Executive Function in Self-Neglecting Adult Protective Services Referrals Compared With Elder Psychiatric Outpatients

Birkenfeld

et al. 2013

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We have previously described high rates of executive function impairment in clients referred by Adult Protective Services (APS) to geriatric psychiatry for decision-making capacity assessments. The purpose of this study was to determine the independent relationship between neuropsychological screening instruments, particularly instruments sensitive to executive function, and performance-based functional tasks in elder referrals. Our retrospective medical review (n = 75/157 referrals completed all neuropsychological and functional assessments) revealed that only the Executive Interview (EXIT25) contributed independent variance to money management performance (R(2) = 0.29, p < 0.001), telephone use ability (R(2) = 0.39, p < 0.001), and summed performance (R(2) = 0.45, p < 0.001). Executive instruments may specifically inform decision-making capacity assessments.

Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 98%

Neuropsychological Correlates of Performance Based Functional Status in Elder Adult Protective Services Referrals for Capacity Assessments

Birkenfeld

et al. 2013

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“…Studies have also focused on factors related to mental status. APS clients were more likely than control or comparison groups to have poor executive function performance (Schillerstrom, Salazar, Regwan, Bonugli, & Royall, 2009) and poor cognition, memory, and processing speed (Dong, Simon, Rajan, & Evans, 2011).…”

Section: Categories Of Studies Characteristics Associated With Abuse mentioning

confidence: 99%

Informing Evidence-Based Practice: A Review of Research Analyzing Adult Protective Services Data

Ernst

Ramsey-Klawsnik²,

et al. 2014

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The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.

“…We have previously reported that APS clients referred for a psychiatric decision-making capacity evaluation are more cognitively impaired than routine geriatric psychiatry patients (Schillerstrom, Salazar, Regwan, Bonugli, & Royall, 2009). Specifically, they are more executively impaired.…”

Section: Introductionmentioning

confidence: 98%

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

Terracina

Aamodt

2014

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The objective of this study was to determine if recidivistic Adult Protective Services (APS) cases referred for a decision-making capacity assessment were more cognitively impaired than nonrecidivistic cases. A retrospective medical record review of neuropsychological and demographic data was gathered during decisional capacity assessments. Recidivistic clients were those referred to APS more than once; those with a single open case were nonrecidivistic. Mean neuropsychological test scores were compared between recidivistic (n = 138) and nonrecidivistic (n = 95) subjects. No significant differences were found for age, gender, ethnicity, education, or dwelling status. Both recidivistic and nonrecidivistic cases performed poorly in all cognitive domains. Recidivistic clients performed significantly worse on measures of executive function (CLOX1, EXIT25). Executive function impairments seem to be one risk factor for recidivism in APS referrals. With 60% of cases referred for decision capacity assessments being recidivistic, identifying risk factors may help identify when targeted interventions are indicated to preclude recurrence of abuse.