Multidisciplinary Healthcare Providers’ Perspectives on Managing Suspected Elder Abuse in the Healthcare Setting

Abstract Elder abuse (EA) is common and has devastating health consequences, yet is rarely detected by healthcare professionals. Veterans are at high risk for EA, and the VA has unique resources (e.g., comprehensive social work services) that can help address EA in the healthcare setting. This qualitative study aimed to assess perceived barriers and facilitators to detecting, reporting, intervening on and monitoring EA for VA providers. Providers from two VA facilities were recruited to participate in a one-on-one semi-structured interview. Transcripts of audio-recorded interviews were analyzed using thematic content analysis. Participants (n=22) were 82% female, age 33-64 years, had 4-25 years practicing in VA, and varied in discipline (e.g., nurse, physician, social worker) and practice setting (e.g., emergency department, geriatrics, primary care). For detecting EA, patient and caregiver cognitive impairment were frequently cited barriers, while an interdisciplinary team approach and ability to do home visits were noted facilitators. Common challenges with reporting EA to adult protective services (APS) were perceived lack of APS follow up and discrepancies in VA provider and APS investigator findings. While removing a patient from an unsafe living situation was a frequently cited successful intervention, providers also expressed feeling conflicted when infringing on patient autonomy. Poor communication with APS, patient loss to follow up, and caregiver interference made monitoring EA cases more difficult; intensive case management and in-home services facilitated monitoring. In conclusion, healthcare professionals see interdisciplinary care, in-home care, and better coordination with APS as key facilitators to managing suspected EA in the healthcare setting.


RISING STAR EARLY-CAREER FACULTY AWARD LECTURE Chair: Cynthia Hancock
The Rising Star Early-Career Faculty Award lecture will feature an address by2020 recipient Laurinda Reynolds, MA. The Rising Star Early-Career Faculty Award acknowledges new faculty whose teaching and leadership stand out as influential and innovative.

DECONSTRUCTING AGEISM Laurinda Reynolds, American River College, Sacramento, California, United States
Fifty years of ageism research has identified the psychosocial subconstructs and consequences of ageism and produced over 30 published definitions. However, some educators still define ageism as age discrimination or prejudice against one age group by another age group. This oversimplification provides camouflage for insidious ageism, messages that are not recognized as harmful by their source or by the target of the ageism message. This type of ageism message cultivates implicit fears of aging and negative self-perceptions, and because they are not recognized, they undermine efforts to reframe aging. This presentation deconstructs ageism to make this extremely complex phenomenon clear without oversimplifying its nature or understating its consequences. It differentiates ageism from youthism through their developmental processes, persistence, and consequences. Knowledge will be integrated and synthesized across disciplines using a biopsychosocial lens. Examples of insidious ageism are presented to increase one's capability to recognize and avoid insidious ageism. COVID highlights the importance of accurate estimates of the risk of elder abuse to guide prevention. Reliability of data is problematic; reports have issues with consistency of definitions, time periods, and stigma. This paper demonstrates the use of US Census data to estimate risk of elder abuse by mapping generational incongruities between care-givers and care-receivers that invite dissonance (Cohen, 2011). Using the 2014-2018 Nebraska Public Use Microdata and 5-year American Community Survey, this research identifies and profiles personal care aides/nursing aides for institutionalized persons (65+). Data reveal generation gaps in age, education, and race between care-receivers and care-givers that are geographically comparable in the three most populous counties (the Big-3), but different for the 90 rural counties. In Nebraska's Big-3 Counties the difference in education between care-givers (ages 25+) and care-receivers (65+) is considerable; 42.9% of Big-3 care-givers have some college, while 43.6% of care-receivers have only high school. Intergenerational differences in education are greater in Nebraska's 90 rural counties than in the Big-3; 41.2% of rural care-givers have some college; 46.1% of rural care-receivers have only high school. Racial intergenerational differences are greater in Big-3 than in rural counties; 90.3% of care-receivers and only 62.3% of care-givers are non-Hispanic White. For rural Nebraskans, intergenerational differences in race are smaller, 97.2% of care-receivers and 79.4% of caregivers are non-Hispanic White. This type of analysis can be used to identify geographic settings where elder abuse is most likely to happen and guide the development of preventive measures that mitigate elder abuse.
qualitative study aimed to assess perceived barriers and facilitators to detecting, reporting, intervening on and monitoring EA for VA providers. Providers from two VA facilities were recruited to participate in a one-on-one semi-structured interview. Transcripts of audio-recorded interviews were analyzed using thematic content analysis. Participants (n=22) were 82% female, age 33-64 years, had 4-25 years practicing in VA, and varied in discipline (e.g., nurse, physician, social worker) and practice setting (e.g., emergency department, geriatrics, primary care). For detecting EA, patient and caregiver cognitive impairment were frequently cited barriers, while an interdisciplinary team approach and ability to do home visits were noted facilitators. Common challenges with reporting EA to adult protective services (APS) were perceived lack of APS follow up and discrepancies in VA provider and APS investigator findings. While removing a patient from an unsafe living situation was a frequently cited successful intervention, providers also expressed feeling conflicted when infringing on patient autonomy. Poor communication with APS, patient loss to follow up, and caregiver interference made monitoring EA cases more difficult; intensive case management and in-home services facilitated monitoring. In conclusion, healthcare professionals see interdisciplinary care, in-home care, and better coordination with APS as key facilitators to managing suspected EA in the healthcare setting.

PERCEIVED SOCIAL SUPPORT AND HELP-SEEKING AMONG U.S. CHINESE OLDER ADULTS WITH ELDER MISTREATMENT
Ying-Yu Chao, 1 Dexia Kong, 2 and XinQi Dong, 2

Rutgers School of Nursing, Newark, New Jersey, United States, 2. Rutgers University, New Brunswick, New Jersey, United States
Background/Purpose: Older immigrants are at risk of experiencing marginalization and social exclusion. Traditional Chinese culture values could deeply influence the older Chinese immigrants' perceptions regarding mistreatment and motivating them to seek help. This study aimed to examine the associations between perceived social support and informal/formal help-seeking intentions and behaviors among U.S. Chinese older adults experiencing elder mistreatment. Methods: Data derived from the Population Study of Chinese Elderly in Chicago (PINE). Independent variables were positive and negative perceived social support. Dependent variables were informal/formal help-seeking intentions and behaviors. Descriptive statistics and logistic regression analyses were performed. Results: A total of 423 participants experienced elder mistreatment (mean age: 72.4 ±7.88 years old). The most common informal help-seeking sources were adult children, followed by partner, and friends/neighbors/ colleagues. The most common sources of formal help-seeking were community social services organizations and the legal criminal justice system. After controlling for covariates, positive perceived social support was associated with informal help-seeking intentions (OR=1.14, 95% CI: 1.05-1.24, p < .01) and behaviors (OR=1.12, 95% CI: 1.04-1.22, p < .01).
However, the associations between perceived social support and formal help-seeking intentions and behaviors were not significant. Conclusions & Implications: Further research is needed to examine the mediating effects of cultural values on the relationship between perceived social support and help-seeking among mistreated older Chinese immigrants. In addition, additional studies are needed to identify impede or facilitate factors of informal/formal elder mistreatment help-seeking. Prevention and intervention programs should incorporate valuable cultural insight to improve help-seeking among this population. Ariunsanaa Bagaajav, The Graduate Center, CUNY, New York, New York, United States Every year, approximately 10% of older adults worldwide experience elder abuse (EA), a serious violation of human rights. A wide range of consequences of EA have been identified including increased vulnerability to morbidity and mortality. Some countries have regulations to protect victims of EA either under stand-alone EA laws or relevant laws such as mandatory reporting. As of 2016, family physicians (FPs) in Mongolia became mandatory reporters of domestic violence alongside other human service workers under the newly amended Law to Combat Domestic Violence. Evidence shows that health providers who report abuse cases have greater awareness of their mandatory obligations to report. No rigorous study has explored the extent to which FPs in Mongolia know about mandatory reporting and their perceptions about its effectiveness to help victims of EA. An exploratory qualitative study was conducted. Through purposive sampling, 15 FPs participated in semi-structured in-depth interviews. The data collection took place over Skype. All interviews were recorded, transcribed verbatim and analyzed using thematic analysis. Surprisingly, all participants were aware of their mandatory obligations to report cases of domestic violence including EA. However, the study revealed that FPs were doubtful that potential victims of EA would be effectively protected under the new regulation due to the public perception that services and legal resources are designed primarily for women and children. Addressing this misconception is critical for ensuring that resources are appropriately utilized for potential victims of EA as well.

SUCCESSFUL INFORMAL HELP-SEEKING AND RESOLUTION OF ELDER FAMILY FINANCIAL EXPLOITATION: A CASE STUDY
Tina Kilaberia, 1 and Marlene Stum, 2 1. UC Davis Health,Sacramento,California,United States,2. University of Minnesota,Twin Cities,Saint Paul,Minnesota,United States Effective interventions are needed to address elder family financial exploitation (EFFE), one of the most prevalent types of elder abuse globally. This poster examines the unique and critical help-seeking role informal family support