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The Geriatrician clinicians of the Texas Elder Abuse and Mistreatment Institute – Forensic Assessment Center Network (TEAM-FACN) in Houston, have many years of experience providing capacity assessment services for Adult Protective Services (APS) and Texas courts. A process has developed which is efficient, consistent, and evidence-informed. In the last two years, telecommunication has been added to this process to conduct assessments of APS clients in areas of Texas remote from the Houston area. Of the 545 capacity assessments TEAM-FACN has completed across the state of Texas over the first two years of adding telecommunication, 211 (39%) were conducted with in-person interviews and 334 (61%) were conducted using videoconference interviews. APS and the courts in remote areas of Texas have embraced the use of the videoconference assisted capacity assessments. This article describes this evidence-informed process and how telecommunication technology is incorporated to expand the reach of the service. [ABSTRACT FROM AUTHOR]

Senior financial exploitation (FE) is prevalent and harmful. Its often insidious nature and co-occurrence with other forms of mistreatment make detection and substantiation challenging. A secondary data analysis of N = 8,800 Adult Protective Services substantiated senior mistreatment cases, using machine learning algorithms, was conducted to determine when pure FE versus hybrid FE was occurring. FE represented N = 2514 (29%) of the cases with 78% being pure FE. Victim suicidal ideation and threatening behaviors, injuries, drug paraphernalia, contentious relationships, caregiver stress, and burnout and victims needing assistance were most important for differentiating FE vs non-FE-related mistreatment. The inability to afford housing, medications, food, and medical care as well as victims suffering from intellectual disability disorder(s) predicted hybrid FE. This study distinguishes socioecological factors strongly associated with the presence of FE during protective service investigations. These findings support existing and new indicators of FE and could inform protective service investigation practices. [ABSTRACT FROM AUTHOR]

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]

Mistreatment and self-neglect among older adults are linked to significantly high mortality rates, but research in this area is hindered by a lack of standardized assessments to identify these circumstances. No available assessment has been tested for construct validity (CV) or measurement invariance (MI) across gender or race/ethnicities. This study presents the CV and MI properties of a comprehensive assessment of elder mistreatment (EM) and self-neglect (SN). The 57-item Texas Adult Protective Services Client Assessment and Risk Evaluation (CARE) tool was completed on 7,580 substantiated cases of EM and SN. Confirmatory factor analysis (CFA) and cross-validation techniques were used to assess CV, and MI techniques were used to assess item and domain bias across genders and race/ethnicities. Model fit was estimated using robust estimators. A 43-item CARE tool with 5 domains reached good fit and cross-validated (X2 DIFF TEST, p = 0.69). Overall, the construct reliability ranged from 0.78 (physical/medical) to 0.93 (living conditions).The same model was measurement invariant across gender (X2 DIFFTEST, p = 0.02). The financial status domain could not be used for the Hispanic population, but a 4-factor CARE tool model was measurement invariant across African Americans, Caucasians, and Hispanics (X2 DIFFTEST, p = 0.05). The constructs of the CARE tool appear to be valid and reliable assessments of EM and SN. Overall, the use of this assessment to identify EM and SN does not result in health or social service disparities among older adults. Further research on this topic is needed. [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]

Elder self-neglect is the most common form of elder mistreatment. Individuals who cannot provide basic needs for themselves may develop social, functional, and physical deficits. The systematic characterization of self-neglecting individuals is the goal of the Consortium for Research in Elder Self-Neglect of Texas project. This study reports on the nutritional status of self-neglecting elderly. Self-neglectors (SN) were recruited based on referrals along with matched control (CN) subjects. Data are for 40 SN subjects (age 76 +/- 7 y) and 40 CN subjects (76 +/- 7 y). Blood samples were collected and analyzed for indices of nutritional status. SN subjects had a greater serum concentration of total homocysteine than CN subjects (13.6 +/- 4.5 vs. 11.6 +/- 5.6 micromol/L, P < 0.05) and a lower concentration of red blood cell folate (1380 +/- 514 vs. 1792 +/- 793 nmol/L, P < 0.05). Plasma beta-carotene and alpha-tocopherol were lower in SN subjects (0.28 +/- 0.2 vs. 0.43 +/- 0.33 micromol/L; 23.2 +/- 9.3 vs. 27.8 +/- 9.3 micromol/L, P < 0.05). SN subjects had a lower serum concentration of 25-hydroxyvitamin D than CN subjects (33.7 +/- 16.4 vs. 44.1 +/- 19.6 nmol/L, P < 0.05). These differences in markers of nutritional status show that the self-neglecting elderly are at risk for altered nutritional status, particularly of folate, antioxidants, and vitamin D. Evaluation of these data in relation to other functional and cognitive assessments are critical for evaluating the relation between nutrition and self-neglect. [ABSTRACT FROM AUTHOR]

Describes the experience of an interdisciplinary team with abused or neglected elders who underwent interdisciplinary geriatric assessment and intervention. Methodology; Results and discussion.

Looks at law and legislation to prevent elder abuse in the U.S. Estimated incidence of elder abuse in the U.S. each year; Goal of the National Center for Injury Prevention and Control and the Centers for Disease Control and Prevention (CDC) to address the problem of elder abuse in the U.S.; Critique of the enforcement of Adult Protective Services (APS) law in U.S. states; Impact of a task force in Delaware on the detection and prevention of elder abuse; Description of the Texas Elder Abuse and Mistreatment Institute (TEAM), which offers intervention in cases of elder abuse in cooperation with other human service agencies.