Information is Power

Keeping Seniors Safe.

by Mary Keen

New methods of reporting and care planning are needed to manage the rise in elder abuse in a cost- efficient, knowledge-based way.

Many fields, like business and medicine, use information technology to improve efficiency and quality of services. A team of researchers in Chicago proposed that decision support technology could be easily applied to the complex issue of elder abuse. So they pioneered the development of a system that standardizes the way elder abuse is reported. Known as the Elder Abuse Decision Support System (EADSS), it is the first decision support system designed specifically for assessment and intervention in the field of elder abuse. It is designed to address elder abuse by translating research into practice with computerized, web-based standardized screening, assessment, reporting and care planning. It’s believed the system could be replicated nationally with very few adjustments, and many other states, and even other countries, are inquiring about it.

The three-stage project has been supported by three grants from the National Institute of Justice. Stage 1 began in 2006 with concept develop ment of the measurements and system protocol and a field test at seven provider agencies to validate measures. In Stage 2, a prototype of the EADSS was developed with input from numerous elder abuse investigators, supervisors, and program managers locally and at the Illinois Department on Aging. Stage 3 is a wide scale demonstration test of the web-based EADSS.

The project team includes Kendon J. Conrad, Ph.D., Principal Investigator, and Madelyn (Micki) Iris, Ph.D., Co-Principal Investigator, and Jessica Mazza, Research Assistant.

The project evolved through a serendipitous encounter. Dr. Iris had been involved in evaluating one of the demonstration sites Illinois had funded to test models of its elder abuse program. She became very interested in protective services for older adults. Dr. Conrad specialized in measurement theory and development, with a background in Gerontology. He had developed a money mismanagement measure for the seriously mentally ill. Dr. Conrad was displaying results of this research at a poster display session that Dr. Iris was attending, and they immediately saw how their work would complement each other’s. Thus began their collaboration.
The fact that elder abuse exists is a harsh reality of our society. In the most recent National Elder Abuse Incidence Study (2009), researchers who interviewed a randomized sample of almost 6,000 elderly respondents found that over 10% reported emotional, physical or sexual mistreatment or potential neglect during the previous year. According to Dr. Iris, “That number increases every year with the aging Baby Boomer population and more people choosing to age in their homes.” With cuts in critical services added to the mix, conditions are perfect for this problem to escalate. New methods of reporting and care planning are needed to manage the rise in elder abuse in a cost-efficient, knowledge-based way.

How does the decision support system work? Designed to detect physical, emotional, sexual, or financial abuse or neglect, the EADSS uses a screening tool to assess suspected abuse. Staff or providers use web-based measures to interview alleged victims, family, friends, neighbors and alleged abusers. For example for financial abuse screening an interviewer asks such questions as: “During the last 12 months, has ____ lied about how they were spending your money?” and “During the last 12 months, has _____ demanded money from you?” The staff inputs responses, they are recorded, and the web-based system generates a standardized assessment with qualitative and quantitative reports, including a written report with recommendations for interventions and care planning.

Drs. Conrad and Iris tackled this problem because the growing problem of elder abuse had to be managed. As Conrad, the measurement expert, emphasizes, “If you can’t measure it you can’t manage it.” However, measuring elder abuse posed problems. The outcomes of assessments rested heavily upon the skill, knowledge and experience of the person doing the assessment. With high staff turnover, agencies often lost experienced people, and novices had to perform the assessments. In a study at Michigan State (K. Taylor, et al), it was found that one of the barriers to reporting elder abuse was the lack of understanding about reporting procedures. Up to now the quality of the assessments was always questionable.

This decision support system is highly significant because better assessment will help to improve care planning and programming designed to reduce and prevent elder abuse. Also, when many states use EADSS, prevalence studies and research reports will have larger and more representative samples. Besides, there are many benefits  to standardization: A lot of valuable time is spent on the assessment process. (Often, more than half of the time spent with the client is spent on assessment.) Also, through the system, some order is brought to the process of intervention. Where there was previously a disconnect between the stages of diagnosis and intervention, the system is able to help with recommending an intervention and building some connection between the two stages.

The project is unique in many ways. It not only measures the existence of abuse, but also the severity of abuse. In addition, it focuses attention on the abuser and the dynamics of the relationship beyond the abuse itself: The team has developed some measures coming from a strength-based application and dealing with the notion of family preservation (borrowed from child abuse models). “Because so many abusers are family members or care givers, there’s a value to maintaining and supporting that relationship and turning it in the right direction. This is much more preferable than getting rid of the abuser, because the victim will possibly end up in a nursing home,”said Iris.

Thus, decisions made through elder abuse assessments can have serious consequences. Fortunately, this project arms us with the proper tools for measuring and managing elder abuse to avoid unnecessary mistakes and missteps. Stay tuned for EADSS’ completion and how its use grows. 



About the Investigators

Madelyn (Micki) Iris, Ph.D., is Director of the Leonard Schanfield Research Institute at CJE SeniorLife and Adjunct Associate Professor at Northwestern University, in the Department of Anthropology and at the Feinberg School of Medicine’s Department of Psychiatry and Department of Preventive Medicine. She was recently awarded the 2012-2013 Rosalie Wolf Memorial Award from the National Committee for the Prevention of Elder Abuse. For the last 30 years, her work has been multi-focused, combining social program evaluation projects with applied research studies, almost all within the field of aging. Her particular areas of interest are protective services (guardianship, elder abuse, self neglect), and Alzheimer’s Disease. Dr. Iris received her bachelor’s degree in English and a doctorate in Anthropology from Northwestern University.

Kendon J. Conrad, Ph.D., is Professor Emeritus, School of Public Health, University of Illinois at Chicago and Senior Analyst, Chestnut Health Systems, Normal, IL. With interests in long-term care, mental illness, substance abuse, and measurement, he has been the leader on grants from many federal agencies and private foundations. Dr. Conrad received his doctorate in public policy analysis and a post-doctoral master of science degree in public health from the University of Illinois at Chicago.