An Evaluation of AoA's Program to Prevent Elder Abuse: Final Report. Alaska Division of Senior and Disability Services

08/01/2016

Age: Information on date of birth was used to calculate participant's age at time of enrollment in the intervention.

Gender: Response categories include: 'Male;' 'Female;' and 'Other.'

Ethnicity: Response categories include: 'Hispanic;' 'Not Hispanic;' and 'Unknown.'

Race: Response categories include: 'White/Caucasian;' 'Black/African American;' 'Native Hawaiian or Other Pacific Islander;' 'Asian;' 'American Indian/Native Alaskan;' 'Multiracial;' 'Other;' and 'Unknown.' To harmonize the data across grantees, 'Native Hawaiian or other Pacific Islander' was combined with 'Asian.' The categories for 'Multiracial' and 'Unknown' have been collapsed into 'Other.'

Education: Response categories include: 'Elementary School;' 'Junior High School;' 'High School or GED;' 'Some College;' 'Associate Degree;' 'Bachelor Degree;' and 'Graduate Degree.' To harmonize the data across grantees, 'Elementary School' and 'Junior High School' have been collapsed into 'Less than High School,' 'Associate Degree' is collapsed into 'Some College,' 'Bachelor Degree' is considered 'College Graduate,' and 'Graduate Degree' is considered 'Some Graduate Work.'

Marital Status: Response categories include: 'Never Married;' 'Married;' 'Civil Union;' 'Partner/Significant Other;' 'Widowed;' 'Separated;' and 'Divorced.' To harmonize the data across grantees, the category for 'Never Married' is collapsed into the 'Single' category. The categories for 'Separated' and 'Divorced' have been combined as 'Divorced/Separated.' 'Civil Union' and 'Partner/Significant Other' are collapsed into the 'Other/Unknown' category.

Primary Language: Response categories include: 'English;' 'Spanish;' 'American Sign Language (ASL);' and 'Other.' To harmonize the data across grantees, 'ASL' was included in the 'Other' category.

Place of Residence/Living Situation: Response categories include: 'Private Home/Apartment/Rented Room;' 'Multi-Family Home;' 'Assisted Living Home;' 'Group Home' (e.g., Psychiatric, Physical Disability, etc.); 'Hotel/Motel;' and 'Homeless.' To harmonize the data across grantees, 'Assisted Living Home' was collapsed into 'Assisted Living/Nursing Home,' and 'Hotel/Motel' and 'Homeless' were collapsed into 'Other.'

Living Situation: Response categories include: 'Lives Alone' and 'Lives with Husband/Wife or Partner.'

Income: Information was reported on the individual's monthly income. This value was then multiplied by 12 to obtain the yearly income. To harmonize the data across grantees, an ordinal variable was created with income intervals as follows: 'Less than $15,000;' '$15,000-$25,000;' '$25,001-$35,000;' '$35,001-$50,000;' '$50,001-$75,000;' '$75,001-$100,000;' and 'Greater than $100,000.'

Physical Function: Two scales were used to measure physical function. The first is a functional health scale measuring the number of difficulties with accomplishing eight ADLs with or without assistance. ADL functions are essential for an individual's self-care (e.g., dressing and feeding yourself). Response categories include: 'Independently' (0); 'Requires Verbal Cueing' (1); 'Requires Supervision' (2); 'Limited Assistance' (3); 'Extensive Assistance' (4); 'Total Dependence' (5); and 'No Answer' (6). The last response category is considered missing for analytic purposes. Responses to items are summed. The summary score ranges from 0-35. Higher scores indicate difficulty with a greater number of daily activities. The seven items included the following:

  1. Indicates how well the adult positions/repositions himself/herself while in bed.
  2. Indicates the level of assistance the adult needs to move between surfaces.
  3. Indicates the level of assistance the adult needs to ambulate; if in a wheelchair, indicate level of self-sufficiency.
  4. Indicates the level of assistance the adult needs to get dressed.
  5. Indicates the level of assistance the adult needs to eat.
  6. Indicates the level of assistance the adult needs to use the bathroom/toilet.
  7. Indicates the level of assistance the adult needs with completing hygiene related tasks.

     

The second measure of physical function uses the IADL scale. IADL functions are more concerned with independent living skills rather than basic ADLs. Response categories include: 'Independently' (0); 'Requires Verbal Cueing' (1); 'Requires Supervision' (2); 'Limited Assistance' (3); 'Extensive Assistance' (4); 'Total Dependence' (5); and 'No Answer' (6). The last response category is considered missing for analytic purposes. Responses to items are summed. The summary score ranges from 0-45. Higher scores indicate difficulty with a greater number of daily instrumental activities. The nine items included the following:

  1. Indicates the level of assistance the adult needs with completing meal preparation.
  2. Indicates the level of assistance the adult needs in order to use the telephone.
  3. Indicates the level of assistance the adult needs in order to complete daily household chores.
  4. Indicates the level of assistance the adult needs in order to complete more difficult housework.
  5. Indicates the level of assistance the adult needs in order to do his/her laundry.
  6. Indicates the level of assistance the adult needs in order to manage his/her finances.
  7. Indicates the level of assistance the adult needs in order to get groceries.
  8. Indicates the level of assistance the adult needs when traveling outside his/her home or place of residence.
  9. Indicates the level of assistance the adult needs in order to manage his/her medication regimen.

     

Depression: Depression is measured using the PHQ-9. The PHQ-9 is the depression module of the PHQ, which is an instrument for screening, diagnosing, monitoring and measuring the severity of depression. The PHQ-9 incorporates Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) depression diagnostic criteria with other leading depressive symptoms. Questions ask how often respondents have been bothered by specific problems (listed below) over the last two weeks. The tool rates the frequency of the symptoms. Responses include: 'Not at all' (0); 'Several Days' (1); 'More than Half the Days' (2); and 'Nearly Every Day' (3). Responses to each item are summed and are then categorized as follows: 'No Depression' (0-4); 'Minimal Symptoms' (5-9); 'Minor Symptoms' (10-14); 'Major Depression, Moderate' (15-19); and 'Major Depression, Severe' (20 or higher). The summary score ranges from 0-27. The nine items included on the tool are:

Over the past two weeks how often have you...

  1. Little interest or pleasure in doing things.
  2. Feeling down, depressed, or hopeless.
  3. Trouble falling or staying asleep, or sleeping too much.
  4. Feeling tired or having little energy.
  5. Poor appetite or overeating.
  6. Feeling bad about yourself--or that you are a failure or have let yourself or your family down.
  7. Trouble concentrating on things, such as reading the newspaper or watching television.
  8. Moving or speaking so slowly that other people could have noticed? Or the opposite--being so fidgety or restless that you have been moving around a lot more than usual.
  9. Thoughts that you would be better off dead or of hurting yourself in some way.

     

Anxiety: Anxiety is measured using the GAD-7 scale. Response categories include: 'Not at all' (0); 'Several Days' (1); 'More than Half of the Days' (2); and 'Nearly Every Day' (3). Responses to each item are summed. The summary score ranges from 0-21, with higher scores indicating higher levels of anxiety. Items include:

Over the past two weeks how often have you...

  1. Feeling nervous, anxious, or on edge.
  2. Not being able to stop or control worrying.
  3. Worrying too much about different things.
  4. Trouble relaxing.
  5. Being so restless that it's hard to sit still.
  6. Becoming easily annoyed or irritable.
  7. Feeling afraid as if something awful might happen.

Social Support: Three measures of social support are used. At baseline, social support is measured by the LSNS-R. The LSNS-R is correlated with mortality, all-cause hospitalization, health behaviors, depressive symptoms, and overall physical health. Questions 1, 3, 4, 7, 9 and 10 have the following response categories: 0=none, 1=one, 2=two, 3=three or four, 4=five thru eight, 5=nine or more. Questions 2 and 8 have the following response categories: 0=less than monthly, 1=monthly, 2=few times a month, 3=weekly, 4=few times a week, 5=daily. Questions 5, 6, 11 and 12 have the following response categories: 0=never, 1=seldom, 2=sometimes, 3=often, 4=very often, 5=always. Responses to the following questions are summed and the summary score ranges from 0-60:

  1. How many relatives do you see or hear from at least once a month?
  2. How often do you see or hear from the relative with whom you have the most contact?
  3. How many relatives do you feel at ease with that you can talk about private matters?
  4. How many relatives do you feel close to such that you call on them for help?
  5. When one of your relatives has an important decision to make, how often do they talk to you about it?
  6. How often is one of your relatives available for you to talk when you have an important decision to make?
  7. How many of your friends do you see or hear from at least once a month?
  8. How often do you see or hear from the friend with whom you have the most contact?
  9. How many friends do you feel at ease with that you can talk about private matters?
  10. How many friends do you feel close to such that you call on them for help?
  11. When one of your friends has an important decision to make, how often do they talk to you about it?
  12. How often is one of your friends available for you to talk when you have an important decision to make?

     

At the end of the intervention and three months and six months post-intervention, information on the participants' Social Support Network Professional was collected. The item asks if the individual has, and uses a social support network of professionals. The possible categories that the individual can fall under are 'Yes,' 'No' and 'Somewhat.' Similarly, for the measure on Social Support Network Family and Friend, the question asks if the participant has, and uses a social support network of family or friends. The possible categories that the individual can fall under are 'Yes,' 'No' and 'Somewhat.'

Risk of Abuse: Risk of abuse is measured by 12 questions on the VASS. Each item has two possible responses: 'Yes' (1) and 'No' (0). VASS is composed of four factors, with three items each, representing the following domains: vulnerability (items 1-3), dependence (items 4-6), dejection (items 7-9), and coercion (items 10-12). The questions are as follows:

  1. Are you afraid of anyone in your family?
  2. Has anyone close to you tried to hurt you or harm you recently?
  3. Has anyone close to you called you names or put you down or made you feel bad recently?
  4. Do you have enough privacy at home?
  5. Do you trust most of the people in your family?
  6. Can you take your own medication and get around by yourself?
  7. Are you sad or lonely often?
  8. Do you feel that nobody wants you around?
  9. Do you feel uncomfortable with anyone in your family?
  10. Does someone in your family make you stay in bed or tell you you're sick when you know you're not?
  11. Has anyone forced you to do things you didn't want to do?
  12. Has anyone taken things that belong to you without your OK?

     

Stress: Two measures of stress are used. At baseline, stress is measured by the PSS at baseline. For each of the ten questions, response options include: 'Never' (0); 'Almost Never' (1); 'Sometimes' (2); 'Fairly Often' (3); and 'Very Often' (4). PSS scores are obtained by reversing responses (e.g., 0=4, 1=3, 2=2, 3=1, 4=0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. Higher PSS scores are associated with higher levels of stress and indicate a greater likelihood for stress interfering with things like lifestyle changes (a person's efforts to quit smoking) and their ability to improve their shape. Responses are summed for the following questions and the summary score ranges from 0-40:

  1. In the last month, how often have you been upset because of something that happened unexpectedly?
  2. In the last month, how often have you felt that you were unable to control the important things in your life?
  3. In the last month, how often have you felt nervous and "stressed"?
  4. In the last month, how often have you felt confident about your ability to handle your personal problems?
  5. In the last month, how often have you felt that things were going your way?
  6. In the last month, how often have you found that you could not cope with all the things that you had to do?
  7. In the last month, how often have you been able to control irritations in your life?
  8. In the last month, how often have you felt that you were on top of things?
  9. In the last month, how often have you been angered because of things that were outside of your control?
  10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

     

At the end of the intervention and three months and six months post-intervention, stress is measured using the following response categories include: 'Lots of Stress;' 'Some Stress;' and 'Minimal Stress.'

Type of Abuse: Response categories for type of abuse include: 'Abandonment;' 'Physical Abuse;' 'Sexual Abuse;' 'Mental Abuse;' 'Exploitation--Person;' 'Exploitation-Financial;' 'Neglect;' 'Self-Neglect;' and 'Undue Influence.' To harmonize the data across the grantees, 'Abandonment,' 'Exploitation-Person,' 'Undue Influence' and 'Falls' were combined into the 'Other' category. An additional category is available to identify individuals with co-occurring abuse types.