A Novel Intervention to Identify and Report Suspected Abuse in Older, Primary Care Patients

BACKGROUND: Previous research has identified several barriers faced by clinicians in detecting and reporting elder abuse, such as lack of knowledge about the process to report suspected cases of abuse and lack of access to experts to consult with. A novel intervention was designed and tested that embedded two Adult Protective Services (APS) specialists in a healthcare system operating primary care clinics serving a large Medicare population. OBJECTIVES: To examine the types of roles the APS specialists played in the healthcare system and the number and types of cases of suspected abuse among older patients that clinicians consulted them about and reported to APS. DESIGN: Cross-sectional, exploratory study. SETTING: Primary care clinics in five regions of Texas. PARTICIPANTS: Older patients of primary care clinics. INTERVENTION: APS specialists and project staff trained clinicians on how to identify and report abuse, neglect, and exploitation among older patients. The specialists were also available in person or by telephone and email to consult with clinicians about patients suspected of being abused by others or being self-neglecting. MEASUREMENTS: Data were obtained by conducting semistructured telephone interviews with APS specialists; and from APS specialists' written documentation/notes of consultations with clinicians regarding suspicion of abuse among patients and whether a report to APS was warranted. RESULTS: The APS specialists trained clinicians on abuse, consulted with clinicians, and served as a liaison between the healthcare system and APS. During the project, clinicians reported 529 older patients to APS, and 386 patients received one or more services documented by APS at case closure. These cases involved 902 allegations of various types of abuse, of which the most common was self-neglect (617 or 68%). CONCLUSION: Embedding APS specialists in a large healthcare system led to clinicians' increased awareness of the importance of identifying and reporting elder abuse, particularly self-neglect. J Am Geriatr Soc 68:1748-1754, 2020.