Executive Function Impairment and Recidivism in Adult Protective Services Clients Referred for a Decision Making Capacity Assessment

Terracina, Katherine A; Aamodt, Whitley W.; Schillerstrom, Jason E.

doi:10.1080/08946566.2014.976894

Cited by 11 publications

(4 citation statements)

References 14 publications

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“…They are considered to be supervisory cognitive processes (Alvarez & Emory, 2006). Studies demonstrate that executive functions correlate with reasoning and decision-making abilities and are an important aspect of functional capacity (Schillerstrom et al, 2009, 2013; Terracina et al, 2015; Wood et al, 2014). Research has also associated memory, processing speed, and generally poor cognition as risk factors for elder mistreatment (Dong et al, 2011, 2012; James et al, 2014; Shao et al, 2019).…”

Section: Rapid Response Expert Teammentioning

confidence: 99%

Utilizing comprehensive neuropsychological assessment in adult protective service intervention.

Lande¹,

Gauthier²,

Stanley-Olson³

2022

Professional Psychology: Research and Practice

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Over the past decade, an emerging practice in Adult Protective Services (APS) agencies is to include neuropsychological assessment as part of a multidisciplinary team approach to assessment and intervention. Yet, little empirical research exists examining this approach. Between July 2010 and May 2020, 231 (0.01%) of 25,309 opened APS cases were referred to the Rapid Response Expert Team (RRET) for neuropsychological evaluation of decision-making capacity. Ninety-four percent of these individuals were diagnosed with a neurocognitive disorder. Etiologies were primarily (77.1%) dementia(s). Self-neglect and financial abuses were the most prevalent confirmed allegations, consistent with prior research. Cases referred to the RRET neuropsychologists, compared with cases that were not referred, had a greater total number of allegations, precursor risk factors, biological, psychological, and social indicators at initial evaluation by APS, and utilized a larger number of resources (interventions). The RRET neuropsychological evaluation was shown to provide additional and unique information predictive of functional outcomes to assist APS social workers in identifying interventions and allocation of resources. Specifically, executive functions, language, and learning and memory impairments were significant contributors to functional outcomes. Neuropsychological assessment appears to add to and advance the conceptualization of an individual's functioning and intervention needs for APS. This knowledge will aid in demonstrating the importance of this model of practice at the individual level and in evolving county policy, resource allocation, and staff continuing education. Public Significance StatementThis study suggests that individuals referred by Adult Protective Services (APS) for neuropsychological assessment of decision-making capacity had a greater severity of mistreatment indicators at initial evaluation by APS and utilized a larger number of resources (interventions). Neuropsychological evaluation indicated executive functions, language, and learning and memory impairments were significant contributors to functional outcomes. Neuropsychology consultation is likely to benefit suspected victims of elder and dependent adult abuse as well as APS agencies in their goal of examining intervention needs and improving case outcomes.

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Section: Rapid Response Expert Teammentioning

confidence: 99%

Utilizing comprehensive neuropsychological assessment in adult protective service intervention.

Lande¹,

Gauthier²,

Stanley-Olson³

2022

Professional Psychology: Research and Practice

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“…This study examined the impact of RISE on the outcome of recurrence (a repeat investigation, also referred to as “recidivism”) as defined by the opening of a new investigation for a client whose case was previously investigated. Recurrent investigations increase caseloads and programmatic costs and are a surrogate marker for ongoing revictimization 26 . Prior studies estimate APS recurrence rates ranging between 15% and 23% of all investigations.…”

Section: Introductionmentioning

confidence: 99%

Effect of an elder abuse and self‐neglect intervention on repeat investigations by adult protective services: RISE project

Lewis

Connolly

Salvo³

et al. 2023

J American Geriatrics Society

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BackgroundAdult Protective Services (APS) is the primary agency responsible for investigating elder abuse and self‐neglect (EASN) allegations in the United States. The harms of EASN are well established; however, APS lacks a conceptually derived evidenced‐based intervention phase. RISE is a community‐based intervention designed to complement APS that provides enhanced services and a longer intervention phase. The objective of this study was to test whether exposure to the RISE/APS collaboration was associated with reducing the case outcome of recurrence (repeat investigations) compared to usual care APS only services.MethodsA retrospective observational study (n = 1947) of two counties in Maine where RISE was available to provide enhanced services to persons referred from APS. An extended regression endogenous treatment Probit model using APS administrative data was used to predict case recurrence.ResultsBetween July 2019 and October 2021, 154 cases participated in RISE and 1793 received usual APS only services. 49% of cases in RISE had 2 or more prior substantiated allegations versus 6% for those receiving usual APS care, and 46% of cases in RISE had a recurrence during the observation period versus 6% for usual care group. However, after accounting for the non‐random treatment assignment, RISE was associated with a significantly lowered likelihood of recurrence compared to persons receiving usual care provided by APS (probability of recurrence reduced by 0.55 for the Average Treatment Effect on the Treated and 0.26 for the Average Treatment Effect).ConclusionsA reduction in recurrence carries important implications for APS clients, costs, resources, and workflow. It may also serve as a proxy indicating a reduction in revictimization and harm for EASN victims.

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“…Measurement of executive functioning can provide rich insights into the day-to-day difficulties experienced by individuals and is often critical in the assessment of older adults, especially in cases of capacity decision-making evaluations (Terracina et al, 2015). Executive dysfunction has also been recognized as a core symptom of dementia, especially Alzheimer’s disease, and is indicative of decline in instrumental activities of daily living (IADLs) which are basic life skills that support functional independence (Mansbach et al, 2012; Tuokko et al, 2005).…”

mentioning

confidence: 99%

Relationships Among Executive Dysfunction, Constructive Worrying, and Worry Responses in Older Adults

Granier

Segal

Coolidge

2020

Int J Aging Hum Dev

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Worry is a ubiquitous human experience and core symptom of anxiety. The present study examined the extent to which specific aspects of worry are related to perceived executive dysfunction in older adults. A total of 100 older adult participants ( M age = 68.82 years; range = 65–79 years) completed the Worry Behaviors Inventory, the Coolidge Axis II Inventory Executive Dysfunctions Scale, and the Constructive and Unconstructive Worry Questionnaire. Multiple regression analyses found that worry constructiveness and response behaviors were predictive of executive dysfunction. Specifically, greater avoidance behaviors and unconstructive worry were uniquely predictive of greater executive dysfunctions. Thus, findings indicate that worry constructiveness and approaches to worry management are significantly related to cognitive functioning in older adults. These findings imply a need to assess both worry and executive dysfunction to more accurately determine causal factors regarding anxiety and cognitive decline in older adults.

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Executive Function Impairment and Recidivism in Adult Protective Services Clients Referred for a Decision Making Capacity Assessment

Cited by 11 publications

References 14 publications

Utilizing comprehensive neuropsychological assessment in adult protective service intervention.

Utilizing comprehensive neuropsychological assessment in adult protective service intervention.

Effect of an elder abuse and self‐neglect intervention on repeat investigations by adult protective services: RISE project

Relationships Among Executive Dysfunction, Constructive Worrying, and Worry Responses in Older Adults

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