactic lectures. The University of Michigan Geriatrics Clinical Decision Making Assessment and the University of California at Los Angeles Geriatric Attitude Test was used to evaluate pre- and post-rotation knowledge and attitudes. Residents' knowledge improved after completing the rotation, as shown by a 6.9-point increase in posttest scores ( P<.001). There was also a 10-point improvement in pretest scores over the course of the year ( P=.03). Fifty-seven percent of residents had an improvement in attitude. This study shows that an increase in geriatric and palliative teaching opportunities provided by the establishment of a geriatric and palliative medicine division improves residents' knowledge significantly. [ABSTRACT FROM AUTHOR]

Despite the public health implications of self-neglect, no tool exists for characterizing this condition. Self-neglecters often have no caregivers or surrogates to interview regarding the neglect and are often too cognitively impaired to provide valid self-reports. In response to this need, researchers from the Consortium for Research in Elder Self-neglect of Texas (CREST) collaborated with other experts in the field of elder self-neglect to design the Self-neglect Severity Scale (SSS). The SSS assesses three domains of self-neglect (hygiene, functioning, and environment) and relies on observational ratings assigned by trained observers. After pilot testing and revision, the SSS was field tested in the homes of subjects who had been reported to and substantiated by Texas Adult Protective Services (APS) as self-neglecting and compared with results of subjects recruited from a local geriatric clinic who were reported to APS but had no history of self-neglect. The first field test demonstrated that the SSS could distinguish elderly self-neglecters from community dwellers who do not self-neglect. The SSS exhibited adequate scale reliability (Cronbach alpha) and correlation with case status. Interrater reliability also appeared adequate, although sensitivity and specificity fell below the conventional acceptable range. Future methods are proposed for refining the SSS to improve its use as the benchmark for identifying elder self-neglect. [ABSTRACT FROM AUTHOR]

Identifying impairments in the capacity to make and execute decisions is critical to the assessment and remediation of elder self-neglect. Few capacity assessment tools are available for use outside of healthcare settings, and none have been validated in the context of elder self-neglect. Health and social services professionals are in need of validated tools to assess capacity for self-care and self-protection (SC&P) during initial evaluations of older adults with suspected self-neglect syndrome. Currently, legal and medical declarations of incapacity and guardianship rely on clinical evaluations and instruments developed to assess only decision-making capacity. This article first describes the conceptual and methodological challenges to assessing the capacity to make and execute decisions regarding safe and independent living. Second, the article describes the pragmatic obstacles to developing a screening tool for the capacity for SC&P. Finally, the article outlines the process for validation and field testing of the screening tool. Social services professionals can then use a valid and feasible screening tool during field assessments to screen for potential impairments in the capacity for SC&P in vulnerable older adults. [ABSTRACT FROM AUTHOR]