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Initially funded in 2013 by the National Institute of Justice, the primary purpose of this project was to conduct a randomized-control test of the impact of a victim-focused, forensic collaborative relative to usual care (UC) on older adult victims' health, mental health, and criminal justice outcomes. During the course of the project, researchers responded to enrollment and consent challenges by implementing Arm 2 that focused on collecting caseworker and victim advocate perceptions of cases as well as administrative data from Adult Protective Services (APS).

This collection contains 6 datasets:

• Arm 1 (DS1) contains survey results from victim-focused interviews of 40 older adults who were reported to be victims of abuse, neglect, and/or financial exploitation over 4 time points. Variables describe victim and case characteristics, service use/needs, risk factors for abuse, consequences of abuse and exploitation, and criminal justice process and outcomes.
• Arm 2 (DS2) includes a survey of APS caseworkers reporting on a case of older adult abuse, such as client (older adult victim) and perpetrator demographics, mistreatment details (verbal abuse, physical abuse, sexual abuse, neglect, financial exploitation, and/or housing exploitation), and service use.
• Collateral assessments (DS3) surveyed a trusted individual related to the older adult respondent in Arm 1. This included data on the perceptions of the older adult's functioning and use of services; and the quality of decision-making procedures, desired treatment, and outcomes in the criminal justice system. Of the 40 Arm 1 participants interviewed, 33 gave collateral contact information. Of those 33, 16 could not be reached, one failed the consent quiz, and two declined to participate. Of the 14 who participated in an initial interview, only three participated at the follow-up nine months later.
• Revictimization and Prosecutorial Outcome Data (DS5) includes information on new incidents reported to law enforcement over the nine months following the original incident report and prosecution outcomes, gathered from publicly-accessible police reports and court information for Arm 1 and Arm 2 cases.
• APS administrative data (DS6), such as the demographics of the older adult victim and the primary perpetrator, assessment scores for risk and safety, the alleged mistreatment type, whether mistreatment was substantiated, and APS case status. The data included overall risk/safety scores and summary scores for the domains of physical functioning, environmental context, financial resources, mental health, cognition, medical issues, and mistreatment.

Arm 1 demographic variables includes age, gender, education, employment status, marital status, household size, ethnic minority, and income source. Arm 2 surveys reported ethnicity, gender, age, education, marital status, and employment status; APS data reported age and gender.

Estimates suggest that up to 16% of American adults--approximately 40 million people--fall victim to mass marketing scams each year. Mass marketing scams include any attempts to fraudulently solicit money from consumers through mass communication methods, such as the internet, telephone, and mail. Complaints to consumer protection agencies have risen 240% in the past 10 years (Federal Trade Commission [FTC], 2013, 2023). According to conservative estimates from the most recent Consumer Sentinel Network Report (FTC, 2023), Americans reported more than $2.7 billion in direct losses from fraud in 2022. In addition to financial costs, consequences to victims include feelings of shame and embarrassment, loss of trust, depression, and, in the most severe cases, suicidal ideation. These consequences of fraud are particularly impactful for older adults who suffer higher losses per incident, on average (FTC, 2022) and face greater challenges recovering from losses after retirement. Research on elder mistreatment in general has shown that older victims consume 30% more mental health and substance abuse services and are hospitalized more often than non-victims.

These scams convince susceptible targets that they have won bogus sweepstakes, merchandise, free vacations, or lotteries, but they first need to pay money to claim their winnings. Based on data from one major investigation from 2011 to 2016, the United States Postal Inspection Service (USPIS) found that Americans sent $558 million in checks, credit card payments, and money orders through the mail in response to such scams (USPIS internal data). Overall, the USPIS estimates that 3% of U.S. adults--7.5 million Americans--have mailed a payment in response to mass marketing fraud and that 60%-70% of these individuals are revictimized by a similar solicitation or an entirely different offer. Given these figures, reducing the incidence of mass marketing fraud could save millions of dollars annually.

Although the FTC, the National Council on Aging, the Consumer Financial Protection Bureau, the Better Business Bureau, American Association of Retired Persons (AARP), and other agencies and organizations routinely disseminate fraud education and awareness materials, it is unclear how much of these materials reach the most vulnerable populations. Much of the content is available online, yet according to the Pew Research Center, only 75% of adults older than age 65 use the internet, and only 64% have home broadband. Printed materials are also disseminated at senior centers, libraries, legal service offices, and outreach events, but older adults who are socially isolated and most susceptible to fraud are unlikely to be reached through these venues.

To address gaps in intervention research, Research Triangle Institute (RTI) International and the University of Minnesota conducted the Mass Marketing Elder Fraud Intervention (MMEFI) Study with collaboration and support from the USPIS. This multiphase research project included a secondary analysis of USPIS administrative data on prior scams and a randomized controlled trial test of the efficacy of two variations of a mailed intervention for preventing revictimization by mail fraud. The overall objective was to provide specific policy recommendations to the USPIS and other consumer protection agencies regarding the effectiveness of a mailed intervention. The MMEFI Study had the following specific goals:

• Enhance knowledge and understanding of repeat victimization among older victims of mass marketing scams.
• Engage in rigorous testing of the efficacy of two versions of a fraud intervention strategy geared toward preventing repeat victimization among older victims of mass marketing scams.
• Assess victims' perceptions of the intervention and collect self-report data on experiences with other types of fraud by surveying individuals in the intervention study.

The National Home and Hospice Care Survey (NHHCS) was reintroduced into the field in 2007 after a 7-year break. During that time, the survey was redesigned and expanded to include a computer-assisted personal interviewing (CAPI) system, many new data items, and larger sample sizes of current home health patients and hospice discharges. All agencies that participated in the survey were either certified by Medicare and/or Medicaid or were licensed by a state to provide home health and/or hospice services and currently or recently served home health and/or hospice patients. Agencies that provided only homemaker services or housekeeping services, assistance with instrumental activities of daily living (IADLs), or durable medical equipment and supplies were excluded from the survey. The 2007 NHHCS included a supplemental survey of home health aides employed by home health and/or hospice agencies, called the National Home Health Aide Survey (NHHAS). The 2007 NHHCS data were collected through in-person interviews with agency directors and their designated staffs; no interviews were conducted directly with patients or their families and/or friends. Agency data collected, available in agency administrative records, included information on the year an agency was established, the types of services an agency provided, referral sources, specialty programs, and staffing characteristics. Data collected on home health patients and hospice discharges, available in medical records, included age, sex, race and ethnicity, services received, length of time since admission, diagnoses, medications taken, advance directives, and many other items.

The National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides, was designed to provide national estimates of home health aides employed by agencies that provide home health and/or hospice care. The NHHAS survey instrument included sections on recruitment, training, job history, family life, management and supervision, client relations, organizational commitment and job satisfaction, workplace environment, work-related injuries, and demographics.

Over the past two decades, as the proportion of older Americans has increased, so too have instances of elder abuse, including physical, emotional, and sexual abuse; financial exploitation; and caregiver neglect. The most recent national survey estimates show at least 1 in 10 community-residing older adults experience elder abuse each year, which translates to over 7 million Americans annually. Rates of abuse are magnified for older adults with the least financial and social resources, including those with low incomes, living in isolated rural communities, and facing structural barriers such as systemic racism. Emerging research on the COVID-19 pandemic prompts even greater concern for elder abuse: the virus has disproportionately affected older adults, resulting in increased social isolation, physical health impairment, and exposure to COVID-related fraud.

Recognizing the urgent need to develop and rigorously evaluate programs aimed at preventing elder abuse, the US Department of Justice's National Institute of Justice funded a demonstration from 2017 to 2021 during which researchers from the Urban Institute and practitioners at the Phoenix-based Area Agency on Aging, Region One ("the Area Agency") co-developed an elder abuse prevention program in Maricopa County, Arizona, which Urban's team then evaluated through a randomized controlled pilot study. This multiphase demonstration included an initial planning phase and a subsequent pilot study, which is the focus of this report.

The EMPOWER: Building Late-Life Resilience program is a 12-week in-home intervention, with one-hour weekly visits designed to empower community-residing older adults with the resiliency and resources to lead safe and healthy lives throughout the aging process. EMPOWER provides one-on-one assessments, client-centered prevention education, and needs-responsive life skills training embedded in a series of cognitive reframing conversations with an experienced facilitator. The program has eight modules, each of which culminates in an action plan focused on strengthening a client's internal assets and identifying sources of positive social support. Caseworkers facilitate motivational discussions centered on clients' self-identified goals and action planning, with the aim of optimizing clients' home safety, physical health, social connectedness, and emotional and financial well-being.