Victims Of Elder Abuse Research Articles

The Critical Help-Seeking Role of Family, Friends, and Neighbors in the Lives of Elder Abuse Victims

Elder abuse prevention and intervention is a complex puzzle. We focus on examining the typically invisible role, experience, and impact of nonabusing family, friends, and neighbors, or “concerned persons” in stopping elder abuse. Given the reality that most elder abuse goes unreported and unaddressed, it seems essential to understand if and how concerned persons can play a role in help-seeking for older victims, and to also understand the needs and issues faced by concerned persons as a consequence. First. Breckman presents evidence of the significant distress concerned person’s experience from knowing about elder abuse and trying to assist victims, and shares experience developing and implementing the first Elder Abuse Helpline for Concerned Persons in the U.S. Second, Fraga Dominguez et.al. present an important international perspective highlighting findings about concerned persons as users of a UK elder abuse helpline, their profile, the impact of helping, and variables relating to help-seeking. Third, Stum shares findings from a qualitative study of elder family financial exploitation related to what concerned family members were trying to accomplish by getting involved (motivating goals) and the resulting continuum of outcomes. Fourth, Kilaberia also explores the help-seeking experiences of concerned family members in elder family financial exploitation situations, specifically the range of tasks involved, and the impacts on the concerned family member’s individual health and well- The discussion led by Burnes will focus on understanding contributions of the research presented given the current state of the field, and offer suggestions for future research and intervention directions.

What Are the Most Distressing Aspects of Experiencing Elder Abuse? Findings From a Qualitative Study With Victims

Adult protective services and other community-based agencies respond to hundreds of thousands of elder abuse cases annually in the United States; however, few studies include elder abuse victims’ voices. This study explored the most distressing aspects of elder abuse, as identified by victims themselves; to date, this is the first known study on this topic. Guided by a phenomenological qualitative methodology, this study conducted in-person, semi-structured interviews with a sample of elder abuse victims (n = 30) recruited from a community-based elder abuse social service program in New York City. To enhance trustworthiness, two researchers independently analyzed transcript data to identify key transcript codes/themes. Distressing aspects of elder abuse were identified across three key domains, related to feelings of loss (50% of codes), threats/negative consequences (55%), and client-needs/system incongruity (14%). Specifically, the first theme represented outcomes related to loss of relationships (19% of ‘loss’ codes), personhood (16%), credibility (19%), faith/trust in others (38%), and finances (8%). The second theme looked at threats to physical self (34% of ‘threat’ codes), psyche (39%), and others, including the perpetrator (27%). The third theme focused on mismatches in client/system goals (50% of ‘incongruity’ codes) and legal system involvement (50%). The findings in this study provide a comprehensive and conceptually organized range of aspects to serve as infrastructure for the development of meaningful interventions to address the needs of victims. This study represents one of the largest efforts to understand and integrate the perspectives and needs of victims into elder abuse intervention practice/research to date.

Interpersonal Violence: a Review of Elder Abuse

We review the underappreciated problem of elder abuse with a focus on what trauma surgeons need to know. Because of its prevalence, it is important that clinicians understand types of elder abuse, risk factors in patient and perpetrator, prevention strategies, and the appropriate referral and treatment of potential victims of elder abuse. Elder abuse affects at least 10% of older individuals in the USA. Despite much effort to address the problem via legal and societal approaches, data to support particular programs are poor. And even with extensive efforts, the utility of established prevention strategies or existing screening tools to identify victims of elder abuse in the acute care setting has yet to be established. Elder abuse is a public health problem. As a society, we have only begun to define the extent of the problem. Healthcare systems have failed to effectively prevent or to accurately screen for, diagnose, and report elder abuse. The next steps include broader public awareness, educational initiatives, improved screening tools, and effective intervention strategies. In the meantime, we as trauma surgeons can be more diligent in reporting.

Guidelines for Advancing Clinical Social Work Practice Through Articulating Practice Competencies: The Toronto Simulation Model

Knowledge for clinical social work practice is ever evolving and consists of underlying explanatory concepts, practice models, and intervention skills. Conceptualization and identification of competencies for practice provides a bridge from knowledge and understanding to actual skills needed in clinical sessions. Articulating competencies also guides education of students and provides grounded skills and behaviors needed for clinical research. Analysis of simulation-based practice provides a useful methodology to identify generic practice competencies as well as competencies in specialized fields of practice. This paper presents a simulation education model and illustrates how the use of simulation enabled clinical scholars to articulate core competencies in specialized areas of social work practice. Case examples and related competencies for practice with adolescents, victims of elder abuse, and in mental health practice will demonstrate this process. Examples are drawn from reflections on practice wisdom, analysis of experienced social work practitioners, and relevant literature. Resulting competencies contribute to scholarship for clinical practice.

A scoping review of outcomes in elder abuse intervention research: The current landscape and where to go next

Researchers, practitioners, and policy-makers worldwide recognize elder abuse (EA) as a major threat to the health and well-being of older adults, but rigorous intervention research has greatly lagged behind this interest. A major weakness is the lack of cohesive understanding of appropriate program outcomes to be measured. To address this knowledge gap, we conducted a scoping review of the EA intervention research literature to understand the range of outcomes considered to date and to provide guidance for future research. We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, Ovid Social Work Abstracts, Ebsco AgeLine, Ebsco CINAHL, Wiley Cochrane Central, and Proquest Sociological Abstracts for studies evaluating community-based EA response programs. Two independent reviewers completed record search, screening, and data extraction procedures. We identified 52 eligible studies (1986–2019) that employed a total of 184 outcomes (range: 1–16, mean = 3.5). This study revealed that a large range of outcomes has been employed in EA intervention studies to date, mostly attached to victims or the intervention process itself, with inconsistent operational definitions and measurement procedures. Several key recommendations for future EA intervention research are: 1) implementing intervention outcomes that reflect multiple levels of eco-systemic influence, 2) heightening the analysis of intervention process outcomes beyond description toward modeling them as factors that mediate or moderate successful case outcomes, 3) conducting qualitative research with EA victims and other relevant stakeholders to understand meaningful intervention outcomes from their perspectives, and 4) establishing common EA outcome measures for implementation across studies to facilitate greater data pooling and synthesis.

Association between personality traits and elder abuse in a community-dwelling Chinese population: findings from the PINE study

ABSTRACT Elder abuse is a pervasive public health issue. The relationship between personality traits and elder abuse remains unclear. This study aims to examine the associations between neuroticism, conscientiousness, and elder abuse. Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged study of 3,157 US Chinese older adults in the greater Chicago area from 2011–2013. Elder abuse included psychological, physical, and sexual abuse, financial exploitation, and caregiver neglect. The assessments of neuroticism and conscientiousness were derived from the NEO Five-Factor Inventory. Logistic regression was used. Higher neuroticism (score range: 6–30, OR = 1.14, CI = 1.11–1.18) and lower conscientiousness (score range: 16–60, OR = 0.97, CI = 0.96–0.99) were associated with a higher risk of elder abuse. With respect to different forms of elder abuse, higher neuroticism was associated with an increased risk of psychological abuse (OR = 1.14, CI = 1.10–1.17), financial exploitation (OR = 1.03, CI = 1.00–1.07), and caregiver neglect (OR = 1.06, CI = 1.03–1.09). Higher conscientiousness was associated with a higher risk of financial exploitation (OR = 1.02, CI = 1.00–1.05). Intervention programs could reduce neuroticism and raise conscientiousness of elder abuse victims.

Trauma from Physical and Emotional Sibling Violence as a Potential Risk Factor for Elder Abuse

ABSTRACTOlder adults who are the victims of previous physical and emotional sibling violence may be more vulnerable to acts of elder abuse. Research establishes that elder abuse is traumatic, as is sibling violence. However, little is known regarding the likelihood of victims of sibling violence becoming victims of elder abuse. To date, no research has identified the trauma associated with sibling violence to be a risk factor for experiencing elder abuse. This conceptual article describes the potential influence of trauma due to sibling violence on later vulnerability to elder abuse. The paper presents definitions of sibling violence, elder abuse, etiology, and risk factors as well as descriptions of trauma associated with elder abuse and sibling violence. The impact of the trauma of sibling abuse as a potential risk factor for elder abuse is discussed. Finally, practical implications and directions for future research in this area are presented.

Dental students' perceived and actual knowledge of elder abuse: An online training curriculum.

Elder abuse, defined as emotional, physical, or sexual abuse, financial exploitation, or neglect, is a growing problem. Dental professionals have the unique opportunity to identify elder abuse. However, elder abuse awareness training, targeting dental students, is insufficient and research is limited. This knowledge gap prompted the research team at the University of Tennessee Health Science Center (UTHSC) to develop, implement, and evaluate an online Elder Abuse Awareness Professional Education Training (EAAPET) program, designed to educate dental and other health professionals to recognize, respond to, and report elder abuse. Ninety-six dental students, attending the UTHSC College of Dentistry during the fall semester of 2018, were enrolled. Pre- and post-assessments, designed to assess changes in students' perceived and actual knowledge, were conducted. Paired sample t-test results indicate that the EAAPET program significantly improved students' perception of their abilities to identify, respond to, and report elder abuse. Improvement was also demonstrated within students' actual knowledge of how to appropriately interact with suspected elder abuse victims. Qualitative assessment suggested the training was well received by the students. Based on these findings, the authors recommend that dental schools integrate elder abuse awareness education into their curriculums.

FACILITATORS AND BARRIERS FOR ELDER ABUSE VICTIMS SEEKING HELP: FINDINGS FROM THE NATIONAL ELDER MISTREATMENT STUDY

Understanding help-seeking among victims of elder abuse is a critical challenge in the field. The vast majority of elder abuse victims remain hidden from formal support/protective response systems, such as adult protective services, legal/justice, law enforcement, or other agencies responsible for addressing this issue in the community. Guided by the Behavioral Model of Health Services Use, this study examined factors that facilitate or impede formal help-seeking among victims of elder emotional, physical and sexual abuse, represented by a call for help in the form of a report to police or other authorities. Data came from a national, population-based elder abuse study in the U.S. with a representative sample (n=304) of victims reporting abuse in the past year. Gold-standard measurement strategies were used to assess each elder abuse subtype. Multivariable logistic regression was conducted to identify help-seeking facilitators/barriers. Help-seeking through reporting to police or other authorities occurred among only 15.4% of elder abuse victims nationwide. Help-seeking was predicted by factors attached to the victim (abuse type, poly-victimization), perpetrator (prior police trouble, social network size), and victim-perpetrator relationship (victim dependence on perpetrator). This study highlights the extremely hidden nature of elder abuse in our society, as well as the need to develop strategies that incorporate victim, perpetrator, and victim-perpetrator relationship factors to promote greater help-seeking among victims.

THE NATIONAL ELDER MISTREATMENT STUDY 8 YEARS LATER: VICTIM MENTAL HEALTH OUTCOMES AND PROTECTIVE FACTORS

The purpose of this study was to conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and poor self-reported health. Methodology: Attempts were made to re-contact, via Computer Assisted Telephone Interview, all 752 NEMS participants who reported mistreatment since age 60 at Wave I, as well as a randomly selected sample of non-mistreated NEMS participants Results: 183 NEMS Wave I elder abuse victims and 591 non-victims provided data. In bivariate analyses, elder mistreatment 8 years earlier increased risk of negative outcomes by 200-700%. However, multivariate analyses revealed that Current (Wave II) social support was highly protective against most negative outcomes (excepting PTSD), and even appeared to nullify effects of mistreatment on GAD and poor self-reported health. Conclusions: Outcomes of elder mistreatment have not been studied prospectively in a national sample. The NEMS 8-year follow-up findings indicate a strong relationship between elder mistreatment at Wave I and negative emotional and physical health 8 years later. Fortunately, current (Wave II) social support appears to be both consistently and powerfully protective against most negative outcomes.

WHAT DOES SUCCESS MEAN IN THE CONTEXT OF ELDER ABUSE INTERVENTION FROM THE PERSPECTIVE OF VICTIMS?

Adult protective services (APS) and other community-based agencies respond to hundreds of thousands of elder abuse cases each year in the United States; however, little is known about what constitutes success in the context of elder abuse response intervention. This study explored the meaning of elder abuse intervention success from the perspective of victims themselves toward the development of a victim-centric taxonomy of outcomes. Guided by a phenomenological qualitative methodology, this study conducted in-person, semi-structured interviews with a sample of elder abuse victims (n = 30) recruited from APS in the states of Maine, New York, and California, as well as a community-based elder abuse social service program in New York City. To enhance trustworthiness, two researchers independently analyzed transcript data to identify key transcript statements into themes. Outcomes of success were identified across broad domains related to the victim, perpetrator, victim-perpetrator relationship, family system, and home environment. Specifically, common themes represented outcomes related to victim safety, autonomy, social support, and state of mind; perpetrator independence and accountability; and victim-perpetrator separation. For decades, the field of elder abuse has struggled to understand how to define success in the context of community-based intervention from a client-centered perspective. The taxonomy developed in this study provides a comprehensive and conceptually organized range of successful outcomes to serve as infrastructure for the development of meaningful intervention outcome measures. This study represents one of the largest efforts to understand and integrate the perspectives and needs of victims into elder abuse intervention practice/research to date.

HARNESSING THE POWER OF NETWORKS TO ADDRESS SOCIAL ISOLATION, LONELINESS, DEPRESSION, AND ELDER ABUSE

Challenges to aging and risks to physical health and mortality arise when older adults have untreated mental health needs, experiences social isolation, loneliness, or is a victim of elder abuse. This symposium presents three innovative models that harness the power of networks and collaboration between aging services and an academic medical center to meet the needs of ethnically diverse community seniors. These model programs include: embedded mental health services on-site in community senior centers; Friendly Visiting to homebound seniors; and PROTECT intervention to treat elder abuse victims’ mental health needs. Research from these innovative, collaborative programs indicate that over 50% of senior center members screened positive for depression and anxiety (higher than the national average of 3-20%), social isolation, loneliness, and elder abuse. Of the 75% who engage in treatment, 37.3% and 41% showed a 3-month improvement of depression and anxiety, respectively. For seniors who have a friendly visitor, one-third also suffer from depression and/or anxiety. Three months after being visited by a friendly visitor, 42% and 53% see improvement in loneliness and social isolation, respectively. Among victims of elder mistreatment, 33% screened positive for depression or anxiety and 16% reported suicidal ideation. Clients receiving the PROTECT intervention had a greater decrease in depression, felt services were more useful, and reported greater improvement in the abuse. To find and build strength in age, it is essential that programs and policy be developed to support collaboration and provide the opportunities for building and utilizing networks across different domains of aging.

Prevalence of elder abuse and neglect: screening in Poland families.

Elder abuse and neglect is one of the most important problems of social and health policy among countries around the world. Making a real and reliable assessment of the occurrence of abuse is difficult to implement. The aim of this work is to show the frequency of physical, psychological, sexual abuse and financial exploitation among older adults. Older adults, who were aged ≥ 60years (N = 200) were qualified for the study. The studied population consisted of 112 women (56.0%) and 88 men (44.0%). The whole project procedure only included filling in the survey questionnaire. The verification of hypotheses was based on tests: Chi square test, Chi square test with continuity correction and logistic regression models. Within the obtained own results, out of 200 older adults, 77 respondents (38.5%) experienced abuse and neglect during the last 12months. Most of the respondents (68.8%) experienced various forms of abuse simultaneously. Among those who experienced abuse, 75.3% experienced psychological abuse, 68.8% financial exploitation, 48.1% physical abuse, and 22.1% experienced sexual abuse. The rate of physical (OR 2.48; 95% CI 1.13, 5.44; p = 0.02), verbal (OR 1.94; 95% CI 1.02, 3.67; p = 0.04), sexual (OR 4.05; 95% CI 1.13, 14.5; p = 0.03) and economic (OR 1.98; 95% CI 1.02, 3.83; p = 0.04) abuse is statistically significantly higher, respectively, in women than in men. The level of education is a risk fact for physical abuse (p = 0.02). It has also been shown that singles, people with the income < 233 EUR and people living in urban areas are most often victims of elder abuse and neglect. The results suggest that elder abuse and neglect is a fairly common phenomenon. Our data also provide confirmation of other researches conducted in this area.

Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line.

Characterizing the types of elder abuse and identifying the characteristics of perpetrators are critically important. This study examined the types of elder abuse reported to the National Center on Elder Abuse (NCEA) resource line. Calls were coded with regard to whether abuse was reported, types of abuse alleged, whether multiple abuse subtypes occurred, and who perpetrated the alleged abuse. Of the 1,939 calls, 818 (42.2%) alleged abuse, with financial abuse being the most commonly reported (449 calls, 54.9%). A subset of calls identified multiple abuse types (188, 23.0%) and multiple abusers (149, 18.2%). Physical abuse was most likely to co-occur with another abuse type (61/93 calls, 65.6%). Family members were the most commonly identified perpetrators (309 calls, 46.8%). This study reports the characteristics of elder abuse from a unique source of frontline data, the NCEA resource line. Findings point to the importance of supportive resources for elder abuse victims and loved ones.

Mistreatment of Elders

Elder mistreatment affects a considerable proportion of individuals older than 60 to 65 years of age and may include intentional abuse (physical, sexual, emotional, or financial) and neglect. As the proportion of the population that is older than 65 years of age increases, elder mistreatment will become an increasingly common issue. Only a minority of cases of elder abuse are reported; thus, an interview with the patient should be conducted in private if elder mistreatment is suspected. Patient risk factors for elder mistreatment include cognitive or behavioral impairment, poor physical health, and poor social supports. This review examines the approach to the patient, as well as definitive treatment, disposition, and outcomes for victims of elder abuse. The figure shows an algorithm for elder abuse assessment and intervention. Tables list types of elder abuse, factors predisposing to elder mistreatment, indicators of abuse, and the Elder Abuse Suspicion Index. This review contains 1 highly rendered figure, 4 tables, and 42 references.

LO13: Characteristics of emergency department visits by community-dwelling older adults who screened positive for elder abuse during home care assessments

Introduction: Elder abuse is infrequently detected in the emergency department (ED) and less than 2% are reported to proper law authorities by ED physicians. This study aims to examine the characteristics of community-dwelling older adults who screened positive for elder abuse during home care assessments and the epidemiology of ED visits by these patients relative to other home care patients. Methods: This study utilized a population-based retrospective cohort study of home care patients in Canada between April 1, 2007 and March 31, 2015. Standardized, comprehensive home care assessments were extracted from the Home Care Reporting System. A positive screen for elder abuse was defined as at least one these criteria: fearful of a caregiver; unusually poor hygiene; unexplained injuries; or neglected, abused, or mistreated. Home care assessments were linked to the National Ambulatory Care Reporting System in the regions and time periods in which population-based estimates could be obtained to identify all ED visits within 6 months of the home care assessment. Results: A total of 30,413 from the 2,401,492 patients (1.3%) screened positive for elder abuse during a home care assessment. They were more likely to be male (40.5% versus 35.3%, p &amp;lt; 0.001), to have a cognitive impairment (82.9% versus 65.3%, p &amp;lt; 0.001), a higher frailty index (0.27 versus 0.22, p &amp;lt; 0.001) and to exhibit more depressive symptoms (depression rating scale 1 or more: 68.7% versus 42.7%, p &amp;lt; 0.001). Patient who screened positive for elder abuse were less likely to be independent in activities of daily living (41.9% versus 52.7%, p &amp;lt; 0.001) and reported having fallen more frequently (44.2% versus 35.5%, p &amp;lt; 0.001). Caregiver expressing distress was associated with elder abuse (35.3% versus 18.3%, p &amp;lt; 0.001) but not a higher number of hours caring for the patient. Victims of elder abuse were more likely to attend the ED for low acuity conditions (Canadian triage and acuity scale (CTAS) 4 or 5). Diagnosis at discharge from ED were similar with the exception of acute intoxication that was more frequent in patients who are victims of abuse. Conclusion: Elder abuse is infrequently detected during home care assessments in community-dwelling older adults. Higher frailty index, cognitive impairment, depressive symptoms were associated with elder abuse during homecare assessments. Patients who are victims of elder abuse are attending EDs more frequently for low acuity conditions but ED diagnosis at discharge, except for acute intoxication, are similar.

Elder abuse victimization patterns: latent class analysis using perpetrators and abusive behaviours

BackgroundResearch on elder abuse has defined it as a multidimensional construct that encompasses a set of different abusive behaviours, victims, perpetrators and settings. The array of possible elder abuse configurations is difficult to capture. This study sought to identify victimization patterns that represent distinct elder abuse configurations based on specific abusive behaviours and on the relationship with the perpetrator; it also sought to determine the association between these latent classes with victims’ characteristics.MethodData comes from two elder abuse surveys: a representative sample of community-dwelling adults and a convenience sample of older adults reporting elder abuse to four state and NGOs institutions. Latent Class Analysis (LCA) was used to categorize victimization in the population-based (N = 245) and in the victims’ sample (N = 510) using 7 items measuring physical, psychological and financial abuse, and appointed perpetrators. Association tests were conducted to determine differences and similarities of victims’ characteristics between the different obtained classes.ResultsThe LCA procedure identified six different latent classes of victimization experiences in each of the samples, which were statistically and plausibly distinct. In the population-based survey: verbal abuse by others (29%); psychological abuse from children/grandchildren (18%); overlooked by others (18%); stolen by others (15%); verbal Intimate Partner Violence (IPV) (14%) and physical and psychological IPV (6%). In the victims’ survey: physical abuse by children/grandchildren (29%); physical IPV (26%); psychological abuse by children/grandchildren (18%); polyvictimization by others (16%); physical abuse by others (6%) and physical and psychological IPV (4%). In the victims survey the 6 groups significantly differ in age, gender, civil status, living arrangements, perceived social support and functional status.ConclusionsThe results support the possibility of the multidimensionality of elder abuse not being accounted by the “classical” abuse typologies. Elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies. The appointed perpetrators may be the most meaningful and relevant aspect in distinguishing victimization experiences. Further research is needed to develop tailored interventions to specific elder abuse cases and enhance successful outcomes.

Remedies for Elder Abuse Victim under Islamic Family Law in Malaysia

Background: Elder abuse is a serious social problem that is a growing concern. In Malaysia, there is no specific legislation dealing with the issue of elder abuse but, abuse of the elderly is recognized as a form of domestic violence. The legislation dealing with matters pertaining to domestic violence are Domestic Violence Act 1994 (Act 521) (DVA) and Penal Code. These statutes are applicable to both Muslims and non-Muslims. Despite the growing literature on the issue of elder abuse in Malaysia and the legal protections offered by the DVA to the elderly victims, little has been written on the protections of the elderly abused victims among Muslims as provided under the under Islamic family law. Objective: This paper aims to explore the remedies available to the abused elderly provided under the Islamic Family Law (Federal Territories) Act 1984. Results: Syariah courts in Malaysia has jurisdiction to hear cases pertaining to family conflicts. The elderly Muslim wife who becomes a victim of domestic abuse can apply for orders in court for dissolution of marriage due cruelty or neglect of maintenance by husband. Besides, the neglected elderly parents have a right to claim maintenance from their children. Conclusion: The Islamic Family Law (Federal Territories) Act 1984 gives rights to the victims of domestic abuse to seek remedies for dissolution of marriage (in the case of a husband and wife) and to seek an order for maintenance in the case of parents.

Elder Abuse, Mistreatment, and Interventions

Up to 1 in 10 Americans over age 60 are victims of elder abuse yearly. Elder abuse is significantly under-reported; for every known case, 24 go unreported. Reasons for under-detection include inadequate training of professionals to recognize abuse and reticence of older adults to report it. Thus, it’s critical to train Adult Protective Services (APS) workers to recognize elder abuse signs and engage suspected victims in a manner maximizing possibilities for abuse disclosure. A team of trainers, social workers and researchers presented a pilot training on engagement knowledge and skills developed with NYC APS workers at an elder abuse conference. Texas APS administrators attended and requested the New York team train the Texas trainers to deliver the 8-hour, interactive training state-wide. We describe the year-long collaboration between the Texas APS Training administrators, NYC academic gerontology center trainers, and a NYC School of Social Work professor of adapting the training to meet the realities and needs of the Texas APS landscape. This includes different laws and procedures; distinct training guidelines; work in rural and semi-rural, in addition to urban environments; use of electronic tablets, rather than paper forms, to collect client information, and varying issues around worker safety. This partnership culminated in a two-day train-the-trainer course in which final adjustments were made to prepare the training for state-wide implementation, which began in Spring 2018. We discuss the challenges and opportunities of such multi-institution, cross-state collaborations for addressing training and resource gaps and developing more effective programs and policies for affected elders.

Flowchart of elderly care victms of abuse: an interdisciplinary perspective

Abstract Objective: To identify the flows of service for older people, victims of violence in different care services and to analyze the main critical issues. Method: This is a descriptive and exploratory study based on interviews with professionals responsible for: health services; judicial and social care, and with elder abuse victims, in a medium-sized city in the countryside of the state of São Paulo. Data enabled the creation of a flowchart to describe and define the critical issues, according to the model created by Franco and Merhy. Results: The following critical issues were identified: lack of centrality when directing complaints; difficulty to contact 100 hotline; collection of insufficient data on the event; lack of communication among services; victim's withdrawal in the middle of the process; lack of knowledge by the services and the population on social care functions; conflict among services in cases of difficult situations to solve, and lack of intervention by primary health care teams in response to a violence complaint. Conclusions and implications for practice: Critical issues point to the need to enhance interventions from the intersectoral perspective, with the aim to improve older people's quality of health.