The purpose of the study was to examine the effectiveness of a multidisciplinary team (MDT) intervention - the Los Angeles County Elder Abuse Forensic Center to: 1) prosecute elder abuse, 2) protect vulnerable older adults through conservatorship, and 3) reduce or prevent recurring cases of abuse.
The study used a quasi-experimental design and focused on elder abuse cases involving victims aged 65 or older reviewed at the Los Angeles County Elder Abuse Forensic Center (the Center) between April 1, 2007 and December 31, 2009. These Center cases were compared to a propensity score match sample of Los Angeles County Adult Protective Services (APS) cases.
The initial dataset used for this study was obtained from a database that tracked the core information from all cases seen at the Center from its inception. The propensity match and the core of the evaluation was based on an electronic case intake dataset provided by the APS. This database contained every report (intake) made to APS from April 16, 2007 through December 31, 2009.
Data for cases from the matched sample were augmented with information extracted from the APS case files. The physical case files were pulled, copied, and redacted by APS staff and interns, and the data were entered by the research project team. More complete data on recurrence patterns of each client in the study were extracted from the APS electronic database by APS interns and used to augment the intake data's recurrence patterns.
Data about case prosecution was gathered directly from records of the District Attorney's Office, in conjunction with office staff members. Data about client conservatorship was gathered by the Office of the Public Guardian staff and transmitted directly to the project research team.
The Los Angeles County Elder Abuse Forensic Center (the Center) team heard 316 cases during the study period, 287 of which involved clients aged 65 and over. These cases were propensity score matched using a database of 33,650 Los Angeles County Adult Protective Services (APS) cases consisting of clients aged 65 and older. Matching variables were selected from available administrative electronic data; after five stages backward variable selection, the model's variables were age, race/ethnicity, APS office (16 geographic categories), total number of abuse types reported (maximum of 9 types), and dichotomous variables for select types of abuse (financial, neglect, self-neglect, isolation, physical, and financial-neglect interaction). There were no significant differences between the Center group and the final propensity score matched group.
All elder abuse cases involving victims aged 65 or older reviewed at the Los Angeles County Elder Abuse Forensic Center and Los Angeles County Adult Protective Services between April 1, 2007 and December 31, 2009.
The propensity score-matched sample dataset (Matched Dataset, 55 variables, n = 570) includes variables on abuse type (physical, sexual, abduction, neglect, abandonment, isolation, financial, and self-neglect), respondent demographics (sex/gender, race/ethnicity, current living situation, marital status, and age) and case referral/reporting source (law enforcement, senior program agency, home health agency, hospital, mental health center, landlord, neighbor, friend, or relative). Prosecution variables included whether a case was submitted to the District Attorney for review, whether criminal charges were filed, whether guilt was established by plea or conviction, sentencing information, and time from APS opening the case to filing and from filing to case closure. Conservatorship variables include whether the case was referred for conservatorship, whether conservatorship was granted, and if so whether it was public conservatorship of the person and estate, just the estate or a third-party, if conservatorship was deemed unnecessary (informal supports, client was self-sufficient or in a facility), and if the case was closed due to client death. Finally, the data include variables on the client's recurrent cases in the 365 days prior to the baseline and 365 after the closure of the baseline case.
The recurrence data (Recurrence Data, 9 variables, n = 1098) includes information about whether the case was seen at the Elder Abuse Forensic Center, whether the case is the baseline case for the client, days before case closure, gap between baseline case date of report and current case's date of report, gap between the baseline case date of closure and current case date of report, gap between baseline case date of report and current case date of closure, and gap between baseline case date of closure and current case date of closure.
The Los Angeles County Adult Protective Services (APS) case file closing summary form data (Closing Summary Data, 82 variables, n = 370) includes findings of self-neglect or abuse and neglect by others (physical, medical, health and safety, sexual, financial, isolation and abandonment), outcomes accomplished (adequate medical care, adequate income, adequate housing, adequate nutrition, and reduction of self-imposed isolation), reason for case closure (including unable to locate client, client deemed to not be in danger, client did not consent to services, services no longer needed, transfer to another agency, and client deceased), and support services and resource now in place (including care management, legal services, mental health services, transportation, home health services and nursing home care).
The APS case file SOC-341 form data (SOC-341 Data, 43 variables, n =825) includes demographic information (client age and gender, suspected abuser age), the relationship of the reporting party to the client, the relationship between the suspected abuser and the client (care custodian, parent, son or daughter, spouse, health practitioner or other), type of abuse reported (assault, constraint or deprivation, sexual assault, over or under medication, neglect, financial abuse, and self-neglect), type of referring agency and cross-reporting.
The APS case file service plan form data (Service Plan Data, 13 variables, n = 226) includes variables on the priorities and desired outcomes such as eliminating or reducing the risk of danger from abuse, adequate medical and psychiatric care, adequate nutrition, adequate income and housing, and reduction in self-imposed isolation. Other variables include planned frequency of face-to-face and telephone contact and the length of time the case is expected to remain open.
The APS case file activities form data (Activities Data, 6 variables, n = 1258) includes variables that track the frequency, duration, order and desired outcome of specific activities recorded on the APS Service Plan.
The APS case file risk assessment data (Risk Assessment Data, 41 variables, n = 590) includes client demographic variables (age, gender, marital status), type of assessments with a case, whether law enforcement assisted in the assessment, reasons client was not interviewed (case was closed, unable to locate client, client moved, or client was deceased), eligibility of the client to receive adult protective services, risk factors for the client (physical health diagnoses, mental health diagnoses, cognitive functioning, problem behaviors, income resources, adequacy of medical and psychiatric care, adequacy of support from friends and family, frequency and severity of the abuse, and the interaction between the client and alleged abuser).
The APS case file SOC-343 form data (SOC-343 Data, 29 variables, n = 330) includes variables on the agencies involved, the types of abuse allegations (physical abuse, financial abuse, neglect, abandonment, isolation, abduction, psychological abuse, and self-neglect) and the investigation findings (physical abuse, sexual abuse, financial abuse, neglect, abandonment, isolation, abduction, psychological abuse, and self-neglect).