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Elder Abuse and Neglect Articles and Publications
July 2003 - June 2004

The following is an annotated bibliography of works published or appearing in print between July 2003 through June 2004.* Some deal directly with issues of elder abuse and neglect while others address issues that contribute to neglect and self neglect of the elderly.

Entries are categorized as National Center on Elder Abuse (NCEA) publications, research, scholarship, books, and hearings. The citations are alphabetized by author's name within the genre categories.

Most of these reference materials may be obtained through your local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the Web addresses are also included.** If you have difficulty obtaining any of these materials, please contact the CANE office for assistance at cane-ud@udel.edu or (302) 831-3525.

*Although some publication dates may be earlier, these publications first appeared in print during this time frame.

**(Note: Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance.)

Publications by the NCEA and Partner Organizations

1. P5310-00
American Bar Association (ABA) Commission on Law and Aging
Resource Packet on Domestic Violence and Sexual Abuse in Later Life American Bar Association (ABA) Commission on Law and Aging, with funding from Office on Violence Against Women at the U.S. Department of Justice, ABA Fund for Justice and Education; Washington, D.C.; July 31 2003.
This resource packet was designed for use in developing training and educational programs to address the needs of older victims of domestic violence and sexual abuse. It includes an adaptable PowerPoint presentation (with CD), resource materials from the National Clearinghouse on Abuse in Later Life (NCALL) and the Wisconsin Coalition Against Sexual Assault (WCASA), a list of state Adult Protective Services (APS) administrators, and selected readings. For more information, contact Lori Stiegel at (202) 662 8692 or lstiegel@staff.abanet.org .

2. P5560-5
Castano, S. & Berdie, J., for the National Association of Adult Protective Services Administrators (NAAPSA), and the National Center on Elder Abuse (NCEA)
Formative Evaluation of Adult Protective Services Curricula
NCEA; Washington, D.C.; 2003
In response to a recent survey wherein state adult protective services (APS) administrators identified limited training opportunities and resources as significant barriers to the delivery of APS services, this formative evaluation tool was developed to assist in the assessment of current training initiatives. (Note: This tool is posted online at the NCEA Web site at the following address: http://www.elderabusecenter.org/pdf/publication/naapsa0310.pdf .)

3. P5287-45
Hughes, S. of the American Bar Association Commission on Law and Aging, for the National Center on Elder Abuse
Can Bank Tellers Tell? - Legal Issues Relating to Banks Reporting Financial Abuse of the Elderly
American Bar Association Commission on Law and Aging, Washington, D.C.; 2003.
As quoted from the paper: "...Banks have the potential of be the 'first line of defense' against financial abuse by identifying the abuse at its outset, before the elder's assets have been dissipated..." This report provides an overview of the impact that the banking industry can have in stemming financial elder abuse, and it explores the legal issues surrounding the roles of bankers as both mandatory and voluntary reporters. Variations in state legislation are presented, and federal laws that provide guidance concerning the liability of banks as reporters, such as the Gramm-Leach-Bliley Act, are discussed. The history of the collaborative bank reporting projects which involve input and training from Adult Protective Services (APS) professionals, beginning with the Massachusetts Bank Reporting project, and the experiences of various state efforts to encourage or mandate reporting are also examined. The paper compares the experiences of states which define bankers as mandatory reporters with those that do not. Among the conclusions, bank reporting projects have proven effective in increasing reporting of financial abuse in both mandatory and voluntary states, and although the presence of mandatory reporting laws alone do not increase reporting, they appear to facilitate the development of statewide bank reporting initiatives. (Note: This report is available online at http://www.elderabusecenter.org/pdf/publication/bank_reporting_long_final_52703.pdf .)

4. P5288-9
Hughes, S. of the American Bar Association Commission on Law and Aging, for the National Center on Elder Abuse
Legal Issues Related to Bank Reporting of Suspected Elder Abuse
American Bar Association Commission on Law and Aging, Washington, D.C.; 2003.
This paper is an abridged version of "Can Bank Tellers Tell? - Legal Issues Relating to Banks Reporting Financial Abuse of the Elderly." It provides an overview of the federal and state legal issues that surround the role of bank employees as reporters (mandatory or voluntary) of suspected financial abuse of the elderly. Adult Protective Services (APS) professionals and elder rights advocates will find this information helpful when meeting resistance from the banking industry to the development of bank reporting projects. (Note: this paper is available online at http://www.elderabusecenter.org/pdf/publication/bank_reporting_summary_final_52703.pdf )

5. P5342-62
Karp, N. & Wood, E. for the American Bar Association Commission on Law and Aging
Incapacitated and Alone: Health Care Decision-Making for the Unbefriended Elderly
American Bar Association Commission on Law and Aging, with funding by Fan Fox and Leslie R. Samuels Foundation, in collaboration with the Samuel Sadin Institute on Law, Brookdale Center on Aging; Washington, D.C.; July 2003.
This report presents the findings of a study of one of the most vulnerable groups of patients in society, the decisionally-incapacitated unbefriended elderly. This patient is defined as one who does not have the capacity to make decisions regarding his or her treatment, who has not executed an advance directive regarding the treatment at hand, and has no legally authorized surrogate or family or friends to assist in the decision-making process. Such patients are often subjected to legal processes that lead to "over-treatment, under-treatment, or treatment that does not reflect their values or best address their well-being." The purpose of this research was to identify the current state of law addressing this issue and to make recommendations for developing practical procedures to assist these patients and guide professionals charged with providing health care. Research methods included statutory and literature surveys, surveys of target groups, in-depth interviews, site visits and focus groups, and an interdisciplinary symposium and state strategy session. Currently, four legal approaches to addressing the decision-making needs of the unbefriended elder exist: statutory authorization for health care decisions; laws that authorize standing committees of trained volunteers to act as surrogates when needs arise; public guardianship for health and financial decision-making; a court process for seeking consent or authorization of a surrogate. When states do not have such a process, health care providers are often on their own to determine the best course of treatment. The report presents policy recommendations, including the need for procedures in long-term care facilities to investigate and record resident values and preferences, the improvement and enhancement of the health care providers' assessment of decisional capacity, and the development of state and local temporary medical treatment guardianship programs. (Note: To obtain a copy, please contact the American Bar Association Commission on Law and Aging, 740 15th St., N.W., 8th floor, Washington, D.C. 20005-1022, telephone 202/662-8690 or by internet at www.abanet.org/aging)

6. P5417-48
National Association of Adult Protective Services Administrators (NAAPSA), for the National Center on Elder Abuse (NCEA)
Report on State Adult Protective Services Response to Financial Exploitation of Vulnerable Adults 2003
NCEA; Washington, D.C.; July 2003.
In preparation for the U.S. Department of Health and Human Services study on financial exploitation of vulnerable adults, the National Association of Adult Protective Services Administrators (NAAPSA) conducted a survey in 2001 of all states, the District of Columbia and Guam, regarding their response to financial abuse cases. Thirty-four states and Guam responded to the mailed questionnaire, 23 using data from the most recent fiscal year, and 8 from the most recent calendar year. Of the results, 28 states had a combined 38,015 reports of financial exploitation; 29 states had mandatory reporting laws for financial exploitation; 11 states included financial institutions as mandatory reporters. Of the states able to describe sources of reports, only 54 of 18,476 reports were made by banks. Fifty-eight percent of the victims were female, and 64.7 percent were aged 66 and older, with approximately 40 percent of reports made on people between ages 65 and 80. While some states reported that victims had higher income levels than the average APS client, others saw no difference in income level. And, while 24 states have multidisciplinary teams (MDTs) to address financial abuse, only 14.3 percent of these have bank representatives as members on state teams. State Attorneys General and law enforcement received the highest quality ratings in terms of response to APS cases; however, the ratings given ranged from "minimal" to "average" with a few noted exceptions. Only ten states had a registry of financial abusers, and only Oregon was able to estimate the value of loss for the year (totaling between $50,000 and $100,000 for 47 substantiated cases). A significant problem in evaluating the data for this survey, as well as in measuring program effectiveness, is the absence of consistent (or uniform) data tracking across state APS departments. Recommendations that were generated in order to better service clients who have been financially exploited include the need for NAAPSA to take the lead in such national initiatives as public awareness campaigns, recognition of best practices, advocacy for APS, development of a national database of perpetrators, and for increased cross training of APS professionals, training of other service responders (including judges and other criminal justice professionals), law enforcement training for interviewing victims, willingness to prosecute crimes involving smaller losses, and greater referral of APS financial abuse cases for prosecution. The report includes a copy of the survey along with descriptions of how each participant responded. (Note: This report is available online at the National Center on Elder Abuse Web site at http://www.elderabusecenter.org/pdf/publication/NAAPSA_9.pdf )

7. P5645-82
National Association of State Units on Aging (NASUA), for the National Center on Elder Abuse (NCEA)
2003 Survey on State Unit on Aging Elder Rights System Development Activities - Progress in Elder Rights
NCEA; Washington, D.C.; March 2004.
Title VII of the Older Americans Act authorizes the State Units on Aging (SUA) to administer programs that foster elder rights (such as Elder Abuse Prevention, Long Term Care Ombudsman Programs, Adult Protective Services, Aging Information and Referral/Assistance Services) and to build networks with state agencies in order to deliver services. In 2003, the National Association of State Units on Aging (NASUA), on behalf of the National Center on Elder Abuse (NCEA), surveyed 57 SUAs (receiving responses from 31) throughout the country regarding Title VII coordination, policy, programming, funding initiatives and legislation. This publication is intended to highlight the progress that has been made since the Act was amended in 1992. Section I addresses interagency and intra-agency collaboration; Section II describes state leadership and management; Section III describes information and access; Section IV summarizes training and education; Section V reviews elder rights funding sources (such as Title VII, Chapter 3 resources, SHIP grant funds, and State General Funds, private and foundation funds); Section VI outlines state elder rights legislation from 2000 through 2003; Section VII discusses identified barriers and challenges within particular states; Section VIII presents system improvements from 2000 through 2003 (which includes enhanced program standards and data collection for some states); Section IX lists future goals and strategies. Appendices include survey summary charts and a sample listing of publications and resources developed by individual states. (Note: This publication is accessible online at http://www.elderabusecenter.org/ pdf/publication/ElderRightsSurveyComplete 040629.pdf.)

8. P5630-39
National Association of State Units on Aging (NASUA), for the National Center on Elder Abuse (NCEA)
40 Years of Leadership - The Dynamic Role of State Units on Aging - Celebrating the Successes - Facing the Challenges - Charting the Future
NCEA; Washington, D.C.; June 2004.
This publication reports upon the evolution of the role of the National Association of State Units on Aging since it was established in 1964. The introduction describes initiatives taken by states (as early as 1915) in addressing elder rights and aging issues, including the implementation of old age pensions, state foster care programs, elder service commissions and geriatric divisions. Since 1965, State Units on Aging (SUAs) have administered programs and services funded through the Older Americans Act (OAA) such as home care, congregate and home delivered meals, transportation, caregiver supports, and advocacy. In addition, numerous SUAs administer Medicaid Home and Community Based Services, senior pharmaceutical programs, long term care Ombudsman programs, legal assistance and elder abuse prevention. Thirty-one SUAs administer their states Adult Protective Services (APS) programs. This report highlights these programs, as well as special initiatives, such as the Cash and Counseling Demonstration Projects, the NASUA Consumer Project, State Health Insurance Counseling and Assistance Program (SHIP), and Senior Medicare Patrols. Current activities by the Center for the Advancement of State Community Service Programs are also detailed. Charts outlining SUA programs in individual states and territories are included, along with a State Units on Aging Directory. (Note: This publication is available online at http://www.nasua.org/pdf/complete_document.pdf .)

9. P5637-52
Nerenberg, L. (primary author), for the National Indian Council on Aging (NICOA) and the National Center on Elder Abuse (NCEA)
Preventing and Responding to Abuse of Elders in Indian Country
NCEA; Washington, D.C.; June 2004.
In 2002, the National Indian Council on Aging (NICOA) was contracted by the NCEA to study the scope and nature of elder abuse in Indian Country, and to identify the unique needs of vulnerable and abused Indian elders. The study involved a literature review along with a review of existing policies regarding elder abuse and neglect, an assessment of current projects and programs as well as recommendations from the "Healing Ourselves, Healing Our Spirits, Healing Our World" conference (2002), small group discussions, surveys of Tribal Title VI Coordinators, input from the Indian Health Services Combined Clinical Councils regarding promising practices, and comprehensive interviews with tribal representatives and other key informants. Title VI directors were asked which types of abuse had been most commonly reported. Among the findings, financial abuse was most commonly reported, with neglect and self-neglect also frequently reported. Physical and psychological abuse was also reported, while no respondents indicated that sexual abuse happened often. However, 46 percent of the directors indicated that sexual abuse was reported on occasion. Seven principles to guide policy development for prevention and intervention are identified, and emphasize the need for initiatives to be culturally compatible. The need for elder abuse initiatives to remain within the jurisdiction of the tribes as sovereign governments is also considered essential. Recommendations include the need for tribe-specific assessments and planning along with national research, including epidemiological studies. The publication also includes promising practices, resources, and contact information. (Note: This report is available online at: http://www.elderabusecenter.org/pdf/whatnew/abuseindian040707.pdf .

10. P5638-29
Nerenberg, L. (primary author), for the National Indian Council on Aging (NICOA) and the National Center on Elder Abuse (NCEA)
Review of the Literature: Elder Abuse in Indian Country - Research, Policy, and Practice
NCEA; Washington, D.C.; June 2004.
This publication presents a summary of the literature review that was conducted as part of the National Indian Council on Aging's (NICOA) initiative (funded by the NCEA) to study the scope and nature of elder abuse in Indian Country, and to identify the unique needs of vulnerable and abused Indian elders. Studies by Brown, Maxwell and Maxwell, and Buchwald et al. are highlighted. Additional publications by the NCEA, Baldridge, Brown, Carson, Hand, Hudson & Carlson, and others are described. Cultural beliefs that may increase or reduce risk within this population are considered. Federal initiatives and tribal responses to elder abuse are highlighted (including tribal elder abuse codes, such as those developed by the Lakota Sioux and the Yakima Nation, and the Navajo's Dine Elder Protection Act) along with issues related to jurisdiction. The publication concludes with a needs assessment for further research, policy development and service delivery. (Note: This publication is available online at: http://www.elderabusecenter.org/pdf/whatnew/litreview040707.pdf .

11. P5361-29
Nerenberg, L., for the Institute on Aging (formerly the Goldman Institute on Aging), and the National Center on Elder Abuse (NCEA)
Daily Money Management Programs - A Protection Against Elder Abuse
NCEA; Washington, D.C.; 2003.
Individuals who are unable to manage personal finances are at risk for financial exploitation, undue influence, and financial abuse by predators as well as by unscrupulous acquaintances, friends and family members. This manual describes Daily Money Management (DMM) programs, which are designed as a preventative measure for elders who are unable to manage their finances. Despite their effectiveness, there are few DMMs. Programs are offered by both public and private, non-profit and for-profit agencies, and routine services such as bill paying, banking, and check writing as well as more complex services such as negotiating with creditors and maintaining home payroll records for home employees are performed. Services are provided by a variety of volunteers and professionals, including accountants, bookkeepers, social workers, private fiduciaries, nurses, etc. Programs vary widely in their scope of services; for example, some offer guardianship of estate. One concern regarding the for-profit DMMs is that the field is largely unregulated. The publication reviews the limited research that has been conducted on DMMs thus far. Also included is a list of indicators that may be used in assessing whether an elder is a viable candidate for DMM services. Risk management strategies are described and include periodic monitoring of bank statements, having clients sign service agreements, and professional consultation (with attorneys, auditors, etc.) Insurance issues are also described and include general liability insurance, malpractice insurance and bonding. Deterrents to providing DMM services are explored, and include issues regarding consent, the complexities of client needs, client resistance, and ethical and cultural considerations. The manual concludes with a list of best practices recommendations and a highlighting of model programs and resources (including the AARP Money Management Program; Delaware's Financial Management Program; Elder Abuse Prevention's Money Management Program in Alameda County, California; Jewish Family and Children's Services in San Francisco, the Peninsula, Marin, and Sonoma Counties; Massachusetts Money Management Program; Southern California Presbyterian Homes Financial Services Programs; and Western Montana Chapter for the Prevention of Elder Abuse). (Note: This manual is available online through the NCEA Web site at http://www.elderabusecenter.org/pdf/publication/DailyMoneyManagement.pdf .)

12. P5412-33
Nerenberg, L., National Committee for the Prevention of Elder Abuse (NCPEA), for the National Center on Elder Abuse (NCEA)
Multidisciplinary Elder Abuse Prevention Teams: A New Generation
NCEA, Washington, D.C.; September 2003.
The purpose of this publication is to describe the key characteristics of multidisciplinary teams, and to highlight models of specialized teams that address various aspects of elder mistreatment, such as financial abuse or deaths related to abuse and neglect. The benefits of the teams include the following: treatment plans that are customized to maximize client autonomy and enhance accessibility to services; supervision and support to members and the opportunity to observe patterns of abuse; and identification of systemic problems and service gaps in the community's response to elder mistreatment. The manual describes how team composition may be developed and which organizations are usually represented (APS, prosecutors, police, criminal justice professionals, physicians and other health care professionals, victims' advocates, domestic violence representatives and mental health professionals). The case review process is detailed, from case selection through review, which allows members to make recommendations for assessment, investigation and interventions. The presenter provides updates so that the team can assess the effectiveness of the recommendations. Contributions made by many model programs are presented, including those of the Vulnerable Adult Multidisciplinary Team of Dane County, Wisconsin, the San Francisco Consortium for Elder Abuse Prevention, and the Senior Strength M-Team of Peoria, Illinois. Also described is the administration of the teams, from recruitment issues, through funding and support, facilitation, membership agreements, contracts, memorandums of understanding (addressing such issues as attendance, conflict of interest, confidentiality, etc.), outcome evaluation, and sources of technical assistance. A review of specialty teams is presented, including a discussion of the Financial Abuse Specialist Teams (FAST) and Rapid Response FASTs, Fatality Review Teams (highlighting the Elder Death Investigation Review Team or EDIRT of Sacramento, California), and Community-Based Medical Teams. A checklist for starting or "revitalizing" a team is provided. (Note: This publication is available online at: http://www.elderabusecenter.org/pdf/publication/EldAbs_complete.pdf )

13. P5610-32
Nerenberg, L., National Committee for the Prevention of Elder Abuse (NCPEA), for the National Center on Elder Abuse (NCEA)
An Introduction to the Civil Justice System and Its Role in Elder Abuse Prevention
NCEA; Washington, D.C.; March 2004.
While many professionals in the Adult Protective Services (APS) and related fields have developed an understanding of the role of the criminal justice system in addressing elder abuse, the civil justice system is not as well understood. This publication is intended to provide information regarding this court system for health care providers and social service professionals. The introduction describes types of civil cases and the processing of civil lawsuits, from the pre-filing phase to the post trial. It also includes discussion regarding the distinction between civil and criminal proceedings. Alternative Dispute Resolution (ADR) is described. The second section highlights remedies available to elder abuse victims through the civil court system, including tort actions, contract actions, and other remedies such as divorce, constructive trusts, eviction, civil protective orders, guardianship and commitment. Preventative measures regarding financial abuse (by power of attorney, abuse of guardianship, abuse of trusts, etc.) are highlighted. The next chapter describes the challenges encountered, notably the lack of clarity regarding competency (mental capacity) and undue influence, and the financial risks of processing abuse cases, the limited effectiveness of restraining orders and attempts to collect the damages awarded by the courts, and issues of accessibility. Recommendations for overcoming these challenges are provided, along with examples of existing programs. The booklet includes a list of resources and promising practices. (To order, please contact NCPEA at 202/682-4140 or via email at ncpea@verizon.net .)

14. P5349-84 (database)
Stack, S., National Association of State Units on Aging (NASUA), for the National Center on Elder Abuse (NCEA)
Promising Practices Catalogue
NCEA; Washington, D.C.; 2003.
To quote from the introduction: "The National Center on Elder Abuse's (NCEA) Promising Practices Database is an online tool of program models and information resources around the country related to elder abuse prevention, intervention, and public education. The searchable database is intended to be a resource for practitioners to learn from each other, avoid reinventing the wheel, and maximize resources for elder abuse prevention and intervention. The database, which is continually updated and currently contains over 250 project descriptions, may be accessed online at http://www.elderabusecenter.org/default.cfm?p=toolsresources.cfm

15. P5283-76
Teaster, P., National Committee for the Prevention of Elder Abuse (NCPEA), National Association of Adult Protective Services Administrators (NAAPSA), National Association of State Units on Aging (NASUA), for the National Center on Elder Abuse (NCEA)
A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective Services
NCEA; Washington, D.C.; 2003.
This publication reports upon the results of a survey of Adult Protect Services (APS) from fifty states, District of Columbia and Guam, conducted in 2000 by the National Association of Adult Protective Services Administrators (NAAPSA) for the National Center on Elder Abuse (NCEA). The survey consisted of 60 items regarding statutory and program information, reporter information, investigatory requirements (including relevant time frames), number of reports received, investigated and substantiated, victim profile and perpetrator profile. While all the states provided information, only Texas was able to complete 100 percent of all questions on the survey, while 15 other states were able to answer 85 percent of the survey. The study indicates that in 2000 there were 472,813 APS reports of elder/vulnerable adult abuse and that most perpetrators were family members (half of which were spouses and intimate partners). Self-neglect was the most commonly reported problem, followed by (in order) neglect by others, financial exploitation and physical abuse. (Note: The complete report is available for downloading in .pdf format on the NCEA Web site at www.elderabusecenter.org)

16. P5458-26
Teaster, P. & Nerenberg, L., National Committee for the Prevention of Elder Abuse (NCPEA), for the National Center on Elder Abuse (NCEA)
A National Look at Elder Abuse Multidisciplinary Teams
NCEA; Washington, D.C.; 2003.
In this report, 31 coordinators of 40 multidisciplinary teams (MDTs) throughout the U.S. responded to an email survey (included) regarding the function and goals of these collaborative work groups. Participants included not only traditional teams dealing with varied types of abuse cases, but one fatality review team, seven financial abuse specialist teams, medically oriented teams, and two teams dealing exclusively with systemic (versus clinical) issues. Coordinators indicated that the primary function of MDTs was the provision of consultation and assistance to workers dealing with difficult abuse and neglect cases. Three-quarters of the teams participate in advocacy, training and education, and coordinated care planning and investigation. Other characteristics of teams were examined, including: attendance policies; composition; level of team formality; funding and source of administration; and costs. Challenges identified include lack of participation by specific professions, lack of cases to present, and issues regarding confidentiality. (Note: This report is available online at the NCEA Web site at: http://www.elderabusecenter.org/pdf/publication/mdt.pdf .)


The following publications use a scientific method to obtain results. The results are usually quantifiable, and the methodology can be replicated and tested for validity and reliability.

17. P5617-24
Allen, P., Kellett, K. & Gruman, C.
Elder Abuse in Connecticut's Nursing Homes
Journal of Elder Abuse & Neglect; Vol. 15 (1), 19-42; 2003.
This study draws upon data tracked by the Connecticut Ombudsman Reporting System from July 1998 through July 2000. Of the 3,443 complaints lodged during this time period, 269 were categorized as abuse, gross neglect or exploitation, while 791 were identified as issues of care. Overall, 47 percent of Connecticut's 261 nursing homes had one or more accounts of abuse. The article also provides an overview of the difficulties of defining elder abuse, and in enforcing established standards of care.

18. P5614-21
Balaswamy, S.
Rating of Interagency Working Relationship and Associated Factors in Protective Services
Journal of Elder Abuse & Neglect; Vol. 14 (1), 1-20; 2002.*
This research was designed to examine the perceived satisfaction of the relationships among collaborative agencies addressing elder abuse and neglect. Participants were selected from human service agencies in five counties in Ohio, including agencies mandated to receive and investigate allegations of elder mistreatment, social service agencies involved in investigation and service delivery, and agencies within the community mandated to report suspected abuse. In all, 34 adult protective services (APS) professionals and 120 individuals from community agencies completed questionnaires regarding their perceptions of the quality of interdisciplinary effectiveness. Respondents were asked to evaluate the performance of agencies involved, the accessibility of staff, difficulty in being understood, productivity in terms of service provision, investigation, and obtaining feedback, frequency of disagreements, and the degree to which such disagreements were resolved and by what means. Community agency participants who were more experienced with elder abuse cases were more likely to be less satisfied with the APS system. APS providers' satisfaction with community agencies appeared related to the extent to which they could access individuals and resolve conflicts regarding case management and disposition.

19. P5482-23
Blakely, B. & Dolon, R.
Another Look at the Helpfulness of Occupational Groups in the Discovery of Elder Abuse and Neglect
Journal of Elder Abuse & Neglect; Vol. 13 (3), 1-23; 2001.*
In 1997, 395 adult protective services (APS) professionals from 43 states completed questionnaires regarding the perceived helpfulness of 17 occupational groups in identifying suspected elder abuse and neglect. Results were then compared to the results of a similarly structured survey conducted in 1986 regarding the perceived helpfulness of 14 of the 17 occupational groups. Although some of the groups moved several rankings higher or lower, all groups were perceived as more supportive in detecting elder mistreatment in 1997 as compared to 1986. Visiting nurses remained the highest ranked group in 1997, while hospital social workers and social service providers were ranked second and third, respectively. The survey also asked participants to report initiatives used for public outreach and professional training and education. Although nearly half of the respondents did not complete these questions, those that did indicated that speaking engagements were the most common method of raising public awareness. Responses indicated that little time and few resources were available for outreach.

20. P5601-8
Boyle, V. et al.
Recognition and Management of Depression in Skilled-Nursing and Long-Term Care Settings - Evolving Targets for Quality Improvement
American Journal of Geriatric Psychiatry; Vol. 12 (3), 288-295; May-June 2004.
This research evaluates the effectiveness of Michigan's Quality Improvement Organization (MPRO) in the recognition and management of depression among nursing home residents. The Minimum Data Sets (MDS) and medical records of 818 residents from 14 sites involved in the MPRO project were analyzed for evidence of depression, regardless of initial diagnosis. Three-hundred and thirteen had depressive symptoms by day 14 of their admission, and 68 percent of this group had been admitted with a diagnosis of depression. Ninety-one percent of those admitted with a depression diagnosis were already receiving treatment (medication or therapy). Only 34 percent of the 53 residents who were being treated for depression after a 60 day stay exhibited improvement. Of those who did not show improvement, only 41 percent had had a change in medication, adjustment of dosage, augmentation of treatment, and/or documented evidence of reassessment. While detection of depression appears to have improved, the management and monitoring of the condition continues to require attention. Researchers recommend supplementing the administration of the MDS with the Geriatric Depression Scale (GDS).

21. P5460-14
Brandl, B., Hebert, M., Rozwadowski, J. & Spangler, D.
Feeling Safe, Feeling Strong
Violence Against Women; Vol. 9 (12), 1490-1503; December 2003.
In 2003, researchers from the National Clearinghouse on Abuse in Later Life (NCALL) interviewed facilitators of 34 support groups for older battered women throughout the U.S. Support groups were identified in 16 states; some had been established over a decade ago but most were founded since 1996. The facilitators were often older women. Groups provided not only support, but an arena for problem solving and developing survival strategies. Logistical issues of running these programs (such as location, scheduling, and structure) are discussed. The impact of language choice in the therapeutic environment is also described. The article concludes with a guideline of principles for working with older victims of domestic violence, including believing the victim, offering hope, and supporting the choices that each individual makes.

22. P5503-7
Brown, L., Bongar, B. & Cleary, K.
A Profile of Psychologists' Views of Critical Risk Factors for Completed Suicide in Older Adults
Professional Psychology: Research and Practice; Vol. 35 (1), 90-96; 2004.
This article presents the results of a survey of psychologists regarding their perceptions of risk factors for suicide among older clients. Complicating the issue of suicidal risk is the presence of indirect self-destructive behaviors (ISDBs), which include noncompliance with medical treatment, refusal of food and liquids, and risk-taking behaviors. A random sample of the American Psychological Association yielded 321 completed surveys (representing a 47 percent usable response rate) evaluating 36 risk factors associated with suicide in older adults as either critical, moderate or low. History of suicide attempts, severe hopelessness, seriousness of previous suicide attempts, and acute suicidal ideation are among the 17 factors rated as most critical. Eighteen factors were rated as moderate and one (scratching excessively) was rated as low.

23. P5586-11
Bruce, M. et al.
Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients - A Randomized Controlled Trial
JAMA / Journal of the American Medical Association; Vol. 291 (9), 1081-1091; March 3 2004.
Noting that older adults who commit suicide are likely to have seen their primary care physician within months of their deaths, the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) study examines the impact of primary care based interventions designed to reduce suicide risk factors in elders, specifically depressive symptoms and suicidal ideation. In this randomized controlled trial, elders were screened for depression in 20 primary care settings throughout the New York City, Philadelphia and Pittsburgh areas. The final sample included 598 participants who received either the intervention (which was first line treatment with citalopram and, for those declining medication, interpersonal psychotherapy with a depression care manager) or the usual care, enhanced by education for physicians regarding geriatric depression treatment guidelines. Outcome measurements included assessment for suicidal ideation and depression severity at baseline and then at four, eight and twelve month intervals. Despite random assignment and equivalent rates of depression at baseline, the intervention group had a higher suicidal ideation rate (29.5 percent) than the comparison group (20.1 percent). However, the intervention group experienced a greater reduction in suicidal ideation (12.9 percent) than the comparison group (3 percent) at the four month interval. Resolution of symptoms was greater and quicker for those receiving the intervention; at eight months the intervention group resolution rate was 70.7 percent compared to 43.9 percent of the usual care group. Researchers point out that despite the limitations, this study included participants that are typically excluded from such trials, including patients with mild cognitive impairment and co-morbid medical conditions, and therefore suggest that the findings may have greater relevance to actual practice.

24. P5673-22
Buchbinder, E. & Winterstein, T.
"Like a Wounded Bird": Older Battered Women's Life Experiences with Intimate Violence
Journal of Elder Abuse & Neglect; Vol. 15 (2), 23-44; 2003.
In this qualitative analysis, researchers conducted in-depth interviews with twenty Jewish battered women in Israel, aged 60 to 80.Twelve were living with their partners while eight were separated. The guided interviews covered topics including the effects of abuse on perceptions of life experiences; the emotional and intimate relationship with the batterer throughout the life span; reasons for staying; effects of the abuse upon their children; differences in perceptions of older versus younger victims; and future hopes. Content analysis of the interview transcripts reveals four themes: self-perceptions as either heroines or fools; self-sacrifice for the sake of the family; perception of their children as either friends or foes; and being lost between "a painful past and a trap-like future." Many women perceived the time lost in damaging relationships as limiting their current life choices.

25. P5771-15
Chang, V. & Greene, R.
Study of Service Delivery by Community Mental Health Centers as Perceived by Adult Protective Services Investigators
Journal of Elder Abuse & Neglect; Vol. 13 (3), 25-39; 2001.*
Noting the need for coordination of services between adult protective services (APS) and mental health services, researchers designed this qualitative study to evaluate the perceptions that Indiana APS investigators held regarding their interactions with the state's Community Mental Health Centers (CMHCs). Thirty-three of the state's 34 investigators participated in the interview process which addressed topics such as the problems and frustrations perceived when referring to CMHCs, procedural issues, quality of working relationships, needed improvements, and service gaps. In particular, diagnostic issues (mental illness versus dementia or other medical conditions, such as traumatic brain injury) posed barriers to evaluation and psychiatric hospitalization of endangered adults. Other issues included problems in sharing information due to perceived conflicts with confidentiality on the part of the mental health clinicians, and limited placement options, especially for clients demonstrating aggressive behaviors related to dementia. Investigators identified a number of strengths, including effective working relationships and increased understanding regarding information sharing on behalf of endangered clients. Increased dialogue and interdisciplinary team approaches were among the recommended interventions to enhance service delivery.

26. P5432-12
Coon, D. et al.
Anger and Depression Management: Psychoeducational Skill Training Interventions for Women Caregivers of a Relative with Dementia
The Gerontologist; Vol. 43 (5), 678-689; 2003.
The purpose of this study is to consider the effectiveness of two psychoeducational skill training interventions for caregivers of relatives experiencing dementia. One-hundred and sixty-nine female caregivers, aged 50 and over, were randomly assigned to either an anger management group, a depression management group, or the waiting list control group. Participants were assessed (for depressive symptoms and anger/hostility) three times: at intake, four months later (post intervention), and again three months later. Both the anger management and depression management interventions consisted of small group, workshop type sessions, which included lecture, skill practice, discussion and homework. Results indicate that the skill training was effective; participants with higher levels of anger appeared to benefit the most from the anger management intervention and those experiencing higher levels of depressive symptoms appeared to benefit the most from the depression management intervention, while the participants of both groups experienced reductions in anger and depression when compared to the control group. The study also focuses on the role of specific moderator variables (present at baseline) and mediator variables (those that are impacted by the intervention and, in turn, effect outcome variables). Self-efficacy increased for participants of both psychoeducational groups. In order to maximize the skill training, pre-treatment assessments are important in prescribing appropriate interventions.

27. P5495-21
Daly, J. & Jogerst, G.
Statute Definitions of Elder Abuse
Journal of Elder Abuse and Neglect; Vol. 13 (4), 39-57; 2001.*
This study reviews elder abuse statutes from 50 states and the District of Columbia in order to begin the development of definitions that may be usable to researchers, practitioners and policy makers. Individual state statutes were analyzed by a multidisciplinary team in order to code definitions and terms associated with the concept of elder abuse. The terms "abandonment," "mental anguish," "exploitation," "neglect," "self-neglect," and "sexual abuse" were most commonly used in both the statutes that provide independent definitions of elder abuse and in those addressing "abuse not otherwise specified." The authors also suggest that definitions and terminology related to adult protective services interventions (such as "referral," "report," "investigation," etc.) also require codification in order to allow comparisons from one state to another and to facilitate research. Tables are included that illustrate which states contain specific definitions of the above terms identified.

28. P5676-22
Daly, J., Jogerst, G., Brinig, M. & Dawson, J.
Mandatory Reporting: Relationships of APS Statute Language on State Reported Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 15 (2), 1-21; 2003.
Forty-four states and the District of Columbia have mandatory reporting laws that require "individuals who assume the care of older adults, which includes health care providers" to report suspected elder abuse and neglect. This article analyzes the impact of state APS reporting statute language upon rates of reporting, investigating and substantiating domestic elder abuse. Researchers hypothesized that neither the requirement to report nor the type of reporter, time frame for reporting, nor penalties for nonreporting would impact rates of reporting, investigation and substantiation. The number of reports made, investigations conducted and substantiation of allegations for elder abuse in each state (either in 1999 or fiscal year 1999-2000) were identified. The following predictor variables were studied: mandatory reporting; description of mandatory reporters; mandatory education for mandatory reporters; penalty for failure to report; type of penalty; time period stipulated for reporting; the term "social work" specified as a mandatory reporter; the term "nurse" specified as a mandatory reporter; the term "physician" specified as a mandatory reporter; the term "police officer" specified as a mandatory reporter. Investigation rates were significantly higher in states with mandatory reporting. Terminology describing mandatory reporters, penalty for nonreporting, and time frames for reporting did not appear to impact reporting, investigation and/or substantiation rates. The appendix includes a table of state statute listings of mandatory reporters.

29. P5540-13
Jogerst, G., Daly, J. & Ingram, J.
National Elder Abuse Questionnaire: Summary of Adult Protective Service Investigator Responses
Journal of Elder Abuse & Neglect; Vol. 13 (4), 59-71; 2001.*
This study examined the characteristics of adult protective services (APS) investigators and APS programs throughout U.S. A 23-item questionnaire was developed to gather demographic information on investigators and to address the investigative structure of APS programs. Surveys were completed by 1,409 of 1,860 offices, representing an 80 percent participation rate. Among the findings, 76 percent of the investigators were female, the mean age was 46.4 years old, and 49 percent held a baccalaureate degree (with 66 percent holding a degree in social work), and 99 percent were full-time employees with an average of nine years experience in their current positions. The APS investigative structure characteristics revealed that nearly half of the programs used elder abuse screening and/or risk factor instruments, while 93 percent used agency-developed or state mandated instruments. Forty percent of the programs had no formal elder abuse training in place. Twenty-seven percent of the programs combined child abuse and adult abuse investigations within the same caseload.

30. P5615-19
Dimah, K. & Dimah, A.
Elder Abuse and Neglect Among Rural and Urban Women
Journal of Elder Abuse & Neglect; Vol. 15 (1), 75-93; 2003.
The article dispels certain myths that traditional family values protect against domestic elder abuse in rural settings. In particular, social and geographic isolation can add to the potential for abuse while limiting the victim's ability to access intervention services. The study was designed to examine and compare patterns of abuse, neglect and exploitation between older rural and urban women. Six types of elder mistreatment are analyzed: physical abuse, emotional abuse, confinement, deprivation, passive neglect, and financial exploitation. Drawing upon data from the Illinois Elder Abuse and Neglect Program's "Abuse, Neglect, and Exploitation Tracking System" (ANETS), 1989-2001, the sample consists of 7,178 rural women and 7,614 urban women, aged 60 and over, who were identified as victims of abuse, neglect and exploitation. Rural victims represented higher rates of physical abuse, emotional abuse and deprivation, while urban victims demonstrated higher rates of neglect. In both groups, abusers were typically offspring, non-caregivers, with no legal responsibility for the victims. At least half of the abusers resided with their victims, and in over one-third of the cases provided informal care. The finding that 88 percent of the rural victims were willing to accept services (commensurate with the 86 percent of the urban victims) holds implications for policy implementation.

31. P5660-12
Estes, C. et al.
State Long Term Care Ombudsman Programs: Factors Associated with Perceived Effectiveness
The Gerontologist; Vol. 44 (1), 104-115; 2004.
This article reports upon a nationwide survey of factors associated with perceived effectiveness of state Long Term Care Ombudsman Programs (LTCOPs). Telephone interviews were conducted with representatives of LTCOPs from each state, Washington, D.C., and Puerto Rico. Overall, LTCOPs perceived their programs as effective, with nearly one-third reporting their program was very effective, and two-thirds indicating their program was somewhat effective. Three factors appear positively associated with perceived effectiveness: adequate resources; program autonomy; and relationship with other agencies. Detailed discussion regarding organizational placement, and its subsequent impact upon the program's level of autonomy, is provided as 54.9 percent of the respondents felt that their location limited their autonomy and contributed to conflicts of interest. Findings suggest that being located in a State Unit on Aging (SUA) may hinder the LTCOP's effectiveness in resolving complaints; however, such location was also reported to be beneficial in terms of practical support. In addition to the interviews, researches used data from the Administration on Aging National Ombudsman Reporting System (NORS, 1999) to analyze elements of program effectiveness.

32. P5600-8
Fenton, J. et al.
Some Predictors of Psychiatric Consultation in Nursing Home Residents
American Journal of Geriatric Psychiatry; Vol. 12 (3), 297-304; May-June 2004.
Several studies have found that the prevalence of psychiatric disorders among nursing home residents exceeds 70 percent, yet fewer than ten percent of nursing home residents receive explicit mental health interventions. The purpose of this research was to document the number of psychiatric consultations requested for a diverse nursing home population and to identify demographic, clinical and facility characteristics associated with the consultations. Fifty-nine facilities throughout Maryland were randomly selected and new admission residents from September 1992 through August 1995 were eligible. Two-thousand and fifteen residents were evaluated for depression, dementia, cognitive deficits and agitation. Residents, their staff, or significant others were interviewed, and medical records were examined to determine whether or not a psychiatric consult had been ordered within the first 90 days of admission. Only 20 percent of the sample had been referred for consultation. Behaviors that were associated with referrals included agitation, verbal abuse, wandering, manic/destructive acts and anxiety. However, depression in developmentally disabled and psychotic patients did not trigger a consultation. Researchers suggest that the mental health needs of the quietly depressed or developmentally disabled resident may be overlooked, and encourage care staff to be aware of such symptoms as social withdrawal or lethargy.

33. P5575-19
Filinson, R.
Evaluation of the Impact of a Volunteer Ombudsman Program: The Rhode Island Experience
Journal of Elder Abuse & Neglect; Vol. 13 (4), 1-19; 2001.*
In 1995, a study by the Institute of Medicine revealed that Rhode Island, although it had the highest proportion of institutional facility beds in New England, had the third lowest ratio of designated ombudsmen for the nursing home population. At that time, it had one paid ombudsman to advocate for 11,147 residents, with no additional volunteers. This research was designed to measure the impact of the Rhode Island Volunteer Ombudsman Program, initiated in 1997. While focus group findings regarding awareness of the ombudsman's role and its impact yielded contradictory results, facilities with assigned volunteers generated a higher proportion of complaints, and the complaints were of greater complexity. In addition, nursing home inspection data revealed that a negative and significant correlation exists between the length of time a volunteer had been assigned to a facility and the number of deficiencies documented. Quality of care issues and volunteer perceptions were also surveyed and discussed.

34. P5671-17
Fisher, B. et al.
Services and Programming for Older Abused Women: The Ohio Experience
Journal of Elder Abuse and Neglect; Vol. 15 (2), 67-83; 2003.
This article reports upon the status of service delivery to older abused women in Ohio. In spring of 2002, domestic violence (DV) centers in the state were surveyed to determine how many programs had offered assistance to women aged 55 and over. In particular, the survey considered such issues as center characteristics, specific programs designed for older women, staffing, and shelter operations and medication policies. Fifty-two representatives of the state's 71 DV centers completed the survey. Approximately one-third of the centers provided outreach to older women. Twenty-nine percent of the centers provided one-on-one services to at least one woman aged 55 and older during 2001; older women accessed nearly 20 percent of their crisis lines; and 40.1 percent of the centers had at least one older woman participate in support groups. Information on staff training, outreach provided and referral sources are also included. The article concludes with practical recommendations to enhance services to these women.

35. P5435-8
Fulmer, T., et al.
Themes From a Grounded Analysis of Elder Neglect Assessment by Experts
The Gerontologist; Vol. 43 (5), 745-752; 2003.
This exploratory research highlights the program used by the Mount Sinai Medical Center's Neglect Assessment Team (NAT), an interdisciplinary team that is comprised of a geriatric nurse practitioner, a social worker and a geriatrician. Data collected using the Elder Assessment Instrument (EAI) was reviewed in NAT meetings; the discussions were audiotaped, transcribed and analyzed using a grounded theory analysis to identify relevant themes of neglect. Participants were aged 70 or over who had presented to the emergency department of the Mount Sinai Hospital, scored 18 or higher on the Folstein Mini-Mental Status Exam, and had a paid or unpaid caregiver for at least 20 hours weekly. In all, 19 cases of neglect and 4 practice cases from the literature were analyzed. Four themes emerged which became the framework for further analysis: "...understanding the underlying health status of the elder and caregiver, understanding the socioeconomic and life circumstances of the dyad, credibility of data collected by others, and the consequences of the assessment outcome..." While the screening for neglect with instruments such as the EAI is important in clinical settings such as the emergency room, the review by an interdisciplinary team of professional clinicians such as the NAT provides a more in-depth assessment and a valuable tool for case disposition.

36. P5564-12R
Fulmer, T. et al.
Profiles of Older Adults Who Screen Positive for Neglect During an Emergency Department Visit
Journal of Elder Abuse & Neglect; Originally published in Vol. 14 (1), 49-60; 2002; revised with corrected text and republished in Vol. 15 (2), 103-116; 2003.
As research indicates that elders are more frequent users of emergency medical departments, emergency rooms may be an important environment in which to assess for elder abuse and neglect. In this study, data collected on older emergency department (ED) patients (from Tampa, Florida, and New York) was analyzed to observe differences between those who were neglected by domestic caregivers and those who were not. Participants were aged 70 or older, scored 18 or higher on the Mini Mental Status Examination, lived in the community and received 20 hours of care (paid or unpaid) throughout the week. The final sample yielded 334 patients including 22 identified as neglected. The Elder Assessment Instrument (EAI) was administered. In addition to general assessment, the tool assesses neglect (including emotional and psychological neglect), and lifestyle, social and medical domains. Characteristics of age, gender and language spoken were similar across both groups. Non-neglected patients were more frequently accompanied by caregivers (most paid). While rates of gastrointestinal, respiratory, psychiatric, changes in mental status presenting problems were similar for both groups, the non-neglect group had a significantly higher incidence of cardiac presenting problems. As a group, the neglected patients tended to have poorer financial circumstances, poorer social interactions with friends, family and caregivers, poorer support systems and living arrangements. No differences regarding medication or substance use were detected. The authors urge further use of the ER for screening for elder mistreatment, and recommend the use of the EAI as patients demonstrating evidence of mistreatment without sufficient clinical explanation may be immediately referred to APS or social services for follow-up.

37. P5477-11
Grossman, S. & Lundy, M.
Use of Domestic Violence Services Across Race and Ethnicity by Women Aged 55 and Older
Violence Against Women; Vol. 9 (12), 1442-1452; 2003.
Observing that there is limited research on older minority victims of domestic violence (DV), this study examines race and ethnicity differences among a population of female DV service users aged 55 and over. This article draws upon data collected by the Illinois Coalition Against Domestic Violence on clients who utilized services funded by the Coalition from July 1990 through June 1995. Of the 2,702 older women requesting assistance, nearly 77 percent were White, 17.5 percent were African American, 4.5 percent were Hispanic, 0.7 percent was Asian, 0.2 percent was American Indian, and 0.3 percent was biracial. The White, African-American and Hispanic groups were similar in that nearly all service users experienced emotional abuse, but a higher percentage of White and African-American women had special needs (9 percent and 8.5, respectively) than Hispanic women (5.1). Comparisons of types of abuse experienced and relationships with abusers are reported.

38. P5636-10
Guion, L., Turner, J. & Wise, D.
Design, Implementation, and Evaluation of an Elder Financial Abuse Program
Journal of Extension; Vol. 42 (3); June 2004.
This online publication describes the cooperative pilot project between the University of Florida Cooperative Extension and the University of Tennessee Agricultural Extension Service entitled "Striking Back: Elder Financial Abuse Prevention." The educational program consists of the "Leader's Guide," (developed for peer educators), the "They Can't Hang Up Videotape," (which uses cases scenarios to debunk the myths that victims are isolated and vulnerable), eight practice scenarios, the Federal Trade Commission's "Ditch the Pitch" publication, "Thirteen Ways to Say No," handout, and a fact sheet addressing the scope of the problem along with barriers to prosecution. Seventy-nine elders in six Florida counties participated in the program. Sixty-six participants signed follow-up consent forms, which allowed researchers to randomly contact individuals six weeks after the program and present a mock telemarketing pitch to determine the percentage who would immediately hang up or use one of the described strategies to end the call. Pre- and post tests were also used to evaluate the program's effectiveness. Of the 42 usable tests analyzed, there was an aggregate 19 percent increase in scores regarding knowledge of financial abuse, with individual scores showing an increase in 30 percent of the participants. Of the 44 contacted for the mock telemarketing follow-up, four hung up immediately, 16 interrupted the telemarketing pitch and then hung up, 22 used one of the strategies learned to refuse a solicitor, and two continued to listen and began to consent to donate money. In debriefing, participants indicated that the program was helpful in practical terms as well as in providing confidence to deal with solicitors. (Note: This article is available online only at
http://www.joe.org/joe/2004june/a6.shtml .)

39. P5470-8
Hawes, C. et al.
A National Survey of Assisted Living Facilities
The Gerontologist; Vol. 43 (6), 875-882; 2003.
This survey was designed to assess the current state of assisted living facilities (ALFs), the fastest growing segment of long-term care in the United States. Administrators of 1,251 ALFs were interviewed via telephone to develop a sense of the variety of the types of facilities in terms of size, cost, services provided, etc., and to determine if the services available were consistent with the basic philosophy of assisted living. The principles of assisted living, as described by the Assisted Living Quality Coalition, is a setting that provides 24 hour supervision and assistance and is designed to allow for "aging in place" while maximizing the dignity, autonomy, privacy, independence and safety of residents. In 1998, there were an estimated 11,459 ALFs with over half a million residents. Approximately 60 percent provided a combination of low service and low privacy, and 11 percent provided high service with high privacy. The goal of allowing elders to "age in place" is limited by the need for assistance with transfers, or the development of moderate to severe cognitive impairments, behavioral symptoms and the need for nursing care. Most facilities were private pay with the most common monthly charge being $1,582. Therefore, this living arrangement was largely unavailable to low to moderate income seniors unless they also had assets available for spending down.

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