Predictors of Depression in Healthcare Patients at Risk of Self-Neglect

More than half of reports to Adult Protective Services agencies nationwide involve allegations of self-neglect. An intensive case management intervention for preventing self-neglect was evaluated in a longitudinal study conducted collaboratively by a large healthcare system, Adult Protective Services, and a gerontological research institute. Patients (444) who were older (60+ years) and/or disabled (18+ years) were randomly selected for participation from 19 primary-care clinics if they had risk factors for self-neglect, including depression, substance abuse, dementia, and/or impairment in activities of daily living. Average age was 68 years (SD=12.5), 68% were Hispanic, 68% had monthly income of less than $1,361, and 67% were female. Clinics were randomized into intervention and control groups. Intervention clinic patients received intensive case management services; control clinic patients received usual care, including social work services. Subjects were interviewed at baseline and four months later. The Stress Process Model guided a multiple regression analysis. Domains of background characteristics, primary and secondary stressors, and support (patients in intervention or control group) were entered in blocks to predict depression levels at post-test. While no significant differences were found in post-test depression levels between intervention and controls, the final model was statistically significant (adjusted R2=.452). Significant predictors of depression were: younger age (disabled adults), poorer self-rated physical and emotional health, greater loneliness, and less social support. Future analyses will examine effects of moderating variables on post-test depression levels. Practice implications of preliminary analyses include addressing disabled adults’ mental health needs, especially if they are isolated and lack social support.

A Scoping Review of Financial Elder Exploitation Interventions

Elder financial exploitation (EFE), defined by the National Center for Elder Abuse (2021) as “the misappropriation of an older person’s money or property,” is a continuing public health crisis shown to cost individuals at least $2.9 billion a year (MetLife Mature Market Institute, 2011). Many believe this impact will increase exponentially due to the effects of COVID-19. In fact, a recent study conducted by Chang & Levy (2021) found that the prevalence of elder abuse as a whole increased from 1 in 10 older adults to 1 in 5 in the past year. Although increased collaboration between state attorneys general, Adult Protective Services, and financial institutions has driven progress in the field; there is still little known regarding EFE interventions. To address this issue, this study conducts a scoping review of the EFE intervention literature. This approach was chosen over a systematic review primarily due to the lack of a universal definition of EFE, as well as the limited number of studies available delineating between EFE and elder abuse as a whole. The main findings of the review reveal that current EFE intervention practices are focused on preventing abuse before it occurs by addressing risk factors for abuse in older adults; and are largely reliant on Adult Protective Services and the legal system. This finding is significant because state policies differ in their qualifications of EFE, thus leaving many older adults vulnerable and unprotected. Further interventions that address EFE while it is occurring and alignment across governing bodies are needed.

Best Practices to Overcome Barriers to Capacity Evaluations

Because of the increasing incidence of elder abuse and financial exploitation, Adult Protective Services (APS) cases open for these individuals often relay on capacity evaluations conducted by a clinician to facilitate legal assignment of a surrogate decision maker. Despite this growing need, the number of physicians willing and capable of performing them is limited. Barriers reported by physicians reportedly impair their ability to conduct these evaluations include absence of relevant case information and lack of knowledge about the process itself. Geriatricians and related clinicians often perform these assessments. Sharing best practices with internists and family physicians may help overcome these barriers. A survey of geriatric medicine providers was conducted to identify essential components and questions necessary in the assessment of general decision making capacity. Twenty-nine providers at 6 academic institutions in Ohio responded to the survey and its follow-up inquiries. Though variability existed in evaluation styles and content between providers, a uniform set of recommendations was able to be generated. A total of 13 different summary recommendations were generated from this survey. Necessary components to these evaluations include (1) performance of cognitive testing (2) obtaining collateral information regarding functional status from another trusted individual (3) assessing the individual’s insight into any reported functional impairments or safety concerns by explaining discrepancies between that individual’s own observations and reported concerns from the trusted individual, and (4) using hypothetical situations to assess a person’s judgment and reasoning in addressing any gaps in care or safety concerns raised during the interview.

COVID Pandemic Impact on Nevada Adult Protective Services

Empirical data regarding Covid pandemic impact on the Nevada Adult Protective Services (APS) Program clients, casework, and staff was gathered and analyzed as part of a multi-faceted program evaluation. Key findings include: 66% of the staff agreed or strongly agreed that the pandemic made their jobs more challenging. Respondents reported Covid-related challenges faced by clients, the program, and themselves as social workers serving older and vulnerable adults. Adverse client impacts observed included increased social and emotional isolation, loss of housing, exacerbation of symptoms of mental illness, necessary services being cut from clients subsequent to testing Covid positive, and fear and reluctance to allow needed visiting service providers, such as home health aides, into their homes. We will discuss the implications of the findings on APS services and clients, and on related health and human services designed to promote the wellness and independence of older and vulnerable adults.