Evaluating the Feasibility of a Clinical Protocol to Address Elder Mistreatment

Challenge

Elder mistreatment—whether physical, financial, emotional, or sexual—is consistently found to affect at least 10% of older adults. Yet in emergency departments (EDs), one of the few places where older adults can be evaluated by trained clinicians, only 1 in 10 cases of elder mistreatment are identified and referred for assessment.

To address this gap, the National Collaboratory to Address Elder Mistreatment (Collaboratory)—a multi-disciplinary group of leaders in the fields of geriatrics and gerontology led by EDC—developed a comprehensive care model that EDs can use to address elder mistreatment. EDC is evaluating whether diverse EDs are able to implement the model and how use of the model affects (1) staff ability to identify and manage cases of elder mistreatment and (2) overall ED functioning.

Key Activities

EDC collaborated with six hospital EDs to conduct a mixed-methods evaluation that included the following activities:

Implement the Elder Mistreatment Emergency Department Assessment Profile to identify strengths and gaps in best practice
Train staff on the basics of elder mistreatment and how to administer brief and triggered screening tools
Evaluate changes in staff knowledge, attitudes, and efficacy prior to and following their training participation
Interview key staff at each site immediately after implementation and again at six months into implementation
Leverage Collaboratory expertise to provide regular and ongoing technical assistance on protocol implementation
Facilitate quarterly cross-ED meetings to share implementation lessons, challenges, and success stories
Guide rapid cycle testing of care model iterations and promote resultant midstream adaptations
Collect hospital-level ED data on older adult patients who were screened, identified as at risk, reported to Adult Protective Services, and referred to community resources
Document patient-level risk factors, ED response, and tool utility based on completed screenings

Impact

Findings from the evaluation provided the following:

Data that the Collaboratory can use to refine program elements and prepare for wider dissemination
Tried and tested tools and processes that other EDs can use to implement the new care model