Evaluation of the Administration of Aging’s Program to Prevent Elder Abuse

Challenge

Millions of older Americans are vulnerable to abuse, neglect and exploitation.

As the number of older adults increases, communities nationwide face growing concerns about the abuse of their elders. In 2010, the Elder Justice Act was incorporated into the Patient Protection and Affordable Care Act and became law. The Elder Justice Act represents the most comprehensive federal elder abuse prevention law to date, calling national attention to the millions of vulnerable older Americans who are victims of abuse, neglect, and exploitation.

Since then, the U.S. Department of Health and Human Services (HHS) has been studying various interventions that aim to stop the mistreatment of some of the most vulnerable members of our society.

Solution

NORC used a mixed methods approach to evaluate interventions helping to prevent elder abuse.

HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted NORC to design and conduct an evaluation of pilot interventions to prevent elder mistreatment through the Elder Abuse Prevention Interventions Program. We studied the development and implementation of five state grantee elder abuse interventions, using mixed methods to evaluate the program’s processes and outcomes.

While pilot projects shared common objectives and requirements—including targeting elders at high risk of abuse, establishing stakeholder partnerships, and collecting and providing certain data—grantees were afforded broad discretion in tailoring interventions to their specific communities and contexts. Using grantee’s administrative data, we developed a core set of data elements on client characteristics, program activities, and outcome measures. We also conducted site visits to learn about their implementation and infrastructure. This included the theoretical or clinical basis of the prevention intervention in context, implementation of the intervention’s core component, partnerships, facilitators and barriers, service utilization, state and local data collection systems, project replicability and lessons learned.

Results

All grantees used multiple components and interventions to address victims and elders-at-risk.

Each grantee had considered the complex and multi-dimensional nature of elder abuse while developing an intervention that addressed the needs of victims, at-risk elders, or care recipients needs. Interventions included:

Screening for elder abuse in primary care settings, applying preventive measures, and involving Adult Protective Services (APS)
Using multi-disciplinary teams to intervene in cases of financial exploitation
Testing a multi-component model for primary and secondary prevention of abuse of older people with dementia
Mobilizing supports for at-risk and victimized elders
Increasing medication adherence among older adults with a substantiated report of self-neglect and decreasing social isolation

Core components were implemented as intended. Each prevention intervention was standardized through manuals and protocols for implementation. While delivery methods and service duration varied, home visits were a common delivery element across grantees. As the prevention interventions varied, so did the outcomes. Some resulted in increased referrals to APS for care coordination, halting financial exploitation, decreased vulnerability, and access to social supports.