CAPTIONS BEGIN MOMENTARILY >> THANK ALL OF THE PLANNING MEMBERS, CAN YOU ALL STAND FOR ONE SECOND? [ APPLAUSE ] THANK YOU AND YOU CAN ASK THESE PEOPLE A QUESTION THROUGHOUT THE DAY IF YOU ARE FEELING LOST. BACK IN JUNE WE GATHERED INSTITUTE DIRECTORS FROM ACROSS THE NIH, TO DISCUSS HOW NIH COULD CONTRIBUTE TO THE WHITE HOUSE CONFERENCE ON AGING AND THE INITIATIVE ON ELDER ABUSE AND OTHER JUSTICE, WE ENVISIONS A WORKSHOP ON HEALTH AND ELDER ABUSE THAT WOULD TIE TOGETHER RESEARCH FROM THE NIH INSTITUTES AND CENTERS, OUR PLANNING TEAM INCLUDED REPRESENTATIVES FROM INSTITUTES AND OFFICES OF THE DIRECTOR ALSO, IN A FEW MINUTES YOU WILL HEAR FROM THE DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE ON AGING, DR. MARIE BERNARD AND THE DIRECTOR OF THE OFFICE OF RESEARCH ON WOMEN'S HEALTH, DR. JANINE CLAYTON. WE HAVE AN AMBITIOUS AGENDA FOR A ONE DAY MEETING, THERE'S NO WAY WE CAN COVER EVERYTHING TODAY SO WE WOULD LIKE EVERYONE THROUGHOUT THE DAY TO FOCUS ON THREE ARENAS TO INFORM THE RESEARCH AGENDA FOR NIH AND OTHER FUNDERS OF ELDER ABUSE RESEARCH. SO THE THREE THINGS WE WANT TO FOCUS THIS DISCUSSION AROUND ARE THE SCIENTIFIC AND STRUCTURAL BARRIERS TO BUILDING AN EVIDENCE BASE, WHAT KEY FINDINGS FROM RELATED FIELDS CAN INFORM ELDER ABUSE RESEARCH, INCLUDING WHAT WORKED WELL AND WHAT HASN'T WORKED WELL AND FINALLY WHAT ARE THE BIG RESEARCH OPPORTUNITIES FOR ELDER ABUSE RESEARCH OVER THE NEXT TYPH TO 10 YEARS, WE HOPED HERE THE QUESTIONS SWRED THROUGHOUT THE DAY IN THE THREE PANELS AND FOUR CONCURRENT BREAK OUT SESSIONS TED NIH MEETING TEAM MEMBERS WILL BE TWEETING THROUGHOUT THE DAY AND WE HOPE TO HEAR FROM MANY OF YOU THROUGHOUT THE ROOM AND WATCHING ON VIDEOCAST AND TWITTER SO THESE ARE THE HASH TAGS WE WILL BE USING TODAY. WE HAVE ONE ALTERATION OF THE AGENDA, BOB WALLACE CAN'T BE HERE TODAY, AND MARK LAX IS TAKING OVER WITH LESS THAN TWO DAYS NOTICE, WE APPRECIATE THAT AND M. T. CONNOLLY WILL BE HELPING WITH THE WRAP UP SESSION AS WELL. THANK YOU TO BOTH OF THEM FOR STEPPING UP AT THE LAST MINUTE. WE'RE INTERESTED IN HEARING THE DISCUSSION FROM THE PRESENTERS AND THE AUDIENCE SO WE WILL BE STRICT ABOUT THE FIVE MINUTE PRESENTATION TIME LIMIT AND I KNOW IT'S REALLY HARD BUT WE'RE GOING TO TRY TO STICK TO THAT AS MUCH--WELL, WE ARE GOING TO STICK TO IT. [LAUGHTER] THERE WILL BE A LOT OF THINGS THAT WON'T BE COVERED IN THE FIVE MINUTE PRESENTATION BUT THERE'S A LOT OF TIME WE ALLOICATED TO DISCUSSION BOTH THE MODERATED DISCUSSION AND THE AUDIENCE PARTICIPATORY DISCUSSION, A FEW PROCEDURAL NOTES, THERE'S A TACTSY SHEET FOR THE SIGN UPS FOR THIS END AND THEN SIGN UP AND PASS THAT AROUND TO MAKE SURE WE'VE GOT YOU COVERED. TURN OFF CELL PHONES AND ALL OF THAT AND BATHROOMS ARE OUT THE HALL TOWARDS THE ELEVATORS SO PANELISTS COME TO THE PODIUM TO GIVE YOUR BRIEF REMARK AND THEN TAKE YOUR NAME TAGS WITH YOU TO THE BACK PANEL FOR THE DISCUSSION. LUNCH WILL BE DELIVERED OUTSIDE IF YOU ORDERED A BOX LUNCH SO YOU'LL PICK THAT UP AND TAKE IT WITH YOU TO THE BREAK OUT SESSIONS. WE'RE GOING TO DISPLAY THIS AGAIN LATER BUT THESE ARE THE BREAK OUT ROOMS. AND WE WILL ALSO HELP DIRECT YOU AND THE NIH TEAM MEMBERS CAN HELP DIRECT YOU TO THE BREAK OUT ROOMS AT 12:20. SO WITH THAT WE ARE DELIGHTED TO HAVE NORA SUPER DIRECTOR OF CONFERENCE ON AGING HERE TODAY AND I WILL TURN IT OVER TO HER NOW TO SHARE OPENING REMARKS AND THEN ON TO MARIE BERNARD AND JANINE CLAYTON. >> GOOD MORNING EVERYONE, IT'S WONDERFUL TO BE HERE TODAY AND I'M DELIGHTED TO WELCOME YOU TO THE CONFERENCE AT NIH ON MULTIPLE APPROACHES TO UNDERSTANDING AND PREVEPTING ELDER ABUSE AND MISTREATMENT. AS YOU MAY KNOW, THE WHITE HOUSE HELD ITS SIXTH CONFERENCE ON AGING ON JULY 13th, 2015. LET THESE CONFERENCES TAKE PLACE ONLY EVERY 10 YEARS, THEY OFFER AN OPPORTUNITY TO SHARE--SET A SPOTLIGHTOT ISSUES OF MOST IMPORTANCE TO OLDER AMERICANS AND THEIR FAMILIES, FOR THIS YEAR'S CONFERENCE, SORRY, WE'LL GET THAT RIGHT, WE FOCUSED ON FOUR PRIORITY AREAS, RETIREMENT, SECURITY HEALTHY AGING, LONG-TERM SERVICES AND SUPPORT. AND ELDER JUSTICE. SINCE JULY OF 2014, WE HELD OVER 100 LISTENING SESSIONS AND STAKEHOLDER SESSIONS ACROSS THE COUNTRY TO GATHER INPUT OF IDEAS, WE HOSTED FIVE REGIONAL FORUMS IN TAMPA, PHOENIX SEATTLE, CLEVELAND AND BOSTON. AND SEVERAL WHITE HOUSE EVENTS ON EACH TOPIC INCLUDING ELDER JUSTE, WE ALSO RELEASED POLICY BRIEFS WHICH WERE OPEN FOR PUBLIC COMMENT ON EACH OF THE PRIORITY AREAS. IT'S A TESTAMENT TO MANY OF THE ADVOCATES AND RESEARCHERS IN IN ROOM TODAY THAT ELDER JUSTICE WAS SELECTED AS A PRIORITY ISSUE. IT'S BECAUSE OF YOUR DETERMINE NATION AND LIFTING AND RAISING AWARENESS OF THIS ISSUE TO MANY THAT THE WHITE HOUSE BECAME SO INVOLVED. ELDER JUSTICE ISSUES ARE RELATIVELY UNKNOWN TO MANY AMERICANS THOUGH THE IMPACT IS WIDE SPREAD AND DEVASTATING TO ITS VICTIMMINGS, IN 2010 AS YOU PROBABLY KNOW, THE ELDER JUSTICE ACT WAS ENACTED INTO LAW AS PART OF THE AFFORDABLE CARE ACT, PROVIDING NEW AUTHORITIES AND OPPORTUNITIES FOR THE FEDERAL GOVERNMENT TO ADDRESS ELDER ABUSE, THE LAW ESTABLISHED THE ELDER JUSTICE COORDINATING COUNCIL WHICH INCLUDED MORE THAN 20 FEDERAL AGENCIES TASKED TO MOVE ELDER JUSTICE ISSUES FORWARD. IN 2014 THE ELDER JUSTICE ROADMAP WAS RELEASED WHICH PROVIDED AN OVERVIEW OF 750 STAKEHOLDER PRIORITIES, THE WHITE HOUSE CONFERENCE ON AGING WAS ABLE TO BUILD UPON THIS ROADMAP TO HELP FOCUS OUR EFFORTS. TODAY BEFORE YOU BEGIN THIS IMPORTANT MEETING, I'D LIKE TO SHARE WITH YOU SOME OF THE INSIGHTS WE GAIN FROM PARTICIPANTS IN OUR EVENTS IN RESPONSE TO THE ELDER POLICY YESTERDAY BRIEF. MANY OF THE RESPONSES AT THE WHITE HOUSE CONFERECE ON AGING RECEIVED MYRIAD OF PRIORITIES IN THE ELDER JUSTICE ROADMAP WHICH REFLECTS THE CONSENSUSOT PUBLIC'S PRIORIY, OVERALL RESPONDENTS SHARED WELL THEIR CONCERN WITH THE IMMEDIATEIASY OF NEEDS. THEY DESCRIBED THE ALARMING PICTURE OF ELDER ABUSE, SEVERAL KEY AREAS INCLUDING SERVICES, PREVENTION, A COORDINATED RESPONSE SAYS AND OVERALL LACK OF RESEARCH ON ELDER ABUSE. RESPONSES COALESCED ON THREE CENTRAL THEMES, THE FIRST THEME HIGHLIGHTED THE NEED TO INCREASE PREVENTION AND RESPONSE EFFORTS. PREVENTING ABUSE BEFORE IT HAPPENS AND TO PROVIDE A COORDINATED RESPONSE WHEN IT DOES. PUBLIC EDOCCASION AND AWARENESS WERE SEEN AS KEY PRIORITIES TO EDUCATE THE UNDERSTANDING OF THE PROBLEM AND HELP THEM OOH DENTIFY RESOURCES. TRAINING AND COLLABORATION ACROSS SECTORS WERE COMMONLY DISCUSSED AS AN ETC.KIVE STRATEGY TO RESPOND TO ELDER ABUSE CASES. THE SECOND THEME FOCUSED ON LEGISLATION AND FUNDING FOR ELDER ABUSE. REGIONAL FORUM AND PARTICIPANTS FOCUSED ON LEGISLATION AND INCREASING FUNDING AS AN IMPORTANT SOLUTION, THE OLDER AMERICANS ACT AND ELDER JUSTICE ACT WILL NEED TO BE REAUTHORIZED AND SUFFICIENTLY FUNDED TO CONTINUE TO SUPPORT ELDER JUSTICE PROGRAMS. ADDITIONALLY ADVOCATES HAVE CALLED NATIONAL STANDARDIZATION OF ELDER ABUSE AND SETTING MIN NUM STANDARDS A RESPONSE FOR SAFE. FINALLY AND MOST RELEVANT TO TODAY'S DISCUSSIONS, RESPONDENTS EMPHASIZE THE NEED TO INCREASE RESEARCH IN ELDER ABUSE AND SERVICES, CONSISTENTLY WE RECEIVE FEEDBACK THAT THE LACK OF RESEARCH FOCUSING ON ELDERA, BUSES IS A MAJOR BARRIER TO CREATING SOLUTIONS AND MOVING ELDER JUSTICE ISSUES AS A POLICY PRIORITY. OVERALL VERY LITTLE IS KNOWN ABOUT THE EXTENT OF THE PROBLEM AND LESS IS KNOWN ON SUCCESSFUL SOLUTIONS TO PREVENT OR STOP ABUSE. THAT IS WHY TODAY'S MEETING IS SO IMPORTANT AND IT'S SOMETHING THE WHITE HOUSE ASKED AND NIH TO SUPPORT AND I'M THRILLED TO SEE THAT SO MANY INSTITUTES AND DEPARTMENTS HAVE BEEN INVOLVED IN PLANNING THIS MEETING. THESE SESSIONS TODAY PROMISE TO HELP ALL OF US BETTER UNDERSTAND WHAT IS KNOWN AND WHAT ARE THE GAPS IN DETECTING PREVENTING AND INTERVENING ELDER ABUSE. MY MAJOR PRIORITY TODAY IS TO MAKE SURE WE HAVE ADVANCED THE RESEARCH IN THIS FIELD. I WANT TO INSURE 10 YEARS FROM NOW WHEN THEY LOOK BACK AND SAY, WHAT DID WE DO WITH THE 2015 WHITE HOUSE CONFERENCE ON AGING, WHERE HAVE WE COME, WE CAN ALL LOOK THE AT SIGNIFICANT NEW DATA WE GATHERED AND MOST IMPORTANTLY, APPLY THIS RESEARCH TO IMPLEMENT SUCCESSFUL SOLUTIONS TO PREVENT OR STOP ABUSE. THANK YOU. [ APPLAUSE ] >> GOOD MORNING I'M MARIE BERNARD FROM THE NATIONAL INSTITUTES ON AGING AND I'M HONORED TO JOIN AND WELCOMING YOU TO A PRECEDENT SETTING MEETING. I DON'T THINK EVER BEFORE NIH AT LEAST AS CONVENED THE CHILD ABUSE COMMUNITY, INTIMATE PART, VIOLENCE COMMUNITY AND ELDER ABUSE IN MISTREATMENT COMMUNITIES AND WE'RE LOOKING FORWARD TO THE SYNERGYS THAT WILL COME FROM THIS MEETING. IT IS AS MENTIONED SOMETHING THAT HAS BEEN SPONSORED BY MANY COMPONENTS OF NIH, THE OFFICE OF RESEARCH WOMEN'S HEALTH, NATIONAL INSTITUTE AND DRUG ABUSE, NATIONAL IPSEITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES, OFFICE OF BEHAVIORIAL AND SOCIAL SCIENCE RESEARCH, NATIONAL INSTITUTE OF MENTAL HEALTH, OFFICE OF CHILD HEALTH AND HUMAN DEVELOPMENT, NATIONAL INSTITUTE ON AGING, NATIONAL INSTITUTE ON AGING RESEARCH, OFFICE OF SCIENCE POLICY AND OFFICE OF EMERGENCY CARE RESEARCH. I SHOULD GET AN EXTRA MINUTE FOR HAVING MENTIONED ALL OF THE SPONSORS. [LAUGHTER] AND IT'S REALLY BEEN A COLLABORATIVE EFFORT THAT HAS BEEN VERY INFORMATIVE. I'VE BEEN ASKED SPECIFICALLY TO TALK ABOUT RESEARCH THAT'S BEEN FUNDED BY THE NATIONAL INSTITUTE ON AGING ON THE PAST AND HOPEFULLY I'LL HAVE TIME TO TALK ABOUT OTHER INSTITUTES AS WELL, WE OF COURSE HAVE AGING AT ANDLEDDER ABUSE HAS BEEN A SIGNIFICANT PART OF OUR PORTFOLIO AND THAT HAS BEEN INFORMED BY SOME IMPORTANT NATIONAL ACADEMIES REPORT IN 2002 NIH COMMISSIONED TED NATIONAL ACADEMIES TO FORMULATE RECOMMENDATIONS ON A RESEARCH AIENDA ANDLEDDER MISTREATMENT. THIS LED TO A COUPLE OF RFAs AND SEVERAL RF21S BEING FUNDED FROM THOSE, IN 2010, WE ASKED THE NATIONAL ACADEMIES TO LEAD A WORKSHOP FOR US ON RESEARCH ISSUES AND ELDER MISTREATMENT ABUSE AND FINANCIAL FRAUD SO WE CAN STEP BACK AND SEE WHAT HAD HAPPENED AS A RESULT OF THE ACTIVITIES AND THE PRIOR YEARS AND DECIDE WHAT DIRECTIONS NEED TO BE FOLLOWED IN THE FUTURE. AND THIS LED TO OR OUTCOMES OF THAT MEETING WERE RECOMMENDATIONS FOR INTERVENTION, MULTIPLE LEVELS, PREVENTION, CLINICAL ENTERVENTIONS AND KEEPING ABUSE ELDERS IN THEIR OWN HOMES. RIGHT AROUND THE SAME TIME, CATHY GREEN LEE, THE ASSIST ACT SECRETARY ON AGING APPROACHED RICHARD HODIS, OUR DIRECTOR STATING SHE WAS INTERESTED IN EVIDENCE BASED RESEARCH THAT COULD BE DISSEMINATED THROUGH HER AGENCY AT THAT TIME, KNOWN AS THE ADMINISTRATION ON AGING, KNOWN AS THE COMMISSION ON COMMUNITY LIVING AND IT'S BEEN A GOOD AND PRODUCTIVE CABORATION AND INTERCHANGE SINCE THAT TIME. ONE OF THE CLEARY RECOGNIZED AREAS OF CONVERGENCE OF ELDER ABUSE. SO WHAT AS BEEN FUNDED AS I MENTIONED, THE RFAs IN 2005, 2006, SEVEN R21S THAT WERE A RESULT OF THAT BUT THE BULK OF OUR INITIATIVE IS INVESTIGATOR INITIATED RESEARCH AND THERE HAS BEEN A GOOD OUTCOME FROM INVESTIGATOR INITIATED PROJECTS, ACL SUPPORTED VERY IMPORTANTLY SOME ADDITIONAL FUNDING FOR THE NATIONAL LIFE OR AGING PROJECT WHICH IS A COMMUNITY NATIONAL SAMPLING OF COMMUNITY ELDERS 57 TO 85 YEARS OF AGE, IT HAD BASELINE INFORMATION FOR VERBAL AND ACL ABUSE AND THEY'RE SUPPORTING A SECOND WAVE OF DATA THAT IS GATHERED AND WILL BE IMPORTANT, I THINK. AS THEY SAID MUCH OF IT IS INITIATED AND SOME EXAMPLES. STUDIES OF PSYCHOLOGICAL DISTRESS, TREATMENT, ELDERS IN COMMUNITY DEVELOPING, CHINESE ELDERS IN CHICAGO, ANOTHER STUDY ON THE NEUROLOGICAL BASIS OF FINANCIAL DECISION MAKING, INDIVIDUALS WITH ALZHEIMER'S DISEASE AND DEMENTIA, DETERMING THE FACTORS THAT MAKE THEM VULNERABLE TO FINANCIAL EXPLOITATION, STILL ANOTHER STUDY WHICH IS PREDICTORS ON RESIDENT STRATEGY AND RESIDENT VIOLENCE IN LONG-TERM CARE AND ANOTHER STUDY LOOKING AT COMMON INJURY PATTERNS AND BIOMARKERS IN ELDER ABUSE CASES HELPING DISTINGUISH THAT BETWEEN FALLS, IES AND VERY IMPORTANTLY THE FUTURE GENERATION OF SCIENTISTS IN THIS AREA IS VERY IMPORTANT AND THEIR PROJECT SUCH AS DR. LACH'S PROJECT LOOKING AT TRAINING INDIVIDUALS IN ELDER ABUSE RESEARCH. AS I SAID, MULTIPLE OTHER INSTITUTES ARE ALSO INVOLVED. I KNOW I AM RUNNING SHORT ON TIME SO I WILL MOVE ON TO MY LAST SLIDE. OUR INTENT HERE IS NOT TO REHASH THE PAST HOWEVER, WHAT WE'RE INTERESTED IN IS WHAT THE FUTURE SHOULD SHOW. WE WANT TO LEVERAGE INFLIGHTS TO THREES THREE FIELDS BROUGHT TOGETHER HERE, EXPLORE SYNERGYS, COLLABORATIVE OPPORTUNITIES, LEARN SUCCESSES, CHALLENGES AND KEY INSIGHTS. HOPING THIS WILL GENERATE NOVEL RESEARCH QUESTIONS AND NEW COLLABORATIONS IN THE FIELD. SO THANK YOU ALL FOR BEING HERE, WE KNOW YOU'RE GOING TO WORK HARD. THANKS. >> GOOD MORNING I'M JANINE CLAYTON OFFICE OF WOMEN'S HEALTH. I WANT TO THANK ALL OF YOU FOR COMING TOGETHER ON A TOPIC THAT TOUCHES THE LIVES OF TOO MANY AMERICANS, AS THE U.S. POPULATION AGES, ANY ISSUE THAT THIS PROPORTIONATELY EFFECTS OLDER PEOPLE IS ONE TO WHICH WE MUST BE SENSITIVE. THIS PARTICULAR PROBLEM HAS MANY INFLUENCES AND THAT IS WHY A MULTIDISCIPLINARY, MULTIFACETED APPROACH IS VERY IMPORTANT. ALTHOUGH THE CUMULATIVE TOTAL OF ELDER ABUSE HAS NOT BEEN QUANTIFIED, THE DEPARTMENT OF JUSTICE ESTIMATES SAY, IT EFFECTS MORE THAN 5 MILLION PEOPLE AND COSTS BILLIONS OF DOLLARS PER YEAR. ALTHOUGH TODAY I'M SPEAKING AS THE OFFICE OF DIRECTOR OF RESEARCH ON WOMEN'S HEALTH AND FEMALE ELDERS ARE ABUSED ASTERISKS A HIGHER RATE THAN MALES THIS IS A PROBLEM MORE WOMEN AND MEN TO CONFRONT. WE NEED ALL HANDS ON DECK AS MANY SECTORS CAN CONTRIBUTE TO THIS ISSUE. WE KNOW THAT CERTAIN FACTORS MAKE IT MORE LIKELY THAT A CAREGIVER OR OTHER INDIVIDUAL CLOSE TO AN OLDER PERSON WILL MISTREAT HIM OR HER, THESE INCLUDE ALCOHOL ABUSE, MENTAL ILLNESS, AGGRESSIVE BEHAVIOR, EXPOSURE TO ABUSE AS A CHILD AND LAST BUT NOT LEAST POOR PREPARATION FOR CARE GIVING. DEMENTIA IN ELDERLY AND OTHER FACTORS INCLUDING BEING A PART OF THE LGBT COMMUNITY ALSO CONTRIBUTE RISK OF HIM OR HER BEING ABUSED. NIH HAS TO BE PART OF THE EQUATION BECAUSE WE CAN SPONSOR RESEARCH TO BETTER UNDERSTAND THOSE RISK FACTORS AND WE CAN DESIGN AND TREAT TEST INTERVENTIONS. THESE ARE TOUGH ISSUES TO TALK ABOUT AND THEY SPAN THE GAMUT OF FACTORS EFFECTING ALL TYPES OF DOMESTIC VIOLENCE. MANY NIH COMPONENTS INCLUDING MY OFFICE AS YOU HEARD HAVE AN IMPORTANT ROLE IN THIS AREA. FOR EXAMPLE, WE COSPONSOR THE 2013 TRANSHHS INTERVIOLENCE SCREENING AND COUNSELING SYMPOSIUM AND A SPECIAL ISSUE ON IPV RESEARCH FOR THE JOURNAL OF WOMEN'S HEALTH ON KEY TOPICS OF THAT SYMPOSIUM WAS PUBLISHED JUST THIS PAST JANUARY. MANY OF THE PEOPLE INVOLVED IN THAT EFFORT ARE HERE TODAY. AGAIN, THANK YOU ALL FOR BEING HERE AND COMMITTING TO SOLVE A PROBLEM THAT IS DIFFICULT FOR ALL OF US TO CONSIDER. IT TOUCHES US PERSONALLY, AND THAT IS ALL THE MORE REASON WHY WE NEED TO FORGE AHEAD WITH SOLUTIONS BASED UPON EVIDENCE, THANK YOU. [ APPLAUSE ] >> SO I'D LIKE TO TAKE THIS OPPORTUNITY TO AGAIN WELCOME ALL OF YOU AND HAVE A CHANCE TO GO AROUND THE ROOM, AROUND THE TABLE, THAT IS AND INTRODUCE ONE ANOTHER BRIEFLY BECAUSE WHAT WE GATHERED HERE IS A VERY INTERDISCIPLINARY GROUP, MULTIPLE PERSPECTIVES ON THIS PROBLEM AND BE HELPFUL FOR EVERYONE IN THE ROOM TO KNOW WHO'S AT THE TABLE. SO I'D LIKE TO MODEL OUR MODE OF INTRODUCTION SO THAT WE COME GET THROUGH THIS VERY QUICKLY: I WOULD LIKE PEOPLE TO JUST SAY THEIR NAME, THEIR DISCIPLINE AND THEIR INSTITUTIONAL AFFILIATION SO THAT WE KNOW WHAT KIND OF EXPERTISE WE HAVE IN THE ROOM AND I AM LIZ NIELSEN AT THE NATIONAL INSTITUTE ON AGING,. >> I'M KATE SALYLER, I'M WITH THE WOODROW WILSON CENTER FOR. >> I'M MARK LAX, OOM A GERITRICIAN AT THE CORNELL UNIVERSITY IN NEW YORK CITY. >> MY NAME'S CATHY I'M A CRIMINOLOGYST AND I'M AT JOHN J. COLLEGE OF CRIMINAL JUSTICE AND CITY UNIVERSITY OF NEW YORK CENTER. >> I'M NATHAN SPRENG, COGNITIVE NEUROSCIENTIST AT CORNELL UNIVERSITY. >> HELLO, ELIZABETH SKOWRON, AT THE UNIVERSITY OF ORGEXPERTISE IS IN CHILD TREATMENT AND INTERVENTION. >> I'M PHYLLIS SHARPS I'M RESEARCHER AT JOHN HOPS KINS SCHOOL OF NURSING AND--HOPKINS SCHOOL OF NURSING. >> I'M SONNIA SOLARI, AND I'M DR OF GRADUATE STUDIES IN DEPARTMENT OF FAMILY AND CONSUMER TODAYS AT THE UNIVERSITY OF UTAH AND SOCIOLOGIST IS GERONATOLOGYST. >> I'M TONY ROSEN, SURGEON FROM UNIVERSITY OF CORNELL. >> LAURA MOSQUEDA, I'M A GERIATTRITION. >> DAN MARSON, PROFESSOR OF NEUROPSYCHOLOGIST, FORMER ATTORNEY AND MY AREA OF INTEREST IS LOSS OF FINANCIAL CAPACITY IN ALWAYS ALZHEIMER'S DISEASE. >> MY NAME IS DAVID BURNS AT UNIVERSITY OF TORONTO IN FACULTY SOCIAL WORK AND SPECIALIZING IN GERIATRICKIZATIONON TO LOGICAL SOCIAL YORK. >> I'M KAREN BURNRIGHT, WITH UNITED AGAINST ELDER ABUSE. >> CHRIS CARPENTER, WASHINGTON UNIVERSITY IN SIEWNT LEWIS, DOCTOR OF MEDICIE, INTERNAL MEDICINE AND GERIATRICS. >> RICHARD GELLES, PHYSICIAN. >> SHERRY FROM THE UNIVERSITY OF THE SOUTH. >> LORI, JERVIS, UNIVERSITY OF OKLAHOMA, MEDICAL ANTHROPOLOGIST AND MEDICAL GERIATRICKIZATIONONATOLOGYST. >> JASON KARLAWISH, AND UNIVERSITY OF PENNSYLVANIA MEDICINE AND I DO RESEARCH THROUGH ALZHEIMER'S DISEASE CENTER. >> I'M MERIAM KELSEY, PSYCHOLOGIST, RETIRED FROM NIA AND I ALSO WORK IN HAD THE AREA OF BIOETHICS, I WAS STAFFED TO THE FIRST OF THE ETHICS COMMISSION THAT GAVE US THE BELMONTE REPORT. PSYCHOLOGY FROM UNIVERSITY OF PITTSBURGH. >> JANE TERESI, HOME AT RIVER DALE AND COLUMBIA UNIVERSITY, MY BACKGROUND AND GERIATRICKIZATIONONATOLOGY AND MEASUREMENT STATISTICS. >> I THINK YOU ALREADY MET ME, JANINE CLAYTON, OFFICE OF DIRECTOR OF WOMEN'S HEALTH. >> YOU'VE MET ME MARIE BERNARD, GERIATRICIAN FROM NIA,. >> AND I'M NON, RA AND I'M WITH THE WHITE HOUSE BACKGROUND ON ELDER AGING AND WITH THE ON THE ECONOMIC HEALTH POLICY. >> THANK YOU ALL AND AND NOW IT'S MARK WILL GIVE THE OVERVIEW TO SET THE STAGE FOR TODAY. >> SO I'M NOT BOB WALLACE, I'M MARK LACHS. I AM HONORED TO SUBFOR HIM. I HOPE I WILL DO HIM APPROPRIATE. I MISAPPROPRIATED A FEW OF HIS SLIDES BUT SIMPLY HONORED TO BE HERE. SO I WANT TO RESPECTFULLY DISAGREE WITH MY FRIEND MARIE BERNARD, YOU DON'T LIKE TO DO THAT WITH THE DEPUTY DIRECTOR AND TELL YOU THAT NIH HAS DON VENED A GROUP OF FAMILY VIOLENCE EXPERTS TO IN AT NIH AND THAT WAS 1990 OR 1991 AND A RICHARD GELLES, AND I WAS INSIGHTED THEW THROUGH MY MENTOR TTERRY FULLER, FACULTY MEMBERS AT YALE, AND LARRY GOT TO MEET THE DOCTOR AND WE CAME TO CORNELL AND CARL LECTURED THE VARIOUS ELDER VIEWS THAT NOBODY KNEW WHAT THEY WERE DOING AND THERE'S BEEN RATHER SUBSTANTIAL PROGRESS IN ELDER ABUSE AND MUCH MORE THAT NEEDS TO HAPPEN. --BOB WALLACE AND IOM REPORT IN 2003, I'LL TALK ABOUT NAIN A FEW MINUTES, THERE HAVE BEEN SEVERAL ELDER JUSTICE INITIATIVES, ONE IN 2008 AND 2010 NIH AND NIH SPONSORED MEETING RESEARCH ISSUES AND ELDER ABUSE--ONE OF THE MOST UNSUCCESSFUL--AND IT HAS BEEN--MY FORMER PROGRAM OFFICER A REAL FRIEND OF ELDER ABUSE RESEARCH. I SHOULD ALSO MENTION AS NORA DID, THE DOJ ELDER JUSTICE ROADMAP DONE IN 2014, A BIG SHOUT OUT TO ANDIE MAU, AND TERRY WHO I BELIEVE ARE HERE SETTING POLICY AGENDAS THROUGHOUT THE UNITED STATES AND SYSTEMATIC LOOK THROUGHOUT THE FIELD OF THOUSANDS OF EYES AND CONTRIBUTORS AND PARTICIPANTS AND PART OF THE MOTIF IS TO BRING THE EXPERTISE OF OTHERS FROM CHILD ABUSE AND DOMESTIC VIOLENCE THERE HAVE BEEN MULTIPLE CONVENING OF FOLK WHO IS DO THAT, CONFERENCES AND COGNITIVE AGING, THE TRAINING NEEDS OF HEALTHCARE PROFESSIONALS GENERALLY IN FAMILY VIOLENCE, ARE THERE HAVE BEEN IMPORTANT CHILD ABUSE REPORTS FROM THE NATIONAL ACADEMIES AND HEALTH AND HUMAN SERVICES IN 2013 SPONSORED HERE AT NIH, TRENDS, INSTITUTIONAL TRENDS AND HUMAN SERVICES SYMPOSIUM ON GENERAL INTIMATE PARTNER VIOLENCE SCREENING AND COUNSELING SO A LOT HAS GONE ON. I'D LIKE TO TALK MORE ABOUT THIS REPORT WHICH IS PROBABLY THE MOST AWIVE CITED SEVERAL PEOPLE IN THE ROOM PARTICIPATE INDEED THAT ARE, LAURA, DR. JERVIS, SEVERAL PEOPLE HAD A ROLE IN THIS REPORT THAT HIGHLIGHT LIGHTED MANY OF THE ISSUES IN ELDER ABUSE RESEARCH. SOME OF THE WEAKNESSES THAT THE VERY IMPORTANT DOCUMENT DESCRIBED INCLUDED UNCLEAR AND INCONSISTENT DEFINITIONS OF ELDER ABUSE. UNCLEAR AND INADEQUATE MEASURES, THE LACK OF POPULATION BASED DATA. LACK OF PROSPECTIVE DATA, THE LACK OF CONTROL GROUPS AND THE LACK OF SYSTEMATIC EVALUATION STUDIES. WHEN YOU DRILL DOWN ON THIS TO ABOUT 20,000 FEET, THERE WERE SOME VERY IMPORTANT REASONS FOR THE SHORT COMINGS, THERE WAS LITTLE FUNDING AND FEW INVESTIGATORS: IT WAS GREAT TO SEE MARIA'S SLIDE BECAUSE THIS HAS IMPROVED, LOTS OF METHOD LOGIC UNCERTAINTIES, LOTS OF EGHT COLQUESTIONS REGARDING RESEARCH PRACTICES INADEQUATE LENGTHS BETWEEN RESEARCHERS AND SERVICE AGENCIES AND EVER PRESENT, NOT ONLY BETWEEN DIFFERENT FORMS OF ABUSE AND HOW DIFFERENT PROVIDERS AND RESEARCHERS USE DIFFERENT DEFINITIONS, SO THERE ARE CONCLUSION WAS THIS IN 2003, ALTHOUGH THE MAGNITUDE OF ELDER MISTREATMENT IS UNKNOWN, IT'S SOCIAL AND MORAL IMPLICATIONS, IS SELF-EVIDENT, HOWEVER THERE IS NO SOLID UNDERSTANDING OF THE NATURE, CAUSES AND CONSEQUENCES OF ELDER MISTREATMENT, THE EFFECTIVENESS AND COST OF CURRENT INTERVEPGZ OR MEASURES THAT COULD SUCCESSFULLY BE TAKEN TO PREVENT IT OR TO AMELIORATE ITS EFFECTS AND THAT WAS 2003. SO ONE MIGHT REASONABLY ASK, 12 YEARS LATER WHAT HAS HAPPENED: WELL, A GOOD BIT, ACTUALLY THERE HAVE BEEN NEW AND IMPORTANT POPULATIONS BASED PREVALENCE STUDIES, I SEE HERE, WE DID THE LARGEST ONE, THERE HAVE BEEN LONGITUDINAL STUDIES, ALTHOUGH THESE ARE PRIMARILY PIGGYBACKS ON AGING COHORTS, LARGELY CREATED BY NIA AND CREATES ISSUES BUT OPPORTUNITIES. WE LEARNED ABOUT THE HEALTH AND EFFECTS OF THE LIFE, YOU ARE MISTAKEN IF YOU THINK FINANCIAL EXPLOITATION IS THE ONLY ISSUE, THERE IS DOCUMENTATION THAT IT IS WITH OTHER FORMS OF ELDER TREATMENT AND IT'S MORBID AND MORTAL. IT'S BEEN DRIVING CONGRESSIONAL INTEREST AND POLICY INTEREST IS FINANCIAL EXPLOITATION BECAUSE OUR STUDY VS SHOWN IT'S A RISK FACTOR FOR ENTITLEMENT PROGRAMS BUT A RISK FACTOR FOR DYING. WE HAVE SOME BUT NOT ENOUGH JUNIOR PEOPLE ENTERING THE FIELD. I THINK THERE'S BEEN A MAJOR CLINICAL ADVANCE THAT'S BEEN STUDIED AND THAT'S THE ADVENT OF DISCIPLINARY TEAMS MODELED AFTER CHILD ABUSE, VERY IMPORTANT ADVANCE, CHAMPAGNE OUT ON THE WEST COAST, THERE HAVE BEEN MANY USEFUL RESEARCH PAPERS, BOB SAID THERE HAD BEEN HUNDREDS OF RESEARCH PAPERS AND HUNDREDS OF USEFUL PAPERS BUT I THINK HAD THERE HAVE BEEN--I'M A NEW YORKER I TEND TO BE A BIT MORE PESSIMISTIC AND THOSE PEOPLE FROM THE MIDWEST. AND THERE HAD BEEN A FEW BASIC SCIENCE OF ELDER ABUSE ADVANCES, I WILL EXPLAIN WHAT I MEAN TO THAT AND THERE'S BEEN 10 IMPORTANT THING AND THE REASON WE'RE HERE WHICH IS THE WHITE HOSCONFERENCE ON AGING MADE ELDER ABUSE A PRIORITY. NOW I WAS A DELEGATE IN 2005, I PARTICIPATED AT THE WHITE HOUSE IN 2015 IN ELDER ABUSE SESSION. I NEVER THOUGHT I WOULD SEE IT IN MY LIFETIME. I NEVER THOUGHT I WOULD SEE AT A WHITE HOUSE CONFERENCE ELDER ABUSE BE A PRIORITY SO THIS IS VERY COMPELLING AND ONE OF THE PRIORITIES EXPLICITLY STATED WAS IMPROVING SCIENCE ON UNDERSTANDING AND PREVENTING ELDER ABUSE, SO THAT WAS EXCITING TO BE AT THE WHITE HOUSE IN JULY, HERE'S A PICTURE OF THE PRESIDENTIAL CUP CAKES MADE IT SERVE, I TRIED TO TAKE SOME HOME. I MADE IT TO UNION STATION AND THEN WERE SQUISHED. IT WAS REMARKABLE TO SEE THIS, A PRIORITY AND I NEVER THOUGHT I WOULD SEE THE DAY. SO, SOME OF THE BUZZ THAT WENT ON IN THE SESSIONS REALLY ALLOWED US TO GET A BIT MORE GRANULAR AROUND WHY THESE PROBLEMS EXIST. THE 2003 REPORT TOUCH OFFICE OF DIVERSITY THIS BUT SOME OF THE DISCUSSION AND POTENTIAL SOLUTIONS REALLY WERE VERY INTERESTING AND I'D LIKE BRIEFLY TO TALK A BIT MORE ABOUT WHAT I SEE AS THE SCIENTIFIC STRUCTURAL AND PRACTICAL CHALLENGES THAT WE FACE, PARTICULARLY ON A DAY LIKE TODAY AT NIH. SO HERE ARE SOME SCIENTIFIC BARRIERS TO RESEARCH AND IT'S NOT AN EXHAUSTIVE LIST BUT IT'S THE KEY ONES, THERE IS A LACK OF A FUNDAMENT AMILLIO BASIC SCIENCE KNOWLEDGE ABOUT ELDER ABUSE AND WHAT DO I MEAN ABOUT BASIC SCIENCE OF ELDER ABUSE. HERE'S A BASIC SCIENCE STUDY OF ELDER ABUSE, OKAY? THIS IS A PAPER, 2005, LAURA I'M LOOKING AT THE LIFE CYCLE OF BRUISES PEOPLE, IT SUGGESTS THAT PEOPLE BRUISE IN A CERTAIN WAY IN ELDERS. LAURA HAD RESEARCH EFFECTIVENESS COLOR COATING WITH PAINT PALLETS, BRUCES THAT WERE ACCIDENTALLY ACQUIRED AND THERE WAS NO PATTERN WHICH WOULD ENABLE TO YOU TO FORENSICALLY DETERMINE HOW A BRUISE OCCURRED. THIS THE IS PAIN TAKING METICULOUS WORK, A NEGATIVE, NEGATIVE STUDY THAT WOULD BE VERY DIFFICULT TO FUND AS AN R21 OR RO-1 BECAUSE IT'S NOT A--WOW THAT'S A GREAT IDEA, LET'S BANG IT OUT OF THE PARK BUT WHO WILL DO THIS WORK AND HOW WILL WE GET IT FUNDED. THE LIMITED UTILITY OF FAMILIAR RESEARCH DESIGNS TO ELDER ABUSE, I STILL HERE PEOPLE SAYING, WE HAVE TO RANDOMIZE PEOPLE TO INTERVENTION A OR B I SEE THE RANDOMIZED TRIAL OLDER PEOPLIZED TRIALS AND I SEE THE CHILD ABUSE PEOPLE SHAKES THEIR HANDS UP AND DOWN, IT'S NOT GOING TO WORK, THIS IS NOT A DRUG FOR HYPERTENSION. I THINK THE LACK OF PERSPECTIVELY COLLECTED DATA FOR THE PURPOSE OFLEDDER ABUSE IS--THE IDEA THAT MANY OF THE COHORT STUDIES HAVE REALLY DEALT WITH OTHER NIH COHORTS ARE GOOD, BUT, YOU KNOW THEY LACK THE KIND OF DETAIL WE NEED ABOUT ELDER ABUSE VICTIMS SO CAN YOU GET THE DATA WE GET BUT IT'S NOT ELDER ABUSE SPECIFIC AND LET'S NOT FORGET THE 800-POUND GORILLA IN THE ROOM, WHICH IS COGNITIVE IMPAIRMENT AND COMPLIICATED EVERYTHING IN THE FIELD. THE DIFFERENTIATES IT FROM EVERY OTHER FORM AND DOMEST AND I CAN INTIMATE PARTNER VIOLENCE. OF IN TERMS OF STRUCTURAL BARRIERS TO RESEARCH AGAIN NOTE AN EXHAUSTIVE LIST, THERE HIPAA ISSUES AND MANY CREATED BY THE COGNITIVE IMPAIRMENT AND THE MANDATORY REPORTING ISSUE, MIRIAM AND I WILL HOST A SESSION IN WHICH WE WILL DUKE IT OUT OVER WHETHER OR NOT SUBJECTS ARE BEING OVERPROTECTED OR UNDERPROTECTED. I HAVE FEELINGS ABOUT THAT. WE CAN TALK ABOUT IT. THE UNDERSAMPLING PARDOCKS, VICTIMS AT THE HIGHEST RISK ARE THE LEAST ACCESSIBLE FOR PREVALENCE STUDIES AND THE LEAST ACCURATELY ABLE TO REPORT ON THEIR EXPERIENCE. THAT'S A REAL PROBLEM. SO I'VE DONE TELEPHONE SURVEYS, DEMENDED PEOPLE WHO ARE AT RISK CAN COME TO THE TELEPHONE, WE NEED METHODS TO GET AT THESE PEOPLE. IF WE'RE ABLE TO FIND OLDER PEOPLE WITH VICTIMS WITH LONG NUDEINAL STUDIES, KEEPING THESE FOLKS ENROLLED IS POSSIBLE GIVEN SOCIAL AND MEDICAL AND THE ISSUES OF DIVERSE POPULATIONS IS ESPECIALLY IMPORTANT HERE BECAUSE THEY'RE MORE DIFFICULT TO ACCESS AND THEY'RE ALL KINDS OF RECRUITMENT AND MEASUREMENT ISSUES. THEN THERE A PRACTICAL ISSUES TO GETTING THIS DONE. HOW WILL WE ATTRACT AGENTS TO THIS FIELD WHEN MORE PROMINENT PROGRAMS ARE FUNDED. HOW DO WE MAKE THIS ATTRACTIVE TO THEM? EVEN MORE COMPELLINGLY IF WE CAN ATTRACT THEM, HOW CAN WE INSURE THEY'RE THE FAIR REVIEW WORK, IF THERE ARE NO ELDER ABUSE RFFs, THERE'S A PERENNIAL REVIEW AT NIH. I SEE HEADS SHAKING. ONE OF MY SAD TORSTORIES, ONE OF MY MENTEES WHO WILL BE THE CHAIR OF NEUROSCIENCE SOMEDAY SUBMITTED COMPELLING INFORMATION ON THIS, EXPLOITED PEOPLE WHO ARE COGNITIVELY NORMAL THROUGH 16 HOURS OF COGNITIVE TESTING AND FUNCTIONAL MRI, IT'S THE LARGEST MOST COMPEL, ASSORTMENT OF DATA YOU HAVE EVER SEEN IN THE WORLD AND I ENCOURAGE THEM TO SUBMIT THAT FOR AN RO-1. LET IT WAS UNSCORED. OKAY THAT HAPPENS IN A STUDY S. WHEN I LOOKED AT THE COMMENTS THE SIGNIFICANCE AND IMPORTANCE FACTOR, FIVE. FIVE, PREVALENCE OF FINANCIAL EXPLOITATION IS FIVE% ANNUALLY IN ADULT, MORBID AND MORTAL. SOMETHING IS WRONG AND WE NEED SORT OF STUDY SECTIONS THAT REALLY UNDERSTAND HOW THIS HAPPENS AND HOW TO CREATE THEM, I'M NOT SURE. AND HOW WILL WE GET THE PAINSTAKES AND UNDPLAS ABUSE TO MOVE THE FIELD FORWARD AND EXECUTED SO HOW DO WE GET A STUDY ON BRUCEING TO GET THE NUTS AND BOLTS PIECES THAT REALLY ARE THE METHOD SECTIONS OF PAPERS THAT NO ONE WANTS TO DO, THEY WANT TO DO THE BIG STUDY BUT THAT NEEDS TO HAPPEN. FELT WELL, I WOULD SUGGEST, AND THIS CAME UP AT THE WHITE HOUSE SESSION, CLEARLY THERE ARE MECHANISMS TO DO THINGS LIKE THIS AND I WOULD POINT TO ONE WHICH IS THE ALZHEIMER PATIENT HYMER'S DISEASE RESEARCH CENTERS AND THESE HAVE BEEN FABULOUS SUCCESSES, EXIST IF OTHER DISEASES, PARKINSON'S DISEASE, DEPRESSION CENTERS AT NIH, THIS ONE IS COMPELLING BECAUSE IT MARYS SCIENCE AND SERVICE, THESE HAVE EXISTED NOW FOR A COUPLE OF FEW DECADES AND THEY REALLY MARY SERVICE TO PATIENTS AND FAMILIES WITH THE BEST SCIENCE AND THEY COLLABORATE MIGHTILY--LET ME JUST TALK CLINICALLY FOR THOSE WHO MIGHT BE UNFAMILIAR ABOUT THESE CENTERS, CLINICALLY THEY MY SCIENCE AND SUPPORT, THEY STUDY THE SUPPORTIVE FAMILIES IN ALZHEIMER'S DISEASE, THEY ARE FOR MOPE IN THE FORM OF INVESTIGATIONAL APPROACHES, DRUG TRIALS FOR EXAMPLE, AND THEY PROVIDE COMMUNITY OUTREACH, I WALK WITH THEM, EVERY FALL IN THE ALZHEIMER'S WALK ON THE UPPER WEST SIDE, SO THEY'RE VISIBLE COMMUNITY PARTNERS--55. >> [INDISCERNIBLE] >> I'M SORRY. OKAY. THEY CREATE STANDARD PROTOCOLS AT ALL SITES, THEY HAVE NATIONWIDE AIMS BUT LOC FOCI AND INTEREST, THEY HAVE RECRUITMENT EFFORTS, THEY PROVIDE PILOT GRANTS FROM IMPORTANT BUT OTHERWISE UNFUNDED IDEAS AND THEY ATTRACT INVESTIGATORS FROM OTHER FIELDS WHOSE WORK HAS RELEVANCE WHICH IS WHAT WE NEED IT ON DO. SO WE HAD MEETINGS AND REPORTS, IT'S TIME FOR SCIENCE, I'VE BEEN TO A NUMBER OF THESE MEETINGS, NONE OF US IT'S NOT THE FIRST TIME AT THE RODEO, WE NEED TO DO THE WORK SO I'M HONORED TO BE HERE. I HOPE THAT ISN'T A FEEBLE SUBSTITUTE FOR DR. WALLACE, BUT THEY THINK YOU--THANK YOU I APPRECIATE IT. >> [ APPLAUSE ] >> WE HAVE TIME TO TAKE A FEW QUESTIONS. >> DR. BROWN FROM NIH, CAN YOU COME TO THE MICROPHONE BECAUSE THERE ARE PEOPLE ON THE VIDEOCAST. >> THANK YOU JEREMY BROWN FROM NIH, GREAT OVERVIEW AND YOU RAISE AN IMPORTANT QUESTION WHICH IS THE ROLE OF PEER REVIEW IN GETTING THESE SUBJECTS OUT, NOW. WE AT NIH ARE OFTEN SEEN AS THE CAUSE OF THE PROBLEM BECAUSE THESE ARE NIH STUDY SECTIONS BUT WE HAVE TO REMEMBER THAT NEARLY ALL OF THE NIH STUDY SECTIONS ARE MADE UP OF PEOPLE FROM THE COMMUNITY YOUR PEERS, SO THE PROBLEM I THINK IS NOT THE NIH STUDY SECTION BUT HOW TO GET THE COMMUNITY OF PEER REVIEWERS TO UNDERSTAND THE IMPORTANCE THAT'S NOT TO SAY THAT NIH DOESN'T HAVE WORK TO DO IF YOU CAN OR TALK ABOUT IT LATER HOW TO GET--EVERYBODY IN THE ROOM THINKS THIS IS A PROBLEM SO WHETHER WHERE IS THE DISCONNECT BETWEEN THAT AND THOSE WHO SIT ON THE STUDY SECTION. >> I THINK THE LACK OF SCIENTIST IN THE FIELD CREATES A LACK OF PEOPLE WHO CAN ENGAGE IN REASONABLE PEER REVIEW, THAT'S PARLIAMENT OF THE PROBLEM AND, YOU KNOW SO A GROWING THE MAN POWER, SO YOU KNOW I DEVOTED MY K24, A STANDARD NIH MECHANISM TO THE DEVELOPMENT OF JUNIOR INVESTIGATORS. A COUPLE ARE HERE AND HAVE BEEN SUCCESSFULLY NIH FUNDED. IT'S A LONG CONVERSATION BUT IT'S ENDEMIC TO ALL NIH REVIEW. BUT HAVING THE CONFERENCEOT HEELS OF WHITE COULD YOU SAY CONFERENCE ON AGING AND TWEETING ABOUT IT, EVERYBODY SHOULD TWEET ABOUT IT IS A GREAT FIRST STEP AND WE'LL TALK MORE ABOUT IT. ANYBODY ELSE? WASN'T THAT GOOD. OKAY. THANK YOU. [ APPLAUSE ] >> I WOULD WOULD LIKE TO BRIEFLY INTRODUCE SCOTT BEACH WHO WILL MODERATE OUR 50 PANEL AND REMIND ALL OF YOU THAT WE'RE GOING RIGHT THROUGH THE TALK, TELL BE FIVE MINUTE TALKS OUR TIMER IS THE BACK, WILL KEEP FOLKS IN LINE AND THEN THERE WILL BE PLENTY OF TIME AT THE END FOR THE QUESTIONS SO EACH OF THE PRESENTERS WILL COME TO THE PODIUM, TAKE YOUR NAME TAG TO THE PODIUM WITH YOU SO THAT PEOPLE ON THE VIDEOCAST CAN SEE YOUR NAME WHEN YOU'RE SPEAKING AND THEN BRING IT BACK TO YOU AT THE PANEL TABLE AT THE END. I'LL TURN IT OVER TO YOU. >> THANKS, IT'S A GREAT HONOR TO BE HERE, I AM MODERATING THE FIRST PANEL, ONE OF THE VERY FUNDAMENTAL ISSUES IN ELDER ABUSE IDENTIFYING ABUSE, SCREENING STANDARD SAYS, DETECTION CHALLENGES, THE SESSION GOALS, WE WANT TO THE HIGHLIGHT THE CHALLENGE OF DEFINING AND IDENTIFYING ABUSE IN CLINICAL HOME AND INSTITUTIONAL SETTINGS, VERY COMPLICATED, WE WANT TO EXPLORE THE PROMISE OF NEW SCREENING AND ANALYTICAL STRATEGIES AND SOME NUMBERS LISTED THERE, EVIDENCE BASED CLINICAL DECISI, FORENSIC METHODS, ET CETERA AND WE WANT TO DISCUSS RESEARCH OPPORTUNITIES AND ELDER ABUSE AND HOW FINDINGS FROM CHILD ABUSE AND PARTNER VIOLENCE AND EMERGENCY GERIATRIC CARE RESEARCH INFORM ELDER ABUSE RESEARCH STAT EDGIES AND DIRECTIONS. SO I WILL PUT THE DECUSHION QUESTIONS YOU HAVE OF THESE IN YOUR MATERIAL, I DON'T NEED TO READ THEM BUT THESE ARE THE DISCUSSION QUESTIONS, AT LEAST THE INITIAL DISCUSSION QUESTIONS FOR THIS SESSION, THIS IS A VERY BROAD QUESTION, HOW CAN WE SCREEN ELDER ADULTS IN VARIOUS SETTINGS, VERY CHALLENGING, WHAT BIOLOGICAL CLINICAL OR ENVIRONMENTAL FACTORS CAN BE USED TO DISTINGUISH ELDER ABUSE VERSES INJURIES OF OTHER ORIGINS AND WE CAN LOOK AT THINGS LIKE FORENSIC IMAGING, RADIO GRAPHS, BIOMARKERS, WHAT ARE THE PROMISING METHOD LOGICAL TOOLS AND TECHNOLOGIES THAT CAN BE LEVERAGED FOR DETECTINGLEDDER ABUSE, EVEN MORE CHALLENGING I THINK CAN MANIFESTATION OF THE BEHAVIORIAL, PSYCHOLOGICAL SYMPTOMS CHANGES IN BEHAVIOR, DECREASES IN FUNCTIONAL ABILITIES BE POTENTIAL INDICATORS OF ABUSE AND HOW CAN THESE BE INCORPORATED INTOLEDDER ABUSE SCREENING AND AS MARK MENTIONED, MARK IS A TOUGH ACT TO FOLLOW BUT AS MARK MENTIONED, ISSUES, COGNITIVE IMPAIRMENTS, I WOULD SAY LIKE MILD COGNITIVE IMPAIRMENT, PEOPLE ON THE EDGE OR MOVING FORWARDS COGNITIVE IMPAIRMENT MAY BE MORE OF A CHALLENGE. HOW DO WE DEAL WITH THAT IN SCREENING AND DETECTION, WE HAVE INDIVIDUALS WITH EPHASIA, THEY CAN'T SPEAK, WE HAVE INDIVIDUALS THAT INTENTIONALLY MISREPORT ABUSE, I'VE BEEN DOING WORK IN THAT AREA OR REPORT, CAN'T REPORT ABUSE FOR FEAR OF RETALIATION. ARE THERE STRATEGIES WITH THESE DIFFICULT POPULATIONS FROM THE CHILD ABUSE IPV AREA THAT WE CAN APPLY. AND FINALLY, HOW CAN WE APPLY EXPERIENCES FROM THESE OTHER AREAS TO INVIGORATE AS MARK SAID THE FIELD OF ELDER ABUSE RESEARCH. WHAT HAS HAPPENED. WANT HOW CAN WE ENABLE COLLABORATION, ENCOURAGE YOUNG INVESTIGATORS AND WHAT MENTORSHIP MODELS WILL BE NEEDED. IN TERMS OF PANELISTS, WE'VE GOT--LET ME USE FIRST NAMES, WE HAVE CHRIS CARPENTER, TONY ROSEN, THOSE ARE BOTH EMERGENCY E. R. PHYSICIANS, AN INTERESTING PERSPECTIVE, WE HAVE PHYLLIS SHARPS FROM JOHNS HOPKINS, BRINGS A NURSING PERSPECTIVE AND RICHARD GELLES, I DIDN'T HAVE ROOM ON THE SLIDE TO PUT ALL YOUR TITLES, BUT THE AREA OF EXPERTISE REPRESENTED ON THE PANEL ARE LISTED THERE, THAT FIRST BULLET IS KIND OF WITH THE SURVEY METHODOLOGIST AND DONE WORK AROUND CAREGIVER STRESS, YOU CAN SEE EMERGENCY MEDICINE, FORENSICS, GERIATRIC EMERGENCY MEDICINE, MATERNAL CHILD ISSUES, NURSING, SOCIAL POLICY PRACTICE, VIOLENCE AND ABUSE AND FAMILIES SO WE HAVE NICE COVERAGE IN THIS PANEL, I WANT TO PUT TWO LAST SLIDES UP TO FRAME THE SETTING AND THIS IS SOMETHING THAT I PREPARED FOR THE WORKSHOP A COUPLE OF YEARINGS AGO AT NIA, IF YOU THINK ABOUT A VARIETY OF SCREENING AND DETECTION METHODS FOR BOTH COMMUNITY DWELLING AND INSTITUTIONALIZE OLDER ADULTS AND THEY'RE KIND OF LISTED HERE AND WE HAVE THE LITTLER CROSS CUTTING ISSUE THAT MARK MENTIONED OF COGNITIVE IMPAIRMENT OR WHETHER SOMEONE'S COGNITIVELY INTACT WE CAN ASK THEM, SURVEY THEM, WE SURVEY THE CAREGIVERS, SURVEY PERPETRATORS, TRICKY, COMMUNITY SENTINALS, IN ANY A. I. S. STUDY, WATCH FOR ELDER ABUSE, WATCH NEAR SCREEN NOTHING E. R.s, WE WILL HEAR ABOUT THAT, SO SERVICE FOR RENT [AUDIO DISTORTION ] THAT'S NOT ME. WE CAN DO VIDEO MONITORING IN NURSING HOMES, AND THESE TECHNIQUES WOULD BE RELEVANT TO RESIDENT AND RESIDENT ABUSE. GENTLEMEN THEMES, I AM GOING TO POP THIS ON, ONE SECOND, I WILL BRING UP--I GUESS ARE WE HAVING THE SPEAKERS COME UP HERE. SO THE FIRST SPEAKER WILL BE TONY ROSEN FROM WHEEL CORNELL MEDICAL COLLEGE. WE CAN COME BACK TO SOME OF THESE LATER. >> IF YOU'RE ON THE PHONE, PLEASE MUTE YOUR PHONES. THANK YOU. >> HI, I'M TONY ROSEN AND I'M CERTAINLY HONORED TO BE HERE TO TELL YOU ABOUT, TELL YOU ABOUT OUR WORK ON IMPROVING IDENTIFICATION AND INTERVENTION FOR ELDER ABUSE IN HEALTHCARE SETTINGS, IT'S CERTAINLY NOT IMPORTANT TO TELL THIS GROUP, I THINK BUT IT'S IMPORTANT TO EMPHASIZE THAT ELDER ABUSE UNDERRECOGNIZE AND UNDER REPORTED. AS WE KNOW FROM FOLKS THAT ACTUALLY DID RESEARCH IN THIS ROOM, AS FEW AS ONE IN 24 CASES IDENTIFIED AND WE THINK THOSE OF US THAT ARE HEALTHCARE PROVIDERS THINK THAT EVALUATION BY HEALTHCARE FOLKS IS VERY LIKELY AN IMPORTANT OPPORTUNITY FOR IDENTIFICATION. THESE ARE VICTIMS THAT MIGHT NOT LEAVE THE HOME FOR OTHER REASONS SO THE HEALTHCARE PROVIDER IS SOMEONE THAT MIGHT REALLY BE AN ASSET TO PROVIDING AND INTERVENING. AND THOSE OF US THAT ARE E. R. FOLKS THINK THAT THE EMERGENCY DEPARTMENT VISIT IS A CRITICAL AREA FOR PARTICULAR FOCUS. DESPITE THIS, I THINK MANY KNOW THIS AS WELL. IDENTIFIERS SELDOM IDENTIFY AND REPORT, THERE'S DUE TO MANY REASONS, POOR TRAINING, A CONCERN ABOUT INVOLVING THE LEGAL SYSTEM BUT ONE OF THE CRITICAL THINGS IS THE DIFFICULTY IN DISTINGUISHING ABUSE FROM ACCIDENTAL TRAUMA, LIKE FALLS, AND WE KNOW THOSE OF OUR COLLEAGUES IN CHILD ABUSE HAVE DONE AN EXTRAORDINARY JOB OVER DECADES OF DESCRIBING INJURIES THAT JUST SHOULDN'T HAPPEN AS A RESULT OF AN ACCIDENT. AND DIFFERENTIATING AXAL AND NONACCIDENTAL ISSUES HAS AIDED IN EXPLORING CASES. UNFORTUNATELY DESPITE THE WONDERFUL SEMINOLE WORK BY HER COLLEAGUES IN BRUISING WE HAVE VERY LITTLE WORK THAT'S SIMILAR IN ELDER ABUSE YET. AND SO, OUR FOCUS AND THANK YOU TO DR. BERNARD AND OTHERS FIDUCIARY SUPPORTING OUR WORK, I WAS ONE OF THE FOLKS SUPPORTED BY THE NIA IS IN DESCRIBING INJURY PATTERNS THAT ARE ASSOCIATED WITH ELDER ABUSE AND TRYING TO DIFFERENTIATE THOSE FROM ACCIDENTAL INJURIES AND OF COURSE WE HAVE A METHODOLOGY CHALLENGE. AFTER ALL IT'S HARD TO IDIDN'TIFY DEFINITIVE INSTANCE OF ABUSE IF WE CAN'T IDENTIFY IT TO BEGIN WITH. AND SO OUR SOLUTION WAS TO PARTNER WITH THE DISTRICT ATTORNEY'S OFFICE SO WE'RE USING LEGAL CASE FILES, WE'RE IN THE DISTRICT ATTORNEY OFFICE AND LOOKING AT PHOTOGRAPHS AND LOOKING AT MEDICAL RECORDS FROM ACTUAL CASES OF ELDER ABUSE WHERE THERE WAS A CONVICTION OR WHERE THERE WAS A PLEA OF GUILTY AND WE'RE TRYING TO IDENTIFY THOSE INJURY PATTERNS. THE BUT FOR US, THE REAL IMPORTANCE IS IN DIFFERENTIATING THOSE YOURS FROM THE FALLS WE SEE EVERY SHIFT ON OUR EMERGENCY PRACTICE, SO WE'RE ACTUALLY CONDUCTING A CASE CONTROL STUDY, COMPARING THE INJURIES WE'RE FINDING IN OUR ABUSE VICTIMS TO ACTUAL GERIATRIC PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT. WE'RE TRYING TO MOVE FORWARD THE DCES BETWEEN INJURIES WE SEE AS AN ACCIDENT AND INJURIES THAT MIGHT BE MORE CONCERNING AND REQUIRE MORE EVIDENCE OR MORE FOLLOW THROUGH AND OUR GOAL IS TO ACTUALLY DERIVE A CLINICAL DECISION RULE TO ASSIST HEALTHCARE PROVIDERS IN ADENTIFYING CASES WHERE THEY NEED TO DO MORE. UNFORTUNATELY AS DR. LACHS MENTIONED THERE ARE LOTS OF GAPS THAT WE IDENTIFY IN DEFINING OUR RESEARCH SO WE HOPE THAT THE SOLUTIONS WE COME UP WITH WILL BE HELPFUL FOR FUTURE STANDARDIZATION AND FIRST WE WANT TO TAKE PHOTOGRAPHS OF OUR VICTIMS AND OUR VICTIMS IN THIS CASE ARE FALL CONTROL SUBJECTS AND STANDARDIZED PHOTOGRAPHY AND WE DEVELOPED, OF PUBLISHED STANDARD, GERIATRICKIZATION RAD YIKE INJURIES AS WE DESIGNED A SYSTEM. SO OUR UPDATE, WE REVIEWED AND ANALYZED THIS AND PRESENTED IT SEVERAL PLACES JUST THIS WEEK AND WE ARE EXPANDING OUR STUDY TO LEVERAGE EXISTING DATA FROM KING COUNTY IN SEATTLE AND WE ENROLLED 200 SUBJECTS ALSO WE'RE TRYING TO EXPAND THE IDEA THAT IDENTIFICATION IS NOT THE RESPONSIBILITY OF ONE GROUP BUT OF MANY FOLKS. CERTAINLY RADIOLOGYST VS BEEN AN IMPORTANT TRIBUTER TO CHILD ABUSE AND WE'RE TRYING TO COLLABORATE AND PUT THIS IN THE DATABASES AND TO PHYSICAL ABUSES, AND THE NEXT STEP FOR US IS DESIGNING AN ED-BASED MULTIDISCIPLINARY ELDER PROTECTION TEAM TO PRESPONDY LIGHTIS TO CASES OF POTENTIAL ABUSE OR NEGLECT. AFTER ALL IF WE'RE IDENTIFYING THIS WE SHOULD BE IDENTIFYING AND WE THINK THIS IS AN IMPORTANT PLACE TO INTERVENE. AND WE APPLIED FOR A HARVARD GRANT, FROM OUR PERSPECTIVE AS DR. LACHS SAID, WE THINK THE NEXT MAJOR STEP IN ELDER AABUSE RESEARCH IS TO TRY TO PROSPECTIVELY ENROLL AND COMPREHENSIVELY ELDER ABUSE VICTIMS, WE THINK IT WILL HELP WITH THE PHENOMENON AND PERHAPS MOST IMPORTANTLY IDENTIFY CRITICAL DIFFERENCES FROM OLDER ADULTS, AND SO THANK YOU EVERYBODY AND SORRY FOR SPEAKING SO FAST. [LAUGHTER] [ APPLAUSE ] >> OUR NEXT SPEAKER IS CRITS PAT. >> LIKE SAID THIS ISSUE OF GERIATRIC ABUSE AND NEGLECT TREATMENT, THE LEADER OF OUR NATIONAL ORGANIZATION LOOKING AT EVIDENCE BASED MEDICINE, IMPLEMENTATION SCIENCE AND EDITOR AND JEFE OF OUR JOURNAL AND ACADEMIC MEDICINE AND ONE OF TED THINGS THAT I PUT A PEER REVIEW LENS TO FOR EVERYTHING WE DO IS THE LEVEL OF EVIDENCE FOR OUR RECOMMENDATIONS AND CORE STUDIES AND URBAN LARGE IT'S THE ISSUE OF KNOWLEDGE TRANSLATION ABOUT 10 YEARS AGO WE PUT TOGETHER THIS PIPELINE TALKING ABOUT HIGH QUALITY CLINICALLY RELEVANT EVIDENCE THAT IS DEFINITIVE AND PROOF OF CONCEPT. AND REPORTING IT TAKES 17 YEARS FOR 14% TO REACH THE BODY SIDE SO ALMOST 20 YEARS 86% OF WHAT WE KNOW IS NEVER USED THE BEDSIDE. PART OF THIS INCLUDES AWARENESS, OUR PRIMARY CARE PHYSICIANS, OUR DENTISTS ARE UNAWARE THIS IS A BIG ISSUE, GERIATRIC OR ELDER ABUSE, THEY PROBABLY WON'T THINK TO SCREEN IT OR READ ABOUT IT OR LOOK FOR IT, SOPHISTICATEDY WE NEED TO RAISE THE BAR OF AWARENESS TO THE LAST DAY OF CLINICAL PRACTICE IN POST GRADUATE EDUCATION AND IN NURSING EDUCATION AND ANCILLARY CARE PROVIDER EDUCATION, WE NEED TO RAISE THE AWARENESS OF THE ISSUE WHICH I DON'T KNOW WE'VE DONE A GOOD JOB IN MY SPECIALTY, OF EMERGENCY MEDICINE AND INTERNAL MEDICINE. THE NEXT LEAK IS ACCEPTANCE, IFEUR COLLEAGUES ARE AWARE THIS IS AN ISSUE, IF THEY DON'T ACCEPT THESE INSTRUMENTS APPLY TO THEIR AREA, THEN THERE ARE CONSEQUENCES AND THEY WILL BE ENVIRONMENTAL ENVIRONMENTAL HEALTH SCIENCESITANT TO USE THEM, AND AND COMPLAINT TO BRINGS THIS TO THE SMRNLG DEPARTMENT AND IMPLEMENTING--LET'S THINK ABOUT IMPLEMENTATION FROM DAY ONE, RATHER THAN AT THE END OF THE PROCESS. THE NEXT WEEK IS APPLICABILITY, IF WE'RE GOING TO RELY ON GERIATRIC CENTERS OR NURSING HOME STUDIES FOR EMERGENCY HOSPITAL PRACTICE THAT WILL NOT BE A BIG SELLER WITH OUR AUDIENCE, THEY NEED TO BE CONDUCTED IN WHICH YOU WANT THEM SO THATY WOO KNOW THIS IS ACTUALLY USEABLE IN OUR ENVIRONMENT MUCH DIFFERENT THAN ANY OTHER ENVIRONMENTS AND/OR SOMETHING WHERE YOU HAVE INFORM THE POSITION WITHOUT ENDANGERING THEMSELVES WITH THE OTHER PERSON IN THE ROOM. AND CLINICANS CAN ACT ON THESE RICK AND YOU HAVE MULTIPLE DISTRACTERS AND 50 PARENTS IN THE WEIGHTING ROOM, AND THESE CONDITIONS, AND THESE TWO WEEKS ARE PATIENT LEVEL WEEKS OF THIS, AND AND DOES NOT PLUG THAT AND I CAME TO THE NIH PART OF A PANEL AND HOW WE CAN CONDUCT AND REPORT IMPLEMENTATION RESEARCH AND WE'RE VERY CLOSE TO GETTING THIS TIME AND AND ELDER ABUSE RESEARCH AND GO TO THESE CHECK LIST AND THE CHANGE AND THE SETTING WHERE YOU WANT TO IMPLEMENT ELDER ABUSE ABUSE SCREENING AND THIS CAN GO ON. HOW CAN THIS BE ADAPTED AND NOT CHANGE THE OUTCOME COMPLETELY BUT WHAT IS THE EFFECTIVENESS THAT YOU ARE GOING TO EXPECT TO OBTAIN AND PARTICULARLY WHAT ARE THE UNINTENDED CONSEQUENCES, HOW CAN YOU MEASURE THAT IF YOU START TO FOCUS ON ELDER ABUSE AND NEGLECT WILL WE MISS OTHER E. D. FOR ELDER CENTERS AND HOW PRAGMATIC FROM THE BEGINNING AND LOOK AT THE LONG-TERM OUTCOMES AND WHAT ARE THE FINANCIAL COSTS, PERSONNEL COSTS AND ARE WE GOING TO ROB PETER TO PAY PAUL. I WILL SKIP OVER THIS, ALSO, THE DIAGNOSTIC DECISION MAKER AND WE PUBLISHED RESEARCH ON THIS, IT'S DIFFICULT TO UNDERSTAND RISKS OF PATIENTS JUST FOR GENERAL VULNERABILITIES AND THERE ARE LOTTINGS OF REASONS WHICH IN TED 90 MINUTE DISCUSSION WE HAVE, I WILL BE HAPPY TO ELABORATE MORE ON HOW THESE OTHER INSTRUMENTS FAILED BUT I'M OUT OF TIME, SO THANK YOU. >> I WAS FIRST CALLED AND INVITED I THOUGHT WAS THE WRONG PERSON BUT I WOULD LIKE TO TALK MORE ABOUT THE GOALS AND WHAT WE LEARNED ABOUT INTIMATE PARTNER VIOLENCE AND SO JUST TO BE CLEAR, IT'S A DIFFERENT OR DISTINCT DEFINITIONS, THAT IS PHYSICAL AND SEXUAL VIOLENCE EMOTIONAL ABUSE BETWEEN INTIMATE PARTNER, AND CDC SUGGESTS IT'S ALSO THE THREAT OF PHYSICAL VIOLENCE PREVALENCE IS OFTEN OVERLOOKED, WE'RE NOT SURE, OFTEN OVERLOOKED BUT LITTLE INFORMATION BECAUSE WE ARE NOT SCREENING SPECIFICALLY FOR INTIMATE PARTNER VIOLENCE BUT SOMEWHERE BETWEEN-25% WHICH IS UNDERREPORTED. THERE ARE PROBABLY AT LEAST TWO PATTERNS OF INTIMATE PARTNER VIOLENCE IN WOMEN, AND THE QUESTION AND AS A SPECIFIC FORM OF ELDER ABUSE, OR IS--DID WE JUST KEEP IT ALTOGETHER AS ELDER ABUSE. , INTIMATE RELATIONSHIP AND IT CHANGES AS THEY MOVE INTO OLDER AND LATE ONSET OF RETIREMENT, DISABILITY, COGNITIVE IMPAIRMENT AND NEW ROLES FOR FAMILY MEMBERS AND SEXUAL CHANGES, AND WE ALSO ARE ACTIVE AGAINST YOUNGER AND OLDER WOMEN, THE PHYSICAL AND MENTAL HEALTH OUTCOMES ARE SIMILAR SO, PERHAPS, PART OF THE ISSUES IN TERMS OF SCREENING IN OLDER WOMEN AND HAVE ABOUT SEXUALITY AND APPARENTLY IS FOR SOME PREVAILING SOMEWHERE AROUND 60 THEY BECOME ASEXUAL AND THEY HAVE NO MORE INTEREST IN SEXUAL ACTIVITY, AND THE OTHER ISSUE IS WE LOOK AT OLDER PEOPLE AS ONE GROUP AND PEOPLE WHO ARE THIRST OR MORE YEARS IN THE ADULT YEARS AND I WOULD SAY THAT PROBABLY OLDER ADULTS DEVELOPMENTALLY AND THAT THE INTIMATE RELATIONSHIP CAN CHANGE OVERTIME. SO THERE ARE ISSUES AROUND INCREASED VULNERABILITY FROM FORCED SEX AND EXPOSURE TO STD AND PERHAPS OR MORE AT REASK FOR COGNITIVE AND INTIMATE PARTNERS WHO ARE FORCING MALE PARTNERS WHO ARE FORCING AND DEMANDING SEX AND FOR FEMALE PARTNERS WHO HAVE BEEN IN LONG-TERM ABUSIVE RELATIONSHIPS SUDDENLY FIND THAT THE MALE PARTNER PERHAP SYSTEM FRAIL AND NOT ONLY IS SHE AN EPITHELIAL MATE PARTNER BUT SHE'S ALSO A CAREGIVER AND MAY HAVE THE OPPORTUNITY TO GET SOME RETRIBUTION FOR THE NUMBER OF YEARS SHE'S BEEN ABUSED. AND CERTAINLY AS WE GET MUCH LATER IN THIS THE 90S AND ON, WE PROBABLY ARE TALKING ABOUT VERY FRAIL INDIVIDUALS AND WHAT ARE THE ISSUES IN TERMS OF PARTNER ABUSE AND SEXUALITY. SO OF COURSE, THERE'S NOT ENOUGH COMPELLING EVIDENCE TODAY TO SUGGEST FROM THE USPSTF THAT WE CAN SCREEN FOR ELDER ABUSE, BUT IMPORTANT IS IT IMPORTANT TO DISTINGUISH IPV FROM OTHER FORMS OF ELDER ABUSE. DO WE HAVE APPROPRIATE SCREENING QUESTIONNAIRES AND METHODS FOR SCREENING ELDER WOMEN IN PARTICULARLY AROUND THE ISSUES WHICH WE HEARD BEFORE OF COGNITIVE IMPAIRMENT? I AM NOW TESTING WITH NIH FUNDING, SCREENING WITH COMPUTER TABLETS AND HOME VISITS AND WOULD THAT BE A TECHNOLOGY BECAUSE OF THE ABILITY TO LISTEN BECAUSE OF THE ABILITY TO HAVE VERBAL ALOS ANGELES AS OTHER PICTURES AND THINGS, WOULD THAT BE SOMETHING THAT MIGHT BE USEFUL FOR ELDERS. AND THEN OF COURSE, THE ISSUES OF HOW DO WE SCREEN'RE INTIMATE PARTNER VIOLENCE ACROSS A VARIETY OF SETTINGS, HOMES, INSTITUTIONS AND OTHER PLACES WHERE ELDERS MAY FIND THEMSELVES: AGAIN, THE ISSUES AROUND COGNITIVE IMPAIRMENT, EITHER IN WRITTEN FORMAT OR EVEN IN SPEAKING OR HAVE INDIVIDUALS IN SPEAKING BACK TO THE SCREENERS. AND THEN IF THERE IS EXISTING DEPRESSION AND SUBSTANCE USE, DOES THAT TRIGGER A SCREEN FOR IPV IN ELDERS, WE KNOW IT DOES IN YOUNGER WOMEN AND I'M GOING TO SIT DOWN, I'M OUT OF TIME BUT THOSE ARE THE QUESTIONS I HAVE. THANK YOU. [ APPLAUSE ] >> YOU HAVE TO PAY ATTENTION TO ME. I'M A RECOVERING POWER POINT PERSON. I WAS HERE IN 1990 AND 1991 ON ELDER ABUSE. SO THE SCREEN AND DETECTION MY ADVICE IS AS FOLLOWS, AS WE TRY TO PUSH FOR 1970 TALKING ABOUT MANDATORY REPORTING OF CHILD ABUSE AND NEGLECT, WE SUCCEEDED BEYOND OUR WILDEST EXPECTATIONS, WE ARE 3 MILLION REPORTS A YEAR, INVOLVING 5 MILLION CHILDREN, ONLY 15% OF WHOM RECEIVE AN ACTUAL SERVICE. TOO, IN TERMS OF DOMESTIC VIOLENCE, WE'VE ALSO BEEN VERY SUCCESSFUL IN MULTIPLE WAYS OF SCREENING AND DETECTION. WE WENT ANOTHER DIRECTION RATHER THAN USING MANDATORY REPORTING, CASES ARE CHANNELED THROUGH POLICE DEPARTMENTS BY OUR EMBING MANDATORY ARRESTS IN THE MID1980S, THE PROBLEM WITH THAT IS AFTER WE ARREST OFFENDERS WE DON'T ACTUALLY HAVE A TOOL BOX TO KNOW WHAT TO DO WITH THEM. SO IT'S VERY IMPORTANT AS YOU CONSIDER SCREENING AND DETECTION, WHAT ARE YOU ACTUALLY GOING TO DO ONCE YOU SCREEN AND DETECT THIS AND DO SOMETHING? IT'S VERY WISE TO KEEP COMING BACK TO THE NATIONAL CRIME VICTIMIZATION SURVEY AND WHEN YOU LOOK AT THE TABLE BY AGE ONE THING STANDS OUT AT YOU, THE LOWEST RATE OF REPORTING OF VIOLENCE OLDER AND IT VARIES BY ECONOMIC CIRC CIRCUMSTANCES AND THE AGE GROUP OF 50 OR OLDER IS FLAT SUGGESTING THAT, THIS IS A DIFFERENT POPULATION OF ABUSERS THAN YOUNGER ABUSERS IN ALL LIKELIHOOD IS NOT LATE ONSET ABUSERS, THEY ARE INDIVIDUALS WHO DIDN'T AGE OUT AS BEHAVIRS, AND THAT CAN BE A VERY DIFFERENT INTERVENTION PROBLEM AND VERY DIFFERENT PROBLEM IN TERMS OF CAUSE FOR MODELING EMPLOYED M O D E L I N G M O D E L I N G. WE HAD A PROGRAM OF RESEARCH AND POLICY NAMED INTERVENTION FOR ELDER MISABUSE WITH THE USUAL, MORE PEOPLE, MORE TRAINING. SO WHAT WE NEED TO DO INSTEAD OF ROUNDING UP THE USUAL SUSPECTS IS BLUEPRINT WHAT ACTUALLY WORKS AND FOR WHOM AND UNDER WHAT CIRCUMSTANCES SO THAT WHEN WE HAVE BECOME SUCCESSFUL IN SCREENING AND DETECTION, WE'RE NOT SIMPLY PUSHING VICTIMS AND AND IT'S HARD TO ACTUALLY DO THIS IN THREE AND HALF MINUTES AND NOT FIVE. [ APPLAUSE ] >> IF THE PANELISTS WOULD LIKE TO COME UP TO THE TABLE AT THE END OF THE ROOM SO WE CAN CLICK OUR NECKS IN THE OPPOSITE DIRECTION AND JEREMY COULD YOU BRING US SCOTT'S SLIDES AGAIN BECAUSE THEY HAVE THE QUESTIONS FOR THE PANEL AND DO YOU NEED THOSE TO BE ADVANCED DURING--I DON'T KNOW IF WE HAVE A REMOTE CONTROL BUT MAYBE YOU COULD ASK? >> OKAY, SORRY, HOW MANY--SHOWING MY LACK OF PRACTICAL SKILLS, SO THIS PANEL, IS HAVING INTERESTING, BRINGS TOGETHER AN INTERESTING SET OF FOLKS AND I GUESS WHAT WE'LL DO, WHAT I PLAN ON DOING WAS STARTING--I FEEL SEPARATED FROM YOU GUYS SOMEHOW, STARTING WITH THE QUESTIONS THAT WERE LAID OUT IN THE OVERALL SESSION, WE CAN DO THIS, I'D LIKE TO KEEP THIS FAIRLY LOSE, I WANT YOU TO THINK THE 50 QUESTION, GO THROUGH MAYBE THESE OVERALL QUESTIONS, GET IMPRESSIONS FROM THE PANEL MEMBERS AND I HAVE MORE SPECIFIC QUESTIONS TPHAOEUGZINIZEATION--ORGANIZATIO N TIME PERMITTINGS FOREM OF THE PANEL MEMBERS AND EACH OF THE PANEL MEMBERS. SO THIS QUESTION IS A BROAD QUESTION, HOW CAN WE SCREEN FOR ELDER ABUSE IN THESE VARIOUS SETTINGS, YOU KNOW, TWO OF YOU TOUCHED ON CLINICAL SETTINGS, I THINK PHYLLIS, YOU DO A LOT OF WORK IN HOME SETTINGS, INSTITUTIONAL MAY NOT BE COVERED AS WELL, BUT DO THE PANELISTS WANT TO MAKE THEM INTO THE GENERAL STATEMENT, SORT OF BEST PRACTICES OR YOUR OPINIONS ON WHAT ARE THE BEST WAYS IN TWO MINUTES OR LESS WE CAN SCREEN SORE CHOOSE A SETTING OR EITHER ONE. AND TONY LIFE LIFE DO YOU WANT TO TAKE A STAB? >> HELLO? IS THAT WORKING. OH GOT IT, COOL. ANYWAY, I'M AN EMERGENCY ROOM DOCTOR AND MANY OF US THAT WORK IN EMERGENCY DEPARTMENTS FEEL LIKE, WE'RE ON THE FRONT LINES AND A POTENTIALLY VERY IMPORTANT SCREENING LOCATION FOR ELDER ABUSE AMONG OTHER TYPES OF FAMILY VIOLENCE, I THINK THAT UNFORTUNATELY, WHERE WE ARE, RIGHT NOW, IS THAT WE NEED BETTER IDENTIN AND SCREENING TOOLS, IN ORDER TO ASSIST US, I THINK THAT WE HAVE PRETTY MATURE SCREENING TOOLS AS I MENTIONED AND IDENTIFICATION TOOLS FOR CHILD ABUSE BUT WE DON'T YET HAVE SIMILAR TOOLS FOR EER ABUSE AND I THINK THAT PARTICULARLY AGAIN, CHRIS AND I BOTH WORK IN BUSY EMERGENCY DEPARTMENTS AND I THINK ALL CLINICAL SETTINGS ARE GETTING BUSIER THAN THEY WERE A GENERATION AGO. WHEN WE THINK ABOUT SCREENING TOOL AND IDENTIFICATION TOOLS ONE OF THE CRITICAL THING SYSTEM TO MAKE SOMETHING SMALL ENOUGH AND USEFUL ENOUGH THAT WILL IT BE TAKEN UP BY CLINICIANS AND USED AND SO, I THINK AS A RESULT, FROM MY PERSPECTIVE WHAT I THINK WE NEED TO FOCUS ON IS HOW CAN WE IDENTIFY THINGS THAT WE WILL HELP CLINICIANS AND ARE EASILY USEABLE. DISEMPLOY. >> RICHARD. >> JUST GO IN ORDER. RICH? >> I THINK THE QUESTION ALREADY BUT WHAT CAME TO MY MIND IS AFTER CLINE IPGZS COME UP WITH THEIR TOOLS, I THINK ONE THING WE NEED--ONE THING WE'RE TRYING TO GET THE CHILD WELFARE FIELD TO EMBRACE AND THEY'RE NOT DOING IT WITH ANY GREAT JOY, IS THE APPLICATION OF BIG DATA. RATHER THAN TO HAVE TO MAKE CLINICAL DECISIONS AS WE CREATE A DATABASE OF SUBSPHANTIAL CHILD ABUSE CASES WE CAN DIFFERENTIATE CASES AS THEY COME IN THIS TERMS OF WHICH ONE'S OUGHT TO BE INVESTIGATED, WHICH ONES SUBSTANTIATED, WHERE ARE THE GREATEST RISKS CONSIDER, WE APPLIED GEOGRAPHIC MAPPING TO THAT AS WELL, SO I WILL TAKE THIS ONE STEP UP FROM THE CLINICIANS AND SAY, AS YOU BEGIN TO DEVELOP YOUR KNOWLEDGE BASE AND YOUR CLINICAL TROLL TOOLS, THERE ARE OUGHT TO BE A PLACE ON THE AGENDA FOR PREDICTIVE ANALYTICS SO WE CAN GO BEYOND THE CLINICAL CASES AND SAY, OKAY, WHERE ARE THE COMMUNITIES, WHERE ARE THE SEGMENTS IN THE COMMUNITIES, WHERE ARE THE FTIES IN THE COMMUNITIES THAT WE HAVE TO LOOK THE MOST CAREFULLY AT IN ORDER TO IMPROVE OUR DETECTION. >> SO LIKE TONY I'M IN THE EMERGENCY DEPARTMENT, I LIKE TO TRY TO THINK OUTSIDE THE BOX AND NOT LIMIT EVERYTHING THAT WE DO TO THE NURSES AND PHYSICIANS WHICH HAS BEEN TRADITION. FOR MY DEMENTIA SCREENING RESEARCH THAT I'VE DONE, I'VE TRIED TO USE MEDICAL STUDENTS AND VOLUNTEER RETIREES TO USE SIMPLE SCREENING TRIEWMENTS THAT HAVE GOOD CAPACITY TO RULE OUT DEMENTIA AND DELERIUM AND LESS CAPACITY TO NONLOW RISK SUBSET, THEY GET THE NURSES AND PHYSICIANS INVOLVED ON A MUCH SMALLER SUBSET OF THE PATIENTS AND START TO CONNECT IT WITH THE EXTERNAL RESOURCES THAT WE HAVE AS A RESEARCHER AND SOMEBODY WHO SITS ON STUDY SECTIONS AND NUMBER WHO IS A JOURNAL EDITORS, WHAT I WOULD SAY IS THE MODELS I'VE SEEN PUBLISHED IN THE PAST HAVE NOT ADHERED TO OUR EMERGENCY LITERATURE ON HOW TO DEVELOP A ROBUST MODEL THAT HAS A GOOD CHANCE OF BEING REPLICATED AND OTHER SETTINGS AND IMPLEMENTATION TRIALS SHOWN TO IMPROVE THE OUTCOMES WE WANT TO IMPROVE, THE GROUP IN OTTOWA HAS PUBLISHED THOSE AND THEY'RE SPECIFIC FOR MEDICINE BUT NOT ENTIRELY BUT A LOT OF OTHER SCREENING TYPE PROCESSES DIDN'TA ADHERE TO THOSE RECOMMENDATIONS. FOR INSTANCE REPORTING, RELIABILITY OF EACH OF THE INDIVIDUAL PREDICTERS AMONG DIFFERENT CLINICIANS IN THE DERIVATION PHASE OR VALIDATION PHASE WHERE WE TAKE IT TO ANOTHER SETTING AS ANOTHER EXAMPLE, CONSIDERING THE USE OF CURSOR PARTIC PICIONING AND IT WAS JUSTS A RIGREGZ TO MAXIMIZE THE SENSITIVATIVITY OF YOUR MODEL AND I THINK FUTURE MODELS WOULD BENEFIT FROM LOOKING AT THOSE RECOMMTIONS AND CONSIDERING WHETHER TO USE THEM OR NOT, THERE ARE ALSO NEW REPORTING GUIDELINES CALLED THE TRiPOD GUIDELINES THAT FUTURE AUTHOR GROUPS ARE GOING TO NEED TO LOOK CLOSELY AT, IT'S A 22 ITEM CHECK LIST WHEN YOU'RE DESIGNING MODELS OF ANY TIME, PROGNOTTIC OR DIAGNOSTIC THOSE WOULD BE WELL WORTH ADHERING TO SO THAT SOCIOLOGY ABUSE AND APPLES TO APPLICATIONSEMS WITH THE MEDICINE HOME RESEARCH AND SO THOSE ARE THE RECOMMENDATIONS I WOULD HAVE SPECIFICALLY TO YOUR QUESTION, SCOTT ABOUT LOOKING AT THE SCREENING TRIEWMENTS AND WHO DO THE SCREENING. >> AS SCOTT MENTIONED MUCH OF WHAT I DO IS IN-HOME VISITING ENVIRONMENTS AND THERE ARE SIMILARITIES IF YOU'RE WORKING WITH ELDERS IN HOME SETTINGS, THERE ARE LIKELY TO BE FAMILY MEMBERS, THE ABUSER COULD BE THERE SO HOW DO YOU SCREEN IN A WAY THAT KEEPS WOMEN OR MEN SAFE FROM FURTHER ABUSE AS A RESULT OF THE SCREENING PROCESS. WE ARE HAVING FAIRLY PROMISING OUTCOMES USING COMPUTER TABLETS IN THAT WE CAN TRANSLATE INTO DIFFERENT LANGUAGES FOR OUR POPULATION. I WORK PRIMARILY WITH MEDICAID ELIGIBLE WOMEN SO THERE'S OFTEN LOW LITERACY SO WE CAN DESIGN QUESTIONNAIRES THAT HAVE LOWER LANGUAGE BUT ALSO THAT PEOPLE CAN LISTEN TO AND THEY CAN TOUCH THE SCREEN AND ONE OF THE THINGS AS I'M SITTING HERE, TABLETS HAVE THE ABILITY TO ADJUST THE SIDE OF WHAT PEOPLE ARE LOOKING AT AND YOU COULD PROBABLY USE OTHER WAYS OF SCREENING THAT DON'T INCLUDE WORDS SO I THINK THAT WHAT WE'VE LEARNED FROM SCREENING WITH PREGNANT WOMEN, THERE ARE SOME THINGS THAT WOULD PROBABLY WORK VERY WELL IN HOME ENVIRONMENTS WHERE YOU ARE GIVING HOME CARE AND HOME WORKERS COULD BE TRAINED TO USE THOSE SCREENING METHODOLOGIES AND IT GIVES YOU TO ANOTHER POPULATION THAT YOU MAY NOT SEE THAT ARE COMING INTEREST OUR EMERGENCY DEPARTMENTS OR OTHER PLACES. >> THIS IS AN EXCELLENT IDEA AND I'M IN AN EMERGENCY ROOM SO IN THE PARADIGM OF THE EMERGENCY DEPARTMENT BUT THIS IS APPLICABLE IN GENERAL AS WELL, SO I THINK WITH SOMETHING THAT'S HARD TO IDENTIFY, IT'S IMPORTANT TO EXPAPPED THE GROUP OF FOLKS THAT CAN BE PART OF THE TEAM THAT IDENTIFIES ELDER ABUSE AND I THINK THAT REALISTICALLY, SOME OF THE--SOME OF THE ANALOGIES IN THE EMERGENCY ROOM DEPARTMENT WOULD BE FOCUSING ON EMERGENCY ROOM PERSONNEL WHO MAKE A HOME VISIT AS PART OF A 911 CALL AND CAN LOOK INSIDE THE REFRIGERATOR AND EVALUATE WHETHER MEDICATIONS ARE TAKEN AND CAN NOTICE UNSAFE HOME ENVIRONMENT AND ALSO THINKING ABOUT? THE SETTING AGAIN OF AN EMERGENCY DEPARTMENT VISIT, I APOLOGIZE THAT'S MY FRAME OF REFERENCE BUT A RADIOLOGIC TECHNICIAN, AFTERALL A LOT OF TIMES IN CLINICAL SETTINGS, THE ABUSER DIDN'T WANT TO LEAVE THE SIDE OF THE VICTIM AND THAT'S NOT GOING TO BE THE CASE IN THE SETTING OF A RADIO GRAPHIC TEST SO FROM OUR PERSPECTIVE ONE THING WE CAN THINK ABOUT IS THAT SOMETHING THAT IS THIS HARD TO IDENTIFY, FOLKS HAVE ARGUED IN THIS THE PAST FOR USING MAIL CARRIERS AND DOOR MEN AND OTHER FOLKS TO HELP WITH IDENTIFICATION PROCESS AND TO EMPOWER THESE OTHER PEOPLE TO ASSIST IN IDENTIFICATION AND I THINK THAT'S AN IMPORTANT THING PARTICULARLY IN CLINICAL SETTINGS TO FOCUS ON. >> THANKS. I THINK WHEN YOU LOOK AT THE SECOND QUESTION THERE, I THINK THE ADVANCES IN FORENSIC AND SO FORTH, TONY COVERED THAT PRETTY WELL, I WANT TO MENTION TECHNOLOGIES FOR A SECOND, I HAVE A BACKGROUND IN SURVEY METHODOLOGY AND SIMILAR TO PHYLLIS I'VE DONE WORK SHOWING THAT PRIVATE COMPUTERIZED METHOD CANS RESULT IN HIGHER PREVALENCE ESTIMATES ON THINGS LIKE PSYCHOLOGICAL ABUSE, FINANCIAL ABUSE AND RANDOMIZED TRIAL AS THE RECIPIENTS. SO PHYLLIS, I NOTICE YOU'RE COMPARING PAPER AND PENCIL TO YOUR TABLET, ARE YOU FINDING YOU HAVE RESULTS FOR US TO REPORT ON THAT? >> INTERESTING YOU ASK THAT, WE HAD OUR DATA SAFETY MONITORING BOARD ON WEDNESDAY, I DON'T HAVE RESULTS I CAN SHARE BUT ANECDOTALLY WHAT'S BEEN INTERESTING IN MY POPULATION, THE WOMEN THEMSELVES WHO ARE YOUNGER IN THEIR 20S SEEM TO REALLY LIKE THE TECHNOLOGY, THE HOME VISITORS WHO ARE OLDER ARE HAVING A LOT OF DIFFICULTY AND I DON'T UNDERSTAND IT BECAUSE EVERYBODY HAS SMART PHONES. SO I THINK CERTAINLY IT HAS BEEN VERY USEFUL FOR US IN OUR POPULATION IN THAT WOMEN AND WE'VE DONE SOME OTHER WORK AT THE UNIVERSITY OF THE VIRGIN ISLANDS WHERE WE USED A COMPUTER ASSISTED AND WE GOT A HIGH PREVALENCE RATE. SO WHAT THE WOMEN TOLD US THAT ARE USING IT IS THAT THEY LIKE THE PRIVACY OF THE IT, AND WE'VE DESIGNED SOME FAIL SAFE THINGS SO THAT IF FAMILY MEMBERS COME IN, THEY CAN SWITCH TO ANOTHER SCREEN THAT HAS NOTHING TO DO WITH PARTNER ABUSE, SO SOME OF THAT MIGHT BE USEFUL, I THINK IT WOULD BE CHALLENGING WHEN YOU'RE DEALING WITH A POPULATION THAT MAY HAVE COGNITIVE IMPAIRMENT BUT WE'VE LEARNED A LOT IN TERMS OF FLEXIBILITY AND CREATIVITY AND USING THE COMPUTER TABLETS AND JUST FROM SPEAKING CAN COLLEAGUES WITH THAT WORK FOR OLDER POPULATIONS, THERE ARE A NUMBER OF ELDERS WHO ARE QUITE SAVVY WITH iPADS AND THINGS LIKE THAT SO IT'S A TECH WE WILL CONTINUE TO FIND USEFUL WAYS TO USE IT. >> THANK YOU. >> TONY I WAS INTERESTED IN YOUR GOAL IS TO DEVELOP A CLINICAL DECISION RULE. CAN YOU ENVISION OR GIVE US AN EXAMPLE, WHAT MIGHT ONE OF THOSE RULES LOOK LIKE. HOW WOULDED IT BE IMPLEMENTED, JUST HERE. >> WE WILL GET THIS SOONER OR LATER, CHRIS AND I ARE EMERGENCY ROOM PHYSICIANS AND WE'RE PRETTY BUSY AND CLINICAL DECISION RULES CAN ASCHIST US A LOT IN IDENTIFYING THINGS THAT WE SHOULD OTHERWISE BE CONCERNED ABOUT. THEY CAN ALSO ACTUALLY HELP WITH A LOT OF OTHER THINGS LIKE REDUCING UNNECESSARY TESTING AND SO ON, BUT FOR THIS PARTICULAR PURPOSE WHAT WE CAN ENVISION AS LEAST AS IT RELATES TO INJURY PATTERN SYSTEM FOR EXAMPLE, WE MIGHT HAVE A LIST OF FIVE OR SIX THINGS LIKE INJURIES ON THE LEFT SIDE OF THEIR FACE, INJURIES ON THE RIGHT FOREARMOT LATERAL ASPECT, AND SO ON, AND IF APPROXIMATE A PATIENT, THAT YOU'RE SEEING IN THE EMERGENCY DEPARTMENT HAS THREE OR MORE OF THESE POSITIVE FINDINGS, THEN THEY NEED ADDITIONAL EVALUATION AND WHETHER THAT ADDITIONAL EVALUATION IS AN INTERVIEW WITH THE PATIENT ALONE OR WHETHER IT'S CALLING THE PRIMARY CARE PHYSICIAN, OR WHETHER IT'S GETTING ADDITIONAL COLLATERAL INFORMATION OR ADMITTING THE PATIENT, THE IDEA IS THAT ULTIMATELY FOR NOW, FOR MANY EMERGENCY PHYSICIANS, ELDER ABUSE SIMPLY ISN'T ON THE DIFFERENTIAL TO BEGIN WITH. AND PART OF THE REASON IF THAT ARE IS WE'RE BUSY. IF YOU COME IN AND YOU SAY, HEY, I FELL, OR WHOEVER'S STANDING NEXT TO YOU SAYS, THEY FELL. ODDS ARE YOU'RE GOING TO THINK, GHEE WELL IF THEY'RE ELBOW HURTS LET'S GET AN X-RAY AND IF THE ELBOW LOOKS GOOD, LET'S GET THEM HOME BECAUSE I HAVE 18 OTHER PATIENTS TO SEE IN THE EMERGENCY DEPARTMENT AND WHAT WE'RE HOPING TO DO IS SAY WELL, NOT ALL OF THOSE ARE FALLS. AND MAYBE THAT IF YOU NOTICE AN INJURY PATTERN THAT'S UNUSUAL, THAT WILL BE THE WORK WE'RE DOING OR AND ONE OF THE THINGS THAT RICHARD AND OTHERS DESCRIBED IF THE PATTERN, AND DEMOGRAPHIC CHARACTERISTICS ARE SUCH THAT THIS PERSON IS AT RISK FOR ABUSE MAYBE YOU NEED TO DO MORE EVALUATION SO FROM OUR PERSPECTIVE, WE ENVISION A PRETTY EASY TO USE RULE, ONE OF THE THINGS THAT CHRIS AND I CAN TELL YOU IS THAT WE USE AND THERE'S LITERATURE ON THIS, SEVERAL HUNDRED CLINICAL RULES AND PRACTICES AS EMERGENCY PHYSICIANS IS IT IMPROVES OUR ABILITY TO DO OUR JOB AND LAST THING I'LL SAY, SCOTT, ABOUT THAT IS THAT THOUGH THERE ARE PLUSES AND MINUSES TO IT, CLINICAL DECISION RULES ARE REALLY THE BEGINNING OF WHAT MANY OF US THINK OF AS CLINICAL DECISION SUPPORT. TO CONSIDER THE THINGS WE NEED TO BE CONSIDERING IN THE CLINIC AND ASKING QUESTIONS WE ASK BEFORE WE DISCHARGE THEM AND PERHAPS THE MOST DANGEROUS THEN WE DO AS PHYSICIANS IS SEND PATIENTS HOME. SO FROM OUR PERSPECTIVE WE WANT TO MAKE SURE WE'RE GIVING A TOOL TO PROVIDERS TO MAKE SURE THEY DON'T SEND PATIENTS HOME UNSAFELY. >> COULD I HAVE THE NEXT SLIDE, PLEASE? SO THE NEXT SLIDE TALKS ABOUT THE VERY TRICKY ISSUE OF PSYCHOLOGICAL SYMPTOMS, BEHAVIORIAL CHANGES, DECREASES IN FUNCTIONAL ABILITIES AND THIS RAISES AN ISSUE THAT I'M VERY INTERESTED IN, IN TERMS OF DECISION RULES AND THESE OBJECTIVE, YOU KNOW USING RADIO GRAPHIC IMAGES, BRUISING PATTERNS, INJURIES, WHERE DOES THE ROLE, WHERE DOES IT MENTION TONY THAT YOU WOULD FOLLOW UP ON AN INTERVIEW WITH THE PATIENT, WHERE IS A SELF-REPORT--WHAT IS THE CLASSIC QUESTION OF YOU FIND YOUR DECISION RULES POSITIVE, YOU ASK THE PERSON AND THEY SAY NO, NO ABUSE IS GOING ON, YOU KNOW HOW DO WE HANDLE THAT. ANYBODY CAN RESPOND TO THAT? AND IT ALSO RELATES, CHRIS, AND OTHER QUESTIONS, I WILL ASK TWO QUESTIONS, I THINK THIS ONE SORT OF RELATES, I WAS FASCINATED, I LOOKED AT YOUR META-ANALYSIS, WHY ARE THE SCREENING TRIEWMENTS AND RISK FACTORS YOU LOOKED AT, WHY DO THEY DO SUCH A POOR JOB OF PREDICTING READMISSION. WHAT ARE WE MISSING HERE, IT'S A DOUBLE QUESTION AND ANYBODY CAN JUMP IN. MENT. >> I WANTED TO RESPOND. REGUARDING PSYCHOLOGICAL BEHAVIOR AND CHANGES AND IT REALLY MOST CASES, WARRANTS A PRIOR BASELINE AS A CLINICIAN IN THE E. D. YOU'RE NOT ALWAYS GOING TO HAVE A PRIOR BASELINE SO IT'S VERY HARD TO KNOW AND YOU KNOW IN TERMS OF THIS CLINICAL DECISION RULE, ONE THING I THOUGHT YOU COULD ADD THORS THAT IS, NOT SIMPLY A PATTERN OF INJURIES THAT MIGHT BE CHARACTERISTIC BUT IS THERE A PATTERN OF REPEATED PRESENTATION IN THE E. D. BY THE SAME INDIVIDUAL AND THE CAREGIVER THAT CAUSES CONCERN. THAT SHOULD BE PART OF THE DECISION RULE. >> I'M HAPPY TO RESPOND TO THAT. ABSOLUTELY. ABSOLUTELY THAT THAT KIND OF PATTERN OF HEALTHCARE DELIVERY AND AS WELL AS DEMOGRAPHIC FACTORS AND SO ON, I THINK WOULD BE A CRITICAL PIECE IN ADDITION TO AND AGAIN, I THINK THAT YOU'RE ABSOLUTELY RIGHT, THE CHALLENGES ASSOCIATED WITH BEHAVIOR ARE KNOWING A BASELINE. AND KNOWING WHAT THE REGULAR BEHAVIOR IS, HOWEVER, AGAIN, I THINK THAT ONE OF THE THINGS, AGAIN, IN AN EMERGENCY CLINICAL SETTING IS THAT IF FOLKS ARE LOOKING OUT FOR THIS, THEY CAN NOTICE UNUSUAL INTERACTIONS OR BEHAVIORS THAT JUST DON'T SEEM QUITE RIGHT AND CAN EXPLORE MORE DEEPLY IF NECESSARY. SO -- >> SO LET ME INTRODUCE A CAUTION. WE DIDN'T THINK OF THIS 40 YEARS AGOINGS WHEN WE FOLLOWED THE SAME PATHWAY OF MULTIPLE ADMISSIONS THROUGH EMERGENCY ROOMS, BUT AFTER 25-30 YEARS EVERYBODY FIGURED IT OUT. AND THAT IS THERE ARE SOCIAL FACTORS TO WHERE THEY LEAD TO THE MEDICAL CARE AND EMERGENCY ROOM PROTOCOLS HAVE PLAYED A FAIRLY SUBSTANTIAL ROLE IN THE DISPROPORTIONATELY PROBLEM IN CHILD MALTREATMENT. SO KIDS AND FAMILIES WITH EXACTLY THE SAME CLINICAL PRESENTATION ARE MORE LIKELY TO BE DIAGNOSED AS CHILD MALTREATMENT CASES IF THEY'RE SEEN IN EMERGENCY ROOMS AS OPPOSE TO BEING SEEN BY A PRIVATE PROVIDER. AND WHO GOES TO EMERGENCY ROOMS IN OUR HEALTHCARE SYSTEM AND WHO GOES TO PRIVATE PROVIDERS IS OFTEN--WELL, NOT OFTEN, IS INCOME DRIVEN AND INCOME DRIVEN CORRELATES IN A CITY LIKE PHILADELPHIA, WITH RACE AND ETHNICITY. SO THERE IS A FLIP SIDE OF THE COIN ON DEVELOPING WONDERFUL PROTOCOLS FOR EMERGENCY ROOMS WHERE YOU CAN SOCIALLY CONSTRUCT A PROBLEM THAT LOOKS LIKE IT BELONGS IN ONE ECONOMIC GROUP OR ONE RACIAL GROUP FALSELY SO. >> SO GETTING TO THE ISSUE ABOUT OUR SYSTEMATIC REVIEW, WHAT WE LOOKED AT SIX DIFFERENT CLINICAL DECISION INSTRUMENTS LIKE TONY DESCRIBED AND OUTCOMES AFTER E. D. VISIT FOR ADULTS AND WHAT WE LOOKED AT WERE THINGS LIKE TWO WEEK RETURN TO THE E. D., ONE, MONTH, THREE MONTH RETURN TO E. D. AND FUNCTIONAL DESIDELINE OVER THE IRCHT VAL AND LONG-TERM PLACEMENT FACILITY AND DEATH, AND THESE YOU WANT INSTRUMENTS HAD BEEN DEVELOPED OVER 25 YEARS IN CANADA AND EUROPE AND THE UNITED STATES AND NONE OF THEM HAD PREDICTIVE CAPACITY TO PREDICT ANY OF THESE OUTCOMES, NONE OF THE TRIEWMENTS FOR ANY OF THE OUTCOMES AT ANY THRESHOLD OR ANY TIME INTERVAL WHICH WAS VERY SURPRISING TO A LOT OF RESEARCHERS AND CLINICIANS AROUND THE WORLD BECAUSE THEY SHAPED POLICY AROUND THE SCREENING INSTRUMENTS AND THEY ARE LESSONED TO BE LEARNED FOR THE ELDER ABUSE SCREENING PROTOCOLS FROM THE OUTSET AS WE BEGIN TO PROCESS OF THINK BEING IT. SOME OF THE ISSUES WE IDENTIFIED WERE THAT A LOT OF THE OUTCOMES THAT WERE MEASURED WERE MEASURED IN DIFFERENT WAYS BY DIFFERENT INDIVIDUALS USING DIFFERENT DEFINITIONS SO YOU MAY NOT BE COMPARING APPLES TO APPLES AND IT'S HARD TO COMPARE SETTINGS WITH SETTINGS WITH THAT AND COMING UP WITH A GOLD STANDARD FOR OLDER ADULT MISTREATMENT AND I KNOW IT'S IT'S DIFFICULT BECAUSE THERE'S SO MANY TYPES OF TREATMENT BECAUSE IT'S ACROSS SPECIALTIES AND ACROSS NATIONS FIGURE OUT WHAT WE MEAN BY THESE TERMS AND THE DAIMPLEGGERS OF NOT DOING SO LOOKING AT IT FROM A DIAGNOSTIC STANDPOINT, YOU HAVE VARIOUS FORMS OF BIAS THAT JOURNAL EDITORS THAT DON'T THINK ABOUT SO YOUR SPECIFICITY WILL BE DRIVEN UPWARD SO YOUR STUDY WILL NOT BE FOCUS BUT SPECIFICITY AND YOU NEED TO TAKE THEM WITH A GRAIN OF SALT WITH A REAL CLINICAL PRACTICE. SPECTRUM BI AS, STICKER POPULATION, YOU DRIVE ESTIMATES SENSITIVITY UPWARD AND DON'T EFFECT SPECIFICITY IF YOU HAVE A LOWER RISK POPULATION AND THE STUDY POPULATION OR IN THE POPULATION THAT YOU'RE APPLYING IT TO, IF THERE'S A MISMATCHED BETWEEN THE STUDIES AND THE CLINICAL POPULATION, YOUR ESTIMATE OF SPECIFIC IT'D IS DRIVEN UP WARD BY THE LESS SIX, LESS RISKY POPULATION. HAVE YOU THINGS LIKE DOUBLE OR DIFFERENTIAL VALID AND RELIABLEIFICATION BIAS WHICH THEY'RE ESTIMATE, WHAT THEIR EFFECT ON SENSITIVITY AND SPECIFICITY DEPENDS ON THE DISEASE BECOMES MANIFEST AFTER THE INDEX TEST, SO VERY COMPLEX CONCEPT THAT ELDER MISTREATMENT TRIALS THINK ABOUT EARLY ON BECAUSE IF YOU DON'T, YOU ENDANGER THIS MONITOR AND IT LOOKS GOOD IN THE CLINICAL TRIAL AND FALLING APART WE TRY TO,A SEASES IT AND IMPLEMENTATION TRIALS DOWN THE ROAD IN NONRESEARCH SETTINGS AND THEN THERE'S THINGS LIKE UNMEASURED CONFOUNDERS RICHARD TALKED ABOUT ONE OF THEM BEING ACCESS TO CARE, OTHERS THAT HAVE NOT BEEN MEASURED WELL IN STUDIES HEALTH LITERACY, IF WE'RE LOOKING AT APPLYING THIS IN POPULATIONS YOU 92 ED TO TAKE INTO ACCOUNT THE POPULATION THAT WE STUDY AND TRY TO APPLY IT TO AND WE DON'T DO A GOOD EXPWHROB OF MEASURING HEALTHITYERACY. COGNITIVE IMPAIRMENT, I KNOW THAT THAT SEEMS LIKE A VERY STRAIGHT FORWARDS ONE BUT MOST OF THE STUDY THAT BEEN DONE LOOKING AT DECISION INSTRUMENTS FOR VULNERABILITY OHM RELIED ON SELF-REPORT OF DEMENTIA WHICH MISSES 70% OF THE CASES AND OUR E. D. ENVIRONMENT AND THEY DIDN'T FORMAL INSTRUMENTS WITH ANY INSTRUMENTS WE DEVELOPED OR COMMONLY RECOGNIZED INSTRUMENTS LIKE MO CA OR NMSE, AND THEN THERE'S THINGS LIKE FRAILTY AND LAST MARCH WE HAD A TWO DAY CONFERENCE ON FRAILTY AND SO MUCH DISAGREEMENT ABOUT WHAT IT IS, WE KNOW IT WHEN WE SEE IT BUT HOW DO YOU MEASURE IT AND PUT IT IN A STUDY. THAT'S A CONCEPT THAT WE NEED TO GET A HANDLE ON. THE. >> I WANT TO RAISE A QUESTION AND WE SEEM TO BE FOCUSING ON DETECTION AND ELDER ABUSE AND DETECTION LOOKING AT THE VICTIM, POTENTIAL VICTIM, WHAT ABOUT PERPETRATOR DETECTION THAT'S VERY INTERESTING. AM PERPETRATORS ARE THE VERY IMPORTANCE OF THE PROCESS AND HASN'T BEEN AS MUCH WORK DONE, IT'S HARD TO DO IT BUT CAN YOU TALK ABOUT DETECTION OF PERPETRATORS, ANY METHODS YOU'RE USING FOR HOW DO THEY--HOW DOES THAT FIT IN, DO HAVE YOU IDEAS ABOUT THAT. ANYBODY? I GUESS WE COULD OPEN IT UP TO THE GROUP. PERPETRATOR DETECTION? I KNOW THAT--I LOOKED AT SOME OF THE BACKGROUND MATERIAL, I DID MY HOME WORK SO I WAS LOOK BEING AT THE FACT SHEETS THAT ARE OUT THERE AND THEY TALK ABOUT RISK OF PERPETRATION, ANYONE IN THE ROOM ACTUALLY DONE PERPETRATOR RISK WORK? HOW THIS DISCUSSION? IT'S INTERESTING THERE'S NOT MUCH REACTION? ANYBODY? >> THIS IS LAURA--GO,A HEAD. >> I CAN TALK. >> SO WE'RE COMPLETING DATA COLLECTION RIGHT NOW ON A STUDY WHERE WE LOOK AT PRIMARY AND SECONDARY PREVENTION, IT'S JUST A PILOT PROJECT OF PEOPLE WITH DEMENTIA AND WE'RE TRYING TO UNDERSTAND THE CHARACTERISTICS THAT MAKE SOMEBODY MORE LIKELY TO BE A PERPETRAOR, I THINK THE LANGUAGE HERE IS ALSO VERY IMPORTANT AND ALSO DIFFICULT BECAUSE IN MY VIEW THIS MAY BE CONTROVERSIAL HERE BUT IN MY VIEW, A LOT OF PEOPLE WHO END UP PURPLE TRAITING ELDER ABUSE ARE NOT BAD PEOPLE BUT THE TERM PERPETRATOR HAS SO MANY CONNOTATIONS THAT THAT MAKES IT DIFFICULT. SO I THINK THERE'S A FEW THINGS THAT WE KNOW THAT ESSENTIALY E SPECIALLY IN THE DIADS OF DEMENTIA RELATED TO PERCEIVED BURDEN, STRESS, STRESS LEVELS, ANXIETY LEVELS, DEPRESSION, SOCIAL ISOLATION, SEEM TO BE THESE CORRELATES IF NOT RISK FACTORS, THAT MAKE ABUSE MORE LIKELY OCCURRENCEOT PART OF A SO CALLED PERPETRATOR. AND THEN I DON'T ALSO WANT TO MISS THE FACT THAT THERE ARE SOME REAL PEOPLE WITH SERIOUS PATHOLOGY WHO ALSO PERPETRATE ABUSE AND I THINK THERE'S DIFFERENT IDENTIFICATION AND PREVENTION AND INTERVENTION STRATEGY DEPENDING ON THOSE CHARACTERISTICS. >> I CAN ALSO RESPOND A LITTLE BIT. CERTAINLY DAVID BURNS IS IN THE ROOM AND CARL DID A NICE REVIEW OF RECENTLY OF SOME OF THE RISKS SURROUNDING BEING A PERPETRATOR AND MOST OF US THAT ARE DOING RESEARCH IN THIS AREA ARE ALSO LOOKING AT AS LAURA SAID, FOLKS THAT ARE PERPETRATING THIS, AND FOLKS THAT ARE IN FACT CRIMINALS PERHAPS INVOLVED IN A CHALLENGING SITUATION. INTERESTINGLY ALSO, A GROUP IN SEATTLE IS DOING A LARGE FOUR YEAR STUDY OF PROSECUTION IN KING COUNTY AND LOOKING AT ALL THE DEFENDS IN THIS KING COUNTY FOR ELDER ABUSE CASES SO THERE IS WORK ONGOING IN TRYING TO INCREASINGLY DESCRIBE WHO PERPETRATORS ARE HOWEVER CHALLENGE OF RISK PERPETRATION HAVE IDENTIFICATION CHALLENGES OF THE REST OF ELDER ABUSE RESEARCH WHERE WE'RE IDENTIFYING THE PERPETRATORS OF THE CASES WE ARE ARKS DENTIFYING AND THAT MIGHT NOT REPRESENT THE PERPETRATORS THAT WE'RE UNABLE TO IDENTIFY. >> JUST A FOLLOW UP ON THAT, YOU KNOW I THINK THAT'S A GREAT POINT, TONY IF WE WANT TO GET A GOOD UNDERSTANDING WE NEED TO DO A PREVALENCE STUDY, RANDOM--LARGE RANDOM SAMPLE OF TRUSTED OTHERS, YOU KNOW PEOPLE WHO ARE IN A TRUSTING RELATIONSHIP WITH AN OLDER ADULT TO REALLY DETERMINE WHO'S MORE LIKELY TO PURPLE TRAIT OR NOT AND AS TONY SUGGESTED, WE'RE--BASING A LOT OF OUR FINDINGS ON THESE CASES WHICH LIKELY HOLD A LOT OF BIAS. >> I'M SORRY, THIS IS LORA I WILL TAKE A COMMENT ON TOP OF THAT WHICH IS THAT THE--IT'S NOT GOING TO BE A ONE-SIZE-FITS-ALL, EITHER. IT'S GOING TO DEPEND ON THE TYPE OF ABUSE, AND THE CIRCUMSTANCES AS WELL, SO I THINK COMING UP WITH A ONE-SIZE-FITS-ALL IS PROBABLY NOT THE WAY TO GO. >> KATHLEEN QUINN I AM GLAD LORA SAID WHAT SHE SAID, BECAUSE THERE'S A TENDENCYY TO SEE PERPETRATORS WITH DOMESTIC VIOLENCE LENS AND THAT'S NOT ACCURATE WITH ELDER ABUSE, BUT I WANT TO ADD ONE THING THAT PEOPLE WE CALL PERPETRATORS ARE ALSO VOWELLENERRABLE ADULTS AND WHO NEED SERVICES THEMSELVES. >> COMMENT, THERE ARE TWO MICROPHONES SO IF FOLKS HAVE A QUESTION AND THEY WANT TO GET TO THE MICROPHONE. >> YES, I WOULD JUST SAY THAT IT'S MY PREVIOUS WORK ON CARE GIVING IS VERY EVIDENT THAT A LOT OF THIS IS OR SOME OF THE STUFF I LOOKED AT IS CAREGIVERS, OLDER CAREGIVERS THEMSELVES FRAIL, YOU KNOW AN 80 YEAR-OLD WOMAN TAKING CARE OF AN 85 YEAR-OLD MAN AND SO FORTH AND THINGS--YOU KNOW WE SHOULDN'T--THEY'RE NOT BAD PEOPLE, IT'S JUST THE WAY THINGS SOMETIMES UNFOLD AND IN TERMS OF A SURVEY, IT'S INTERESTING TO ME WHEN YOU ASK THESE FOLKS THEY WILL TELL YOU, THE PREVALENCE OF THESE STUDIES IN PEOPLE WHO TAKE CARE OF DEMENTIA PATIENTSS SO IT'S VERY INTERESTING, THEY WILL--I DON'T THINK THEY SEE IT AS ABUSE, THEY WILL SAY, YES, I GET FRUSTRATE AND THE I MIGHT HAVE TO YELL AT THAT AND GUIDE THEM FORCEFULLY AND SO FORTH. >> GET TO RON BEFORE HE BURSTS. >> THE LONGEST ANYONE'S EVER BEEN ABLE TO KEEP ME AWAY FROM THE MIC AS THEY WILL TELL YOU. >> WE DID THAT STUDY, IT DOESN'T WORK AS WELL, PROXIES WILL REVEAL BUT THEY WON'T REVEAL AT THE SAME RATE AND THIS IS FOR COMMUNITY RESIDING ACULTS. A COUPLE OF POINTS, I WANT TO TIE A FEW THINGINGS TOGETHER AND OFFEND A FEW PEOPLE IN THE ROOM WHICH IS TYPICAL, WHEN PEOPLE ARE SHOWING RESEARCH AND REPORTING ONLY ONE RO-1, THAT'S NOT A LOT IN PAST YEARS THAT'S NOT SIGNIFICANT ELDER RESEARCH ON ABUSE, THE PROBLEM IS WHEN YOU DO ANALYTICS YOU NEED DATA AND YOU NEED BIG DATA AND WHEN YOU USE PREDICTIVE ANALYTICS IN TIP OF THE ICEBERG SETTINGS, YOU ARE ALSO AS YOU SAID NOT GETTING A REPRESENTATIVE POPULATION AND E. R. IS THE TIP OF THE ICEBERG SETTING, I WAS SCARED WITH WHAT YOU TALK ABOUT WITH RESPECT TO INJURY TYPES BECAUSE OF LORA'S WORK BUT ALSO BECAUSE WE DON'T HAVE THE DATA FOR THE PRACTICE GUIDELINES YOU'RE TALKING ABOUT. FOR DIABETES AND YOU'RE TALKIN ABOUT AUTOMATED HEALTHCARE RECORD, EMR DRIVEN PRACTICE GUIDELINES WHICH IS HOW YOU GOET THROUGH YOUR DAY, WITH A HUNDRED GUIDELINES APPLIED TO ONE PATIENT. WE ARE SO FAR AWAY FROM THAT BECAUSE TO TALK ABOUT IT IS A BIT DISCONCERTING TO MEAS BECAUSE IT MEANS SOMEBODY MIGHT TRUE TO DO IT. AND WE DON'T HAVE THE DATA. AND THE QUESTION BEFORE WAS ON PSYCHOLOGICAL OUTCOME DATA. WELL I CAN TELL YOU WE HAVE BEEN COMPLETELY UNABLE TO DO RESEARCH ON ANY OUTCOMESLEDDER MISTREATMENT UNTILOT SEVENTH TRY, NIH IS FOLLOWING A LONGITUDINAL STUDY, ORIGINAL PREVALENCE STUDY TO SEE WHAT THE HEALTH AND OUTCOMES ARE FOR FIAL ABUSE OUTCOMES AND EDUCATION OUTCOMES BUT WHEN WE LOOK AT EDUCATION THAT'S SUCH A TIP OF THE ICEBERG SO IF YOU'RE GOLD STANDARD IS ONLY THOSE WHO ARE FOUNDED YOU WILL MISS BY DEFINITION MOST OF THE PEOPLE AND THEN CONSULTING THE NIH OVER THERE, UNLESS YOU SET UP A REVIEW GROUPS FOR ELDER MISTREATMENT WE'RE GOING TO CONSISTENTLY GET INANE COMMENTS THAT HAVE ABSOLUTELY NOTHING TO DO WITH THE RESEARCH WE'RE DOING SO WE'RE BASICALLY WAY AWAY FROM THE NUMBER OF STUDIES WE NEED TO FUND, THE TYPE OF PEOPLE REVIEWING THE STUDIES, THE DATA, THE GOLD STANDARDS THAT YOU'RE GOING TO USE TO REFERENCE THOSE PREDICTIVE ANALYTICS AND PREDICTIVE ANALYTICS AND PROXIES DON'T WORK THAT'S HOW I GOT TO THE IN, IC. >> CAN YOU COME BACK UP AND TELL US WHAT YOU REALLY THINK. [LAUGHTER] OKAY, TERRY? >> I'M PRESIDENT OF THE JOHN A. HARTFORD FOUNDATION IN NEW YORK CITY AND MY TEAM AT NYU HAD TWO RO-1 GRANTS AND RO15 TO STUDY EMERGENCY ROOMS AND DO SCREENING AND THEY'RE ONE OF THE THINGS THAT I HOPE THIS GROUP WILL ADDRESS IS THAT WE ENROLLED, WE TAPPED THE SHOULDER OF 3000 PATIENTS IN ORDER TO ENROLL 300. THAT'S NOTE DISSIMILAR TO OTHER STUDIES WHERE IT'S VERY CHALLENGING TO GET PEOPLE TO ENROLL AND THEN WHEN WE FOLLOW INTO THE HOME WE DROP BY ANOTHER 30% SO ALL OF US SHOULD THINK ABOUT THAT. ONE OF THE OPPORTUNITIES WE HAVE WITH OUR INTERDISCIPLINARY GROUP HERE IS TO LOOK AT DAT HARMION AND ELEMENTS AND THINKING ABOUT THE RICH GELLERTIS' GREAT POINT ABOUT HOW TO BUILD ON AND NOT CREATE THE MISTAKES WE HEARD BEFORE SO I'M EXCITED ABOUT THE PROGRESS HERE AND OUR FOUNDATION IS VERY INTERESTED. >> I'M LINDA KINCADE WITH COALITION OF ELDER AND INDEPENDENT RIGHTS AND I APPRECIATE DR. LACHs MENTIONING AN ELEPHANT IN THE ROOM, SO FAR I'VE HEARD A FOCUS ON PHYSICAL ABUSE PRIMARY IN THE HOME WE SEE MUCH MENTAL AND PSYCHOLOGICAL ABUSE IN THE FACIL ILS, HARDLY A WEEK GOES BY THAT WE DON'T HEAR FROM A LOVED ONE TALKING ABOUT SOMEONE BEING WITH HELD IN A FACILITY. ONE LARGE CHAIN OF ASSISTED LIVING FACILITIES INCORPORATES AN OPTION FOR ISOLATION IN THEIR CONTRACT FOR SERVICES. IS THERE ANYONE WHO IS DOING ANYTHING TO INVESTIGATE THIS TYPE OF ELDER ABUSE? >> I DO THINK WE HAVE SOME FOLKS IN THE ROOM THAT HAVE DONE WORK IN INSTITUTIONS, I THINK MARK AND HIS GROUP HAVE REALLY SHOWN LOTS OF RESIDENT ON RESIDENT AGGRESSION WHICH IS SOMETHING THAT'S KIND OF NEW. I THINK SOME PEOPLE DON'T AGREE THAT MIGHT BE ABUSE, THAT'S SOMETHING ELSE TO TALK ABOUT, ANYONE? MARK? WANT TO TALK ABOUT THAT. >> YEAH, I'M SURE OUR WORK ON RESIDAL RESIDENT AGGRESSION IS ON POINT TO THE QUESTION YOU ASK, NOT TO SAY FOR THE PHYSICIAN WHO CARES FOR OLDER ADULTS IN LONG-TERM FACILITIES, ISOLATION IS A DREADFUL FORM OF ELDER MISTREATMENT THAT IS INDIGNANT AND HEART BREAKING. I WON'T COMMENT AS A SCIENTIST, I'LL COMMENT AS AN INTERNIST GERIATRICIAN WHO HAS ENCOUNTERED A NUMBER OF THESE, FOR IT TO BE POLICY WITHIN A LONG-TERM CARE ENVIRONMENT IS MORE THAN PUZZLING, IT'S QUITE CONCERNING. THAT'S ALL I'LL SAY. >> THERE IS ONE POINT I WANTED TO MAKE AND THERE'S EMPHASIS ON USING HIGH-TECH WHICH I THINK IS IMPORTANT AND PROMISING BUT I ALSO WANTED TO INCLUDE TO MAKE SURE THAT OUR STUDIES AND OUR METHODS ARE INCLUDING LOW TECH HIGH TOUCH BECAUSE I THINK TAKING A LITTLE BIT OF TIME, GET HAPPENING PEOPLE ALONE WHETHER THOSE WHO HAVE INDURED ABUSE OR THOSE WHO HAVE MISTREATED HAVING THE COMPASSION, BEING ABLE TO ASK QUESTIONS IS THERE ANYONE YOU'RE AFRAID OF, I THINK IT'S IMPORTANT THAT WE REMEMBER WITH THIS POPULATION A LOT OF THE LOW TOUCH METHODOLOGIES AND BEHAVIORIAL SCIENCE CAN REALLY IMPACT OUR FINDING, LOW TECH. >> I WANTED TO GO BACK TO THE QUESTION OF RISK FACTORS, RISK FACTORS FOR PERPETRATORS AND POTENTIAL OR SUSPECTED VICTIMS. SO AS PART OF OUR STUDY IN OHIO FOR THE [INDISCERNIBLE] OHIO DEMONSTRATION WHICH IS A DEMONSTRATION THAT'S COORDINATING CARE FOR THE DUALLY MEDICARE AND MEDICAIDED POPULATION FUNDED BY CMS, THE DEPARTMENT OF HIGH HIGHWAY DEPARTMENT OF AGING AND OHIO DEPARTMENT OF MEDICAID WERE INTERESTED IN COMING UP WITH A TRAINING PROGRAM FOR CASE MANAGERS, WHO WERE COORDINATING THIS, SO OUR INSTITUTE HAS DONE PREVIOUS WORK IN ELDER ABUSE AND ABUSE FOR ADULTS WITH PHYSICAL OR MENTAL DISABILITIES WHICH WERE A DUAL POPULATION SO IT'S YOUNGER ADULTS AGE 18 AND ABOVE AS WELL AS OLDER ADULTS. SO WE DEVELOPED THREE ONLINE TRAINING MODULES AND ABUSE AND MODULE TWO IS FOCUSED ON SCREENING FOR ABUSE AND WE HAVE TWO-TOOLS, ONE IS CALLED THE RECOGNIZING ABUSE TOOL WHICH FOCUSES ON ACTUAL ABUSE OR SUSPECTED ABUSE THAT IS TAKING PLACE. THE OTHER TOOL IS CALLED THE RISK OF ABUSE TOOL WHICH HAS RISK FACTORS FOR POTENTIAL PERPETRATORS AS WELL AS VICTIMS AND PERPETRATORS THERE ARE QUESTIONS OF HISTORY OF VAST ABUSE, FINANCIAL DEPENDENCY ON THE OLDER ADULT OR THE ADULT, HISTORY OF DOES HE PENDENCY ON PART OF THE ADULTOT PERPETRATOR FOR PHYSICAL ACTIVITIES OF DAILY LIVING AND THINGS LIKE THAT. NOW THE INTERESTING THING IS THAT 454 PEOPLE HAVE BEEN ENROLLED IN THIS TRAINING AND WE HAVE DATA FROM PREAND POST SURVEY DATA FROM THREE OF THEM FROM ALL THREE MODULES WHICH WE HAD RIGHT NOW ANALYZING AND PRESENT A GSA, BUT THE INTERESTING THING IS THAT THESE CASE MANAGERS WERE NOT MONITORIDATED TO USE THAT TOOL. SO THEY WERE JUST TO GO THROUGH THE TRAINING AND YOU KNOW IDENTIFY ABUSE AND STUFF LIKE THAT BUT WE HAVEN'T GOT THE OUTCOMES DATA, NEITHER HAVE WE CONDUCTED A CLINICAL TRIAL, SO THAT WOULD BE THE NEXT STEP TO DO THAT TO SEE--USE OF THE TOOLS AND HOW A CONTROL GROUP THAT DOESN'T USE THESE TOOLS AND DOESN'T GO THROUGH THE FORMAL TRAINING AND THEN LOOK AT OUTCOME IN TERPS OF PIRTRAITORS VIMS AND. >> THANK YOU. >> ANY OTHER QUESTIONS? >> I HAD A QUESTION. TONY I THINK THIS WOULD GO TO SOME OF WHAT YOU'RE DOING, I RECENTLY ORGANIZED A PANEL, A POLICY AT THE PODIUM WHERE I HAD A PEDIATRICIAN COME IN AND SHE DIAGNOSIS CHILD ABUSE CASES AND SHE ALMOST DIDN'T MAKE IT TO THE PANEL BECAUSE SHE WAS INVOLVED IN A LAWSUIT AND BEING SUED BECAUSE OF HER DIAGNOSIS OF ABUSIVE HEAD TRAUMA ON A SHAKEN CHILD. SO SHE WAS POINTING OUT THAT THERE IS SORT OF A--MAYBE A DIFFERENT PERSPECTIVE THAT THE PERPETRATORS ARE IN A MOMENT OF STRESS AND NOT YOUR TYPICAL EVIL DOER AS WE THINK OF, SO, I WAS JUST WONDERING IF YOU THINK THAT MAYBE THE LEGAL ATMOSHPHERE CHANGES AND MIGHT CAUSE PHYSICIANS TO STOP REPORTING OR REPORT FEWER FINDINGS BECAUSE OF CONCERN OF LITIGATION. >> CHRIS CAN ANSWER AS WELL, AND I THINK UNEQUIVOCALLY, YES, I THINK UNFORTUNATELY PHYSICIANS ARE CONCERNED ABOUT--ABOUT LEGAL ISSUES ASSOCIATED WITH REPORTING AND THAT PROBABLY DOES REDUCE REPORTING OR EVEN CONCERN ABOUT IDENTIFICATION BECAUSE OF CONCERNS SURROUNDING REPORTING SO I THINK THAT IS AN IMPORTANT FOCUS GOING FORWARD IS IF WE ARE GOING TO INSURE--IF WE'RE GOING TO GIVE PHYSICIANS BETTER TOOLS AND BETTER INCENTIVES TO REPORT, WE WANT TO MAKE SURE THAT WE'RE REASSURING PHYSICIANS AND OTHER FOLKS THAT MIGHT REPORT ABOUT THE SUPPORT THAT THEY'LL BE GIVEN. >> I THOUGHT ABOUT THE FALSE-POSITIVE PROBLEMS AS WELL, AND I WOULD EXTEND IT BEYOND THE POSITION OF THE REPORTER OR NURSE OR FAMILIES AS WELL AND ONE OF THE DOWN STREAM CONSEQUENCES MIGHT BE THAT THE ELDERLY FEMALE WHO FALLS REPEATEDLY AND PICKS HER UP OFF THE FLOOR MAY BE CONCERNED TO BRINGLER TO THE EMERGENCY ROOM BECAUSE THEY'RE WORRIED THEY WILL BE CHARGED WITH ABUSE, PUSHING HER DOWN OR SLOW TO PICK HER UP AND THAT MAY CAUSE DOWN STREAM INJURIES AND SEQUELLI, AS YOU RAISE AWARENESS OF IT, I'M NOT SAYING DON'T DO IT BUT IT'S SOMETHING TO CONTEMPLATE. >> THIS IS TONY, I WOULD ASK, WHAT'S YOUR EXPERIENCE IN CHILD ABUSE ABOUT THIS ISSUE? >> NUMBER ONE, WE STARTED MANDATORY REPORTING LAWS IN THE MID1960S, IT'S NOW 2015 THERE IS YET TO BE A STUDY THAT ASSESSES THE EFFECT LOCALLY OR NATIONALLY OF MANDATORY REPORTING LINES SO ALL WE HAVE IS SPECULATION AND ANECDOTES. TWO, YOU A LOW BASE RATE BEHAVIOR, YOU HAVE A LOT OF FALSE-POSITIVES. IF YOU HAD 99% ACCURATE INT WITH A TWO% BASE RATE, YOU WILL--I JUST EXPLAINED THIS TO THE NFL ON MONDAY BECAUSE THEY WANT TO SCREEN ALL THEIR FOOTBALL PLAYERS, I SAID GOOD LUCK TO YOU BECAUSE YOU WILL HAVE AS MANY FALSE-POSITIVES AS YOU HAVE ACCURATES IF YOU WANT TO GO OUT AND LABEL POTENTIAL 50 WIFE BEATERS WHO ARE NEVER GOING TO BE BEAT THEIR WIVES, HIRE MORE LAWYERS. [LAUGHTER] , THE SHAKEN BABY SYNDROME IS A NIGHTMARE FOR PEDIATRICIANS BECAUSE THERE ARE YET TO BE CLINICAL ASSESSMENT TOOLS THAT CAN SEPARATE SHAKEN BABIES FROM BIRTH TRAUMA SO THIS THREAT OF LAW SUITS AND A WONDERFUL CONTROVERSIAL ARTICLE A YEAR OR TWO AGO ABOUT THIS AND IT'S NOT BEEN SETTLED BOTTOM LINE IN DOMESTIC VIOLENCE AND CHILD ABUSE AND YOU HAVE TO DECIDE WHAT MISTAKES YOU'RE WILLING TO MAKE AND I HAVE TO TELL YOU OUTSIDE OF THIS ROOM AND I WAS A DEAN OF A SOCIAL SCHOOL, GOD LOVE MY SPOACIAL WORKER STUDENTS THEY DO NOT UNDERSTAND THAT YOU CAN NOT REDUCE FALSE-POSITIVES AND FALSE-NEGATIVES SIMULTANEOUSLY, THEY TRULY BELIEVE AS DO 10S OF THOUSANDS OF CHILD PROTECTIVE SERVICES OUT THERE AND 52 STRAIGHT ADMINISTRATORS THAT YOU CAN REDUCE FALSE-POSITIVES AND FALSE-NEGATIVINGS SIMULTANEOUSLY. WRONG, WRONG, WRONG. IN ELDER ABUSE, YOU HAVE TO DECIDE WHICH MISTAKE WE'RE WILLING TO MAKE AND THEN LEGISLATE POLICY THAT PROVIDE SOME KIND OF FIRE WALL FOR THE WELL MEANING CLINICIAN WHO BELIEVES HE OR SHE IS DOING THE RIGHT JOB. I'M CAROLYN FROM MICHIGAN STATE AND YOU STARTED ASKING IF ANYBODY WAS DOING WORK ON RISK WITH PERPETRATORS AND I DID A STUDY ON PERPETRATORS AND I'M DOING ONE NOW IN INSTITUTIONAL SETTINGS BUT THEY'RE NOT AS VIGOROUS AS SCIENCE, BECAUSE THE RIGOROUS DESIGNS WOULDN'T GET APPROVED BY THE IRB, [INDISCERNIBLE] SO I HAVE STOCK EXCHANGE REPORT EVERY PERSON THAT I ENROLLED INTO MY STUDY ENROLLED IN THEM KNOWING THEY'RE ABUSE PERPETRATORS AND I DEPARTMENT THINK THAT WAS ETHICAL SO HICOME UP WITH ROUND ABOUT WAYS OF RECRUITING AND COLLECTING DATA SO THAT THE UNIVERSITY LAWYER WOULD LIKE MY STUDY AND LET ME DO IT SOPHISTICATED I SEE ALL OF THESE WHAT WE WANT TO DO WITH IF WE WANT TO GET THAT DATA. >> YES, I MEAN, YES. >> [LAUGHTER] >> THIS IS HAS HARD AS ORDERING THE BOX LUNCH WAS. [LAUGHTER] >> [INDISCERNIBLE]. >> YES. >> AND THERE IS A SOLUTION THAT--COME RIGHT NEXT TO THE MIKE. >> YOU TOUCHED ON IT. THE MORE--THE WORLD'S CRAZIEST IRB NIGHT MARRY AT THE UNIVERSITY OF PENNSYLVANIA, I MOVED TO THE UNIVERSITY OF PENNSYLVANIA, DONE RESEARCH FOR 25 YEARS, I ESTABLISHED A TRACK RECORD AT MY LAST INSTITUTION, THEY HAD CONFIDENCE IN WHAT I WAS DOING, MOVED TO A NEW INSTITUTION, NEW IRB SYSTEM, NO TRACK RECORD AND KEEP IN MIND THIS IS THE UNIVERSITY OF PENNSYLVANIA, IT KILLED AN 18 YEAR-OLD USING A BAD IRB PROCEDURE AND FAILING TO PROVIDE INFORMED CONSENT TO HIM AND HIS DAD AND NOW THEY'RE HASSLING ME ON TALKING TO PEOPLE ON THE TELEPHONE, BLAH, BLAH, BLAH, BLAH, WHERE'S THE SOLUTION, RON HIT ON THE SOLUTION. THE YOU HAVE TO CREATE A FOUNDATION OF INVESTIGATORS ACROSS THE COUNTRY WHO KNOW WHAT THE UPSIDE AND DOWN SIDE RISKS ARE OF DOING THIS KIND OF RESEARCH. UNLESS EVERY INSTITUTION AT LEAST RO-1 BASED INSTITUTION VS RESEARCHERS FAMILIAR WITH DOING RESEARCH UNSENSITIVE TOPICS ON CHILD ABUSE, DOMESTIC VIOLENCE, ON IMPAIRED POPULATIONS, ON PRISONERS, ON DEATH ROW PRISONERS EVERY INVESTIGATOR IS GOING TO HAVE A HASSLE BECAUSE WE ARE JUDGED BY PEOPLE WHO LOOK AND SAY, YOU DON'T SERIOUSLY MEAN YOU'RE GOING TO GO OUT AND ASK SOMEBODY IF HE STOPPED BEATING HIS WIFE? HAD AND ONCE YOU DEMONSTRATE THAT THIS IS AN ETHICAL AWAY TO APPROACH DOING THIS AND PEOPLE HAVE DONE IT THEN THE IRB PROBLEMS WILL BEGIN TO DIMINISH BUT AS ALONG AS IT'S ONE RO-1 IN FIVE YEARS AND YOU CAN PUT ALL THE INVESTIGATORS WITH RO-1S IN WHAT USED TO BE CALLED A PHONE BOOTH, IT'S GOING TO BE A HASSLE FOR LOTS AND LOTS AND LOTS OF PEOPLE. >> THIS IS TONY AND I WOULD ECHO THAT AND WHAT MARK LACHS SAID EARLIER, THIS IS A CRITICAL REASON TO HAVE A RESEARCH METHODOLOGY CORE AND HAVE NATIONAL CENTERS THAT AREUS INDEED THIS AREA AND DOING THIS METHOD LOGICALLY CHALLENGING AND RESEARCH THAT REQUIRES NEW INNOVATIVE APPROACHES TO BE DONE SUCCESSFULLY. >> I'M BILL ELLWOOD WITH ONE OF THE AGENCIES TWO SEATS ON THE NATIONAL ACADEMY OF HEALTH LITERACY ROUND TABLE, WE'VE I DON'T KNOW IF I'M ALLOWED TO TELL YOU THAT ONE OF THE ISSUES THE ROUND TABLE CURRENTLY IS CONSIDERING IS A IS TO REVISE THEIR CURRENT DEFINITION OF HEALTH LITERACY AND AS WELL, I THINK I'M ALLOWED TO TELL YOU THAT, I DON'T KNOW IF I'M ALLOWED TO TELL YOU ONE OF THE TERMS THEY'RE BANDYING ABOUT AND THIS IS DIFFERENT FROM THE LAST TWO QUESTIONS AND THIS HEALTH IS MORE LITERAL AND ENUMERATE YOU BECOME, THE MORE EMPOWERED YOU ARE TO NEFF GAT THE HEALTH SYSTEM AND MANAGE YOUR HEALTH, EASTS EATS MY FRIENDS ON AND OFF CAMPUS AND THIS WILL TIE INTO PHYLLIS' WORK ON THE IN-HOME VISITS PATIENTS, EACH THOUGH WITH LOWER LIT RASE MODEL SCHEPOOR NEW TRICIAN, ET CETERA LIKE TOUCH SCREENS, THEY GET TOUCH SCREENS, THEY UNDERSTAND THE QUESTIONS NOW DRAWING ON ANECDOTAL DATA, A NUMBER OF FRIENDS ON AND OFF CAMPUS TOLD ME THEY HAVE SEEN VERY CLEAR CONCISE, CLEAR COMMUNICATION NOTICES IN DISCREET PLACES AT MANY OF THE SITES YOU'VE BEEN TALKING ABOUT TODAY. YOU'VE SPOKEN ABOUT HOW RADIOLOGY TECHS CAN NOTICE THINGS, OTHER PLACES WHERE PATIENTS ARE ALONE AND ARE THERE AND MY BUDS HAVE TOLD ME HOW IMPRESSED THEY ARE BECAUSE THEY'RE NOTICING SIGNS IN THESE PLACES WHERE SENIORS WOULD BE ALONE FROM THEIR CAREGIVERS, SAYING IF YOU'RE EXPERIENCING THESE THINGS THIS, IS A SAFE PLACE TO TELL YOUR HEALTHCARE PROFESSIONAL. ARE THERE THE BEST CLINE TRAIL PRACTICES ABOUT THIS KIND OF SIGNAGE AND IF NOT HA DO YOU THINK ABOUT THAT AS A BASIC LARGER RESEARCH AJEANED? >> I WANT TO SAY ONE OF THE THINGS I'M INTERESTED IN AND ONE OF THE SLIDES HAD TO RUSH THROUGH BECAUSE THE RED LIGHT WAS ON IS SCREENING WHAT SETTING? AND I MEAN VERY SPECIFIC SETTING? ARE YOU--WHERE IN THE E. R. WAITING ROOM? ALONE? CAREGIVER BESIDE YOU? NEXT ROOM WHERE THEY CAN HEAR YOU? VERY RELEVANT QUESTION. PROJECTICAL ISSUES BUT IT HAS IMPLICATIONS FOR PEOPLE'S WILLINGNESS TO REPORT. >> SO THE NEXT SLIDE, NEXT SLIDE, I HAVE 10 MINUTES LEFT, I WANT TO KEEP ON SCHEDULE, JUST HIT ALL THREE, SO THIS IS THE ADVANCED ELEMENT, THIS IS COG IMPAIRMENT AND HOW IT EFFECTS SCREENING AND I WANT TO THROW THIS UP THERE AND GET COMMENTS FROM THE PANEL YOU COULD DO THOSE PHYSICAL INDICATORS WITH SOMEBODY CAN COGNITIVE IMPAIRMENT, YOU DON'T NEED SELF-REPORTS BUT PHYLLIS AND I DON'T KNOW IF APPROXIMATE YOU RUN INTO IN YOUR WORK WITH LADIES AND YOUNGER WOMEN, PEOPLE WITH DEVELOPMENTAL DISABILITIES AND SO FORTH, COULD THE PANEL TALK GENERALLY ABOUT THIS FOR A COUPLE OF MINUTES? >> I CAN SAY A FEW WORDS, SOME OF MY GRANTS TO THE NIH MECHANISM WERE SCREENING FOR DELERIUM IN THE E. D. AND IRPT VENE UPON IT AND CHANGE SUBSEQUENT DOWN STREAM OUTCOMES AND WE RUN INTO LOTS OF BALLETSS WITH OUR IRB AND THE FACT WE WANT TO STUDY DEMENTIA AND E. D. HOW CAN YOU ASSESS CAPACITY AND HOW CAN YOU GET THEIR CONSENT, HOW, IS IT ETHICAL TO DO, PATIENT ASCENT AND CAREGIVER CONSENT AND I THOUGHT WE HAD GOT ON TOP OF THAT AND WE WERE ABLE TO CONDUCT STUDIES AT WASHINGTON UNIVERSITY AND WENT TO THE NIH AND ENCOUNTERED ALL THE SAME BATTLES AGAIN WITH THE STUDY SECTION IS SAYING YOU SHOULD NOT BE STUDYING THIS IT'S UNETHICAL REGARDLESS OF THE STRATEGY YOU USE AND MY GRANTS GOT SHOT DOWN BECAUSE NOW WE'RE TALKING ABOUT ELDER ABUSE AND YOU NEED TO TURN TO A CYSTORRIAN TO ASSESS WHETHER THEY HAVE ABUSE GOING ON, END STAGE DEMENTIA CASES AND IF THAT'S THE PERPETRATOR YOU'RE ASKING, YOU MAY ENDANGER THE PATIENT ONCE THEY LEAVE THE ENVIRONMENT. IT COULD BE RED FLAGS FOR IRBs EVERYWHERE. >> I THINK THE ISSUE ALSO IN TRYING TO UNDERSTAND INTIMATE PARTNER VIOLENCE IN ADOLESCENCES BECAUSE YOU GET THE CONSENT ISSUES WITH THE PARENTS, ONE OF MY COLLEAGUES IN MISSOURI HER IRB SAID, YES YOU CAN CONSENT ADOLESCENTS AND NOT GET PARENTAL CONSENT, AT HOPKINS I'M NOT ABLE TO DO IT AND SO, IT DOES LIMIT WHAT WE CAN LEARN ABOUT WHATEVER THE PATTERNS OF ANY TYPE OF ABUSE IF YOU HAVE TO HAVE A POCKETSY OR ANOTHER PERSON IN TO GIVE CONSENT OR ANOTHER INDIVIDUAL TO SPEAK ALONG WITH IF THERE ARE ISSUES OF ARE ELDERS COG NIDIFBUT IF THERE ARE MENTAL ISSUES WE FIND IN YOUNGER POPULATIONS SO IT IS PART OF THE WORK THAT NEEDS TO BE DONE CERTAINLY IS HELPING IRBs UNDERSTAND THE ISSUES AND WHAT WE'RE GAINING OR LOSING BY EXCLUDING CERTAIN POPULATIONS. >> THIS IS SONNIA, I DID ADULT DAY RESEARCH CENTERS AND WAS INTERESTED IN SEEING IF INDEPTH SURVEYS COULD MAYBE SEE IF APPROXIMATE PEOPLE TALK ABOUT [INDISCERNIBLE] HAPPENING IN THE SETTING AND THINGS LIKE THAT AND ORIGINALLY I DID BRING THIS TO THE IRB AT THE UNIVERSITY OF UTAH AND I WAS KIND OF SHOT DOWN ABOUT THE IDEA OF INTERVIEWING PEO WITH DEMENTIA AND EVEN THOUGH ALL I WAS ASKING PEOPLE IS REALLY DO YOU LIKE BEING IN THE ADWULT DAY CENTER, ARE YOU ENJOYING THE ACTIVITIES, THEY WERE SO NONHARMFUL. BUT ANYWAY, IT WAS MISSING THE INSIDER PERSPECTIVE IF I LEFT THEM OUT AND I DON'T THINK CAN YOU DO A WHOLISTIC RESEARCH PROJECT WITHOUT INCLUDING THE PERSPECTIVE OF PEOPLE WHO MAY OR MAY NOT BE COMPLETELY CONVERSATIONAL ALL THE TIME OR LUCID ALL THE TIME OR WHATEVER BUT NOW IT'S INTERESTING TO SEE THAT IRBs ARE SAYING THAT IF YOU DON'T INCLUDE THESE DISABLED PEOPLE THEN YOU'RE ACTUALLY--IT'S WRONG. IT'S ETHICALLY WRONG TO EXCLUDE THEM SO I LIKE TO SEE THE CHANGE THAT'S TAKEN PLACE WITH REGARD TO IRB AND AT LEAST WHAT I'VE SEEN HAPPEN. >> YEAH. >> SO, YOU KNOW, I'LL JUST REVIEW MY BIAS THAT THE AUTONOMY PENDULUM HAS SWUNG WAY TOO FAR IN THE WRONG DIRECTION AND THEY'RE GOING TO STRANGLE ME IN AN HOUR OR TWO ABOUT THIS BUT I THINK THAT THE RISK THAT THESE PEOPLE FACE IS SO OVERWHELMING AND THE PROBLEM IS WE'RE AN INSTITUTION, TO RICH'S ARD POINT, TO MEDICAL SCHOOL, WHERE PEOPLE ARE DEALING WITH THERAPEUTIC AGENTS IT'S HARD TO FIND DBs FOR THESE PROTOCOLS AND ICU MEDICATIONS AND THOSE THINGS, THAT'S ONE ISSUE, GENE AND I JUST FINISHED AN ROX ONE ON RESIDENT, RESIDENT AGGRESSION THAT YOU REFERENCED EARLIER WE ENROLLED OVER 2000 PEOPLE IN NURSING HOMES LOOKING AT AGGRESSIVE BEHAVIORS TOWARDS ONE ANOTHER, THE VAST MAJORITY HAVE VERY SIGNIFICANT COGNITIVE DEMENTIA AND GENE DEVELOPED METHODOLOGY ABOUT HOW TO CONSENT EVEN RATHER IMPAIRED PEOPLE ABOUT THEIR EXPERIENCE WITH THIS PHENOMENA AND CREATED AN ASCENT PROTOCOL FOR THEIR FAMILY MEMBERS, IF THEY WERE UNABLE THAT WAS APPRECIATED BY ON OUR IRB AND BY THE STUDY SECTION: WHICH I SENT THIS THING TO NIH ORIGINALLY, CONCERNED ABOUT YOU KNOW EXPECTING THE USUAL BLOOD BATH AROUND YOU'RE STUDYING DEPENTINE REGIMENNED PEOPLE, THEY RAISED THE ISSUE, I THOUGHT THIS WAS INTERESTING OF THE RISK OF REPUTATIONAL RISK OF THE FACILITIES I WAS STUDYING AGGRESSION, SO IT WAS QUITE REASONABLE. THERE ARE METHODS, WE WERE FORTUNATE ENOUGH TO HAVE A DOMESTIC VIOLENCE EXPERT RUNNING OUR IRB AND THIS IS ANOTHER CENTER ARGUMENT WHERE WE CAN DEVELOP THE EXPERTISE AND AS RICHARD SAID GET THE WORD OUT THAT THERE ARE ETHICAL WAYS TO DO THIS: AND CONDUCT RESEARCH. IT'S CRITICAL AND THIS WYOMING WE HAVE THE METHODOLOGY COURSE TO DO THAT. >> I THINK WE'RE RUNNING SHORT OF TIME HERE AND WHAT I WANT TO DO WITH THE LAST FIVE MINUTES, I WILL PUT THE PANELISTS ON THE SPOT, I THINK ONE QUESTION WE NEED TO ASK IS THINK ABOUT ONE OR TWO KEY RESEARCH FOE SY MOVING FORWARD, WHAT DO YOU THINK IS MOST IMPORTANT IF WHAT WOULD YOU DO FIRST IF YOU HAD THE MONEY, WHERE SHOULD WE GO? IN A MINUTE OR LESS, TELL US WHAT YOU THINK THE PRIORITIES SHOULD BE. >> WELL I THINK THE PRIORITIES I THINK I WOULD HIGHLIGHT ARE THE ONES WE FOCUSED ON, I THINK THAT WE THEY'D IMPROVED INNOVATIVE RESEARCH METHODOLOGY TO IMPROVE OUR UNDERSTANDING OF THIS PHENOMENA, THE UNIDENTIFIED FOLKS AND I THINK WE ALSO NEED TO START TO DO PROSPECTIVE RESEARCH ON ELDER ABUSE VICTIMS AND THEN I THINK THE LAST THING THAT WE REALLY NEED TO FOCUS ON IS OUTCOMES. LET AND OUTCOMES OF INTERVENTIONS, WE HAVEN'T REALLY TALKED AT ALL MUCH IN OUR PANEL ABOUT THIS OR [INDISCERNIBLE]--[MIC OFF ] >> WELL, I WOULD ECHO THAT, I WOULD LOOK AT THE KNOWLEDGE BASE AND I WOULD SAY WHAT ARE THE BRICKS THAT ARE NEEDED IN THE KNOWLEDGE BASE AND I KEEP COMING UP WITH THE SAME ANSWERS, EXTENT CORRELATE CONSEQUENCES, I WOULD LIKE TO SEE ONE GOVERNMENT AGENCY, I TRY TO DO THIS WHEN I WORK ON THE HILL IN 1996 WHEN WE REVIEW THE JUVENILE DELINQUENCY ACT AND I WROTE A SECTION IN THE LAW THAT GOT DROPPED OUT THAT 10% OF THE FUNDING HAD TO BE USED FOR RANDOM CLINICAL TRIAL ASSESSMENTS OF INTERVENTIONS AND I SAY THAT BECAUSE WHILE WE'RE BUILDING THE KNOWLEDGE BASE, I'M FULLY AWARE OF THE FACT THAT WE'RE NOT GOING TO STOP INTERVENTIONS, SO AS LONG AS WE ROLL OUT INTERVENTIONS WE MIGHT AS WELL EVALUATE THEM WHEN WE DO IT. >> I WOULD TAKE A TWO PRONGED APPROACH. ONE IS THAT I WOULD LIKELY QUICK LE BUILD UP THE EXPERTE IN THE JOURNAL STUDIES AND IRBs SO WE HAVE A ROBUST EXPERTISE THAT WE TURN TO WHEN WE DESIGN THESE STUDIES AT INSTITUTIONS AND I DON'T HAVE THIS CHICKEN AND EGG PHENOMENA BECAUSE YOU NEED TO DO THE RESEARCH FIRST TO BUILD THAT EXPERTISE AND WE COULD RAPIDLY BUILD THE EXPERTISE AND IMPROVE SCIENCE MUCH MORE QUICKLY THAN WE'RE ON PACE TO DO AND SECTIONAL ANALYSISLY AS AN IMPLEMENTATION SCIENTIST, I WOULD LIKE TO UNDERSTAND WHAT THE BARRIERS ON'RE IN EACH OF THOSE OF THE DOMAINS AND UNDERSTANDING THE CULTURAL CAPACITY FOR CHANGE AND THE SUSTAINABILITY, ADAPTABILITY OF THESE DIFFERENT SCREENING PROTOCOLS AND INTERVENTIONS, IF WE CAN UNDERSTAND THOSE LEAPS IN THE PIPELINE EARLY IT WILL HELP US BUILD BETTER INSTRUMENTS QUICKER THE FIRST TIME AROUND. I'D LIKE TO PICK UP ON SOMETHING THAT WAS SAID EARLIER, I THINK IF WE WILL PICK UP ON ELDERLY ABUSE AND PURPLE FREIGHTERS AND PATTERNS AND THAT KIND OF THING BUT WHAT ARE WE GOING TO DO WHEN WE FIND THESE PEOPLE? TO BE SURE THAT WE HAVE NEEDS TO THE VICTIMS AND PERPETRATORS AND THAT WE SET ASIDE IN THE RESEARCH PORTFOLIO FUNDING FOR EVALUATION OF INTERVENTIONS. >> ALL RIGHT. RIGHT ON TIME. LOOK AT THAT. I THANK YOU VERY MUCH FOR ALL YOUR STIMULATING QUESTIONS AND DISCUSSION. >> THANKS, EVERYONE FOR MODELING PERFECT BEHAVIOR SO FAR THROUGHOUT THE ENTIRE MEETING. SO THE NEXT BEHAVIORIAL CHALLENGE WILL BE TO TAKE A 15 MINUTE BREAK AND COME BACK TO THIS ROOM. THERE ARE THOSE LITTLE CUP COFFEES, VENDING MACHINE AT THE END OF THE HALL BY THE ELEVATORS AND IF YOU ARE A FAST WALKER YOU CAN GO DOWN TO THE FIRST FLOOR AND GRAB SHOULD GO IN THE CAFETERIA, OR THE CONCESSION STAND AND WE'LL START AGAIN RIGHT AT 10:30. >> SO OUR SECOND PANEL IS ON--LET'S GET THE TITLE CORRECT: ORIGINS OF ABUSE, EARLY ADVERSITE, CYCLES OF OOH BUSES AND ABUSE ACROSS THE LIFE SPAN. AND M. T. CONNOLLY IS THE MODERATOR FOR THE NEXT PANEL. LET'S DOUBLE CHECK, WE HAVE TWO REMOTE PARTICIPANTS ON THE PHONE. XINQI DONG ARE YOU ON THE PHONE? >> AND KARL, PILLEMER, ARE YOU ON THE PHONE. >> YES I CAN, I HOPE CAN YOU HEAR ME THROUGH THIS CONNECTION. >> WE CAN HEAR YOU BOTH VERY WELL. THANK YOU. >> READY? >> IT'S AN HONOR TO BE HERE TODAY. I THOUGHT I WOULD START WITH A STORY, NOT LONG AGO A COLLEAGUE FROM APS WHICH AS YOU KNOW IS ON THE FRONT LINES OF ELDER ABUSE, TOLD ME I HAD LOTS OF VERY STRONG OPINIONS ABOUT WHAT TO DO, UNFORTUNATELY VERY FEW OF THEM WERE INFORMED BY EVIDENCE. IT'S A COMMENT WITH A HISTORY. IN THE 1960S MARGARET BLANKENER THEN THE RESPECTED HEAD OF RESEARCH AT CLEVELAND'S BENJAMIN ROSE INSTITUTE DID A RANDOMIZED CONTROL STUDY OF ADULT PROTECTIVE SERVICES, IT REMAINS THE MOST RIGOROUS STUDY EVERY DONE OF APS, THE RESULTS SHOCKED HERE AND PRETTY MUCH EVERYONE ELSE. ROSA LEE WOLF, THE GOD MOTHER OF ELDERLY,A BUSES RESEARCH, DESCRIBED THOSE FINDINGS FOR A PANEL THAT MARK MENTIONED EARLIER IN APPROXIMATE PERHAPS THE LAST PUBLIC TALK OF HER LIFE, SHE SAID, THOSE WHO RECEIVED PUBLIC SERVICES HAD A HIGHER MORTALITY RATE AND HIGHER NURSING HOME PLACEMENT RATE THAN THOSE WHO RECEIVE TRADITIONAL SERVICES BUT ADVOCATES FOR THE SYSTEM WENT RIGHT AWAY WITH THEIR WORK AND DESPITE SPINEDDINGS FINDINGS OF THE BENJAMIN ROSE STUDY AND PROTECTIVE UNITS TO BE COSTLY AND A QUESTIONABLE EFFECT, CONGRESS AMENDED THE SOCIAL SECURITY ACT TO MANDATE PRODUCTIVE SERVICES IN ALL STATES. IN THE 50 YEARS SINCE BLANKENER BEGAN COLLECTING DATA MUCH AS CHANGED, INCLUDING APS. MANDATORY REPORTING LAWS THAT E EMULATED FROM THE CHILD REPORTING FIELD HAVE SWELLED A ROSTER OF CASES, A FIRE HOSE, THOUGH WE STILL MISS MOST OF THE CASES, APS HAS MORE CASES AND MORE RESPONILITIES BUT STILL INSUFFICIENT RESOURCES TO CARRY THEM OUT AND NO KNOWLEDGE TO GUIDE THEM ABOUT HOW TO DO SO. RECEIPT PREVALENCE STUDIES ARE SHOWED AND EXPLOITED EVERY YEAR DOING TERRIBLE HARM TO HEALTH AND WELL BEING, THE NUMBERS GOING UP AS 77 MILLION BABY BOOMERS AGE AND YET IN A 2014 ARTICLE THAT JOY ERNTZ, WHO IS HERE TODAY AND CAROL DAYTON AND OTHER COLLEAGUES PUBLISHED REVIEWED 16 YEARS OF RESEARCH FINDING NOT A SINGLE STUDY EXAMINING APS EFFICACY. WE LIVE IN A TIME WHEN THE WHITE HOUSE, KONG AND WE THE PEOPLE CAN AGREE ON AT LEAST ONE THING, THAT PUBLICLY FUNDED PROGRAMS SHOULD BE INFORMED BY A SOLID EVIDENCE BASE FOR BOTH HUMAN AND ECONOMIC REASONS BUT SOMEHOW WE HAVEN'T HELD OURSELVES TO THAT STANDARD WHEN IT COMES TO APS OR ANY OTHER PROGRAM ADDRESSING ELDER ABUSE. ALTHOUGH THOSE PROGRAMS IMPLICATE MILLIONS OF LIVES AND BILLIONS OF DOLLARS ANNUALLY. WHEN IT COMES TO RESPONDING TO OR PREVENTING ELDER ABUSE, WE HAVE NO EVIDENCE BASE AND WE DON'T KNOW WHAT WORKS. THAT'S THE BAD NEWS. GOOD NEWS IS WE'RE POISED FOR PROGRESS. WE'RE BEGINNING TO LAY AWE FOUNDATION TO COLLECT APS DATA FOR THE FIRST TIME IN HISTORY AND WE'RE COALESCING AROUND A FEW GOALS, SCIENTIFIC AND STRUCTURAL INCLUDING THE CENTERS, ELDER ABUSE, RESEARCH CENTERS, THAT MARK MENTIONED EARLIER AND A FEW OTHER PEOPLE HAVE, TOO. WE'RE LOOKING FORWARD TO LEARNING MORE FROM OUR SISTER FIELDING, WHAT WERE YOUR MOST IMPORTANT SCIENTIFIC ADVANCES, HOW DO YOU RECRUIT PEOPLE OF INTELLIGENCE, CREATIVITY AND CONVICTION AND CAN WE SHARE THEM OR POACH THEM. WHAT SHOULD WE AVOID, HOW DO WE WORK TOGETHER WITH YOU, WHAT ARE THE MOST IMPORTANT BUILDING BLOCKS FOR CHANGE, AND AS DR. GELLES SAID EARLIER HOW DO WE NOT KEEP PUSHING VICTIMS OUT INTO THE SAMUME. ELDER ABUSE TO SAY THE LEAST IS A RESEARCH OPPORTUNITY RICH ENVIRONMENT. LET THAT MEANS WE NEED TO USE EXISTING DATA MORE EFFECTIVELY, NEW BASIC SCIENCE AND WE NEED TO BE WILLING TO ASSESS WHAT WE DO NO MATTER HOW GOOD OUR INTENTIONS OR FERVENT OUR CONVICTIONS. TO MAKE THIS HAPPEN, WE URGENTLY NEED CROSS NIH LEADERSHIP, FUNDING AND THE CENTERS NOT JUST FOR INDIVIDUALS AND FAMILIES AND PROFESSIONALS, BUT TO SHAPE POLICY THAT MAKES SENSE AND THAT DOESN'T MAKE THINGS WORSE. BECAUSE IT'S A BIG, PERVASIVE AND DEVASTATING HEALTH PROBLEM, ASTOUNDING ADVANCES IN SCIENCE, MANY OF THEM PROPELLED BY NIH HAVE RESULTED IN LONGEVITY UNMEALINGABLE NOT LONG AGO. IT'S TIME FOR NIH NOW TO DEPLOY COMPARABLE SCIENTIFIC LEADERSHIP, INGENUITY AND FUNDING TO ADDRESS THE MOST INSIDIOUS ASPECT OF AGING THAT LONGEVITY AS WROUGHT. EVIDENCE CAN HELP US FIND BETTER WAYS TO DEAL WITH ELDER ABUSE, WE NEED TO DISCOVER THEM. IT'S TIME TO DO WHAT MARGARET DID 50 YEARS AGO, ASK THE HARD QUESTIONS AND GO WHERE THE FACTS LEAD US. AND HAVING CONCLUDED MY SOAP BOX PORTION NOW I'D LOVE TO INTRODUCE A WONDERFUL PANEL AND LODGER BIOS ARE IN YOUR MATERIALS BUT I'D LIKE TO POINT OUT IN CASE IT HASN'T ESCAPED YOU THAT WHILE THE MEN ARE PHONING IT IN, THE WOMEN ARE IN THE HOUSE. [LAUGHTER] WE WILL START OFF WITH KARL PELLEMER, WHO'S ONE OF MY HEROES, ONE OF LONGEST RESEARCHERS IN ELDER ABUSE, 35 YEARS ALTHOUGH KARL, YOU'LL CORRECT ME IF I'M WRONG, HE'S A PROFESSOR OF HUMAN DEVELOPMENT AT CORNELL AND GERIATRICKIZATIONONATOLOGY AT CORNELL MEDICAL COLLEGE. DIRECTS INSTITUTE FOR TRANSLATIONAL RESEARCH ON ANALLING, PIONEER OF ELDER ABUSE RESEARCH AND PROMULGATE EVALUATION, WORKED ON THE INFLUENTIAL PROJECT WITH ROSA LEE WOLF, CONDUCTED ELDER STUDY ABOWS AND DOMESTIC AND NURSING HOMES AND HE COINED THE TERM THE FLATTERED SIDE OF DESCRIBING ELDER ABUSE RESEARCH. >> THANKS, EVERYONE AND THANKS M. T. AND IT'S A GREAT PLEASURE TO BE HERE ALBEIT ELECTRONICALLY AND ESPECIALLY GIVING MY LONG ENGAGEMENT WITH NIH WHICH HAS SPONSORED MUCH OF OUR RESEARCH ON ELDER ABUSE, I WOULD SAY THIS INITIATIVE IS VERY WELCOME BECAUSE WE DO NEED NIH'S LEADERSHIP IN FOSTERING NEEDED, RESEARCH ON ELDER ABUSE, I WANT TO SAY THOSE FRIENDLY INTRA DUCTORY COMMENTS DO NOT COMMENT ON MY FIVE MINUTES SO CAN YOU START NOW AND LET ME QUOTE THE FAMOUS COMMERCIAL BEFORE I GO ON, AND THAT IS YOU CAN HEAR ME OKAY AT THIS MOMENT? NYES. >> WE CAN HEAR YOU WELL. >> OKAY, GREAT. I WOULD LIKE TO USE MY TIME TO DISCUSS MY RESEARCH NEEDS IN THESE AREAS, IN THIS AREA QUICKLY AND THAT'S KIND OF WHAT I THINK OUR PANEL DECIDED TO DO. LET I THINK IT'S IMPORTANT TO FOCUS ON BOTH WHAT WE NEED TO DO AND WHAT WE DON'T NEED TO DO ANY MORE OF. SO I WOULD LIKE TO THINK ABOUT THE THREE MAIN AREAS OF ELDER ABUSE AND RESEARCH THAT COULD BE CONSIDERED FOR SUPPORT AND I BELIEVE THAT WE CAN THINK OF THESE USING A STOP LIGHT MODEL. SO A RED LIGHT RESEARCH THAT WE SHOULDN'T FUND ANYMORE OF IT, AND WE DENTE NEED ANY MORE OF IT BECAUSE IT'S MARGINAL GAIN AND ADDITIONAL STUDIES, THERE'S YELLOW LIGHT RESEARCH WHERE WE MADE ENOUGH PROGRESS AND MORE IS NOT URGENT BUT WE COULD LEARN MORE IN THIS GREEN LIGHT RESEARCH ON ELDER ABUSE WHERE WE URGENTLY NEED TO PUT OUR RESOURCES NOW AND IN TERMS OF THE THEME OF OUR PANEL WHICH IS LOOKING AT ABUSE OVER THE LIFE COURSE, I WOULD WOULD PROPOSE THAT WE ORGANIZE OUR RESEARCH NEED IN THAT FASHION AND LET ME BEGIN WITH THE RED LIGHT IN MY OPINION, THIS IS ALL MY OPINION, YOU KNOW THE MAJOR RED LIGHT RESEARCH JUST TO STOP VIEWING ARE ANY MORE PREVALENCE STUDIES. I THINK NO FURTHER INVESTMENT SHOULD BE MADE IN ESTABLISHING THE PREVALENCE OF ELDER ABUSE IN DEVELOPED COUNTRYS, ALL WE COULD USE IT IN GEEPING COUNTRIES ARE BETWEEN TWO AND THREE DOZEN NOW REASONABLY GOOD STUDIES, THEY SHOULD VARY CONSISTENT BIND THINGS ABOUT ACTIVE NEGLECT AND PHYSICAL ABUSE AND SEXUAL ABUSE AND FROM A RECENT ANALYSIS WE DID MOST OF THE OTHER DIFFERENCES ARE AMONG PREVALENCE RATES, COME FROM DEFINITIONAL DIFFERENCES. THE MOST EGREEMGIOUS INFLATION OF ELDER ABUSE COMES FROM DEFINITION AND PSYCHOLOGICAL ABUSE OF THE OVERLAP GREATLY WITH NORMAL FAMILY BEHAVIOR, FOR EXAMPLE, NOW IF I'M 60 AND I STEPPED ON MY WIFE'S TOE AND SHE CALLS ME A CLUMSY IDIOT, I WOULD COME UP IN A NUMBER OF ELDER ABUSE STUDIES AS A VICTIM. SO MORE PREVALENCE STUDIES MOST OF WHICH ARE UNRELATED TO THE ACTUAL WORLD IN WHICH COALITIONS ARE TRYING TO DEAL WITH ELDER ABUSES, SHOULD NOT BE DONE OR FUNDED AND THE ONLY EXCEPTION TO ME WOULD BE PROSPECTIVE STUDIES. IN THE YELLOW LIGHT AREAS ARE STUDIES OF RISK FACTORS WHICH I BELIEVE OTHERS ON THIS PANEL TOUCH ON LARGE STUDIES SHOWED IMPORTANT LIGHT ON PROTECTIVE FACTORS AND WE HAVE A REASONABLE IDEA OF RELIABLE RISK FACTORS WHICH I'M HAPPY TO TALK ABOUT LTER IN FOLKS ARE INTERESTED AND OTHERS PROBABLY CAN, BUT MORE STUDIES WOULD BE HELPFUL BUT THE STUDIES ARE LESS PRESENT. I WILL AGREE WITH THE GREEN LIGHT, BRILL YAPT IS FLASHING IS DEVOTING ATTENTION AND RESOURCESES TO DEVELOPING AND TESTING TREATMENTS, PROGRAMS AND INTERVENTIONS TO PREVENT ELDER MISTREATMENT FROM OCCURRING WHEN IT'S OCCURRED THE CONSEQUENCES OF ELDER ABUSE. AND LET'S--UNLESS THIS SUGGESTION SEEMED NOT RELATED TO THIS PANEL AND TO A LATER ONE, I BELIEVE THE EXPERIMENTAL INTERVENTION RESEARCH IN THESE AREAS WILL ALSO PROVIDE A BEST CONTRIBUTION TO BASIC KNOWLEDGE. I THINK THAT WE NOW HAVE TO LAUNCH AN ERA OF EXPERIMENTATION IN THIS AREA, USING RANDOMIZED CONTROL FIELD EXPERIMENTS THAT ARE THEORETICALLY GROUPEDDED AND USE THE MOST RIGOROUS MESSAGE AND THIS IS THE URGENT AND NEW FRONTIER FOR ELDER ABUSE RESEARCH AND TO CONCLUDE I DO WANT TO SAY THAT WE CANNOT BE CONTINUED TO FORCE TO REPORT, AS ALL OF US WHO WRITE ARE FORCED TO REPORT SOME RISK OR DISTURBING STATEMENT THAT WE HAVE NOT ONE SINGLE EVIDENCE BASED INTERVENTION FOR ELDER MISTREATMENT OF ANY KIND AND AS M. T. POINTED OUT THOSE THAT HAVE BEEN RIGOROUSLY EVALUATED USING CONTROL MECHANISMS HAVE FOBBED NEGATIVE CONSEQUENCES FOR VICTIMS SO WE HAVE TO MOVE TO EXPERIMENTATION TO KNOW WHAT WORKS BUT ALSO BECAUSE WHAT WE'RE DOING NOW MAY HAVE PERVERSE NEGATIVE CONSEQUENCES TO VICTIMS AND THEIR FAMILIES AND IT'S THAT RESEARCH AND EXPERIMENT DESIGN THAT WILL SHED LIGHT ON BASIC QUESTIONS. SO I THINK WE SHOULD BUILD ON THESE ADVANCES IN DEFINING THE PROBLEM AND ADENTIFYING RISK FACTORS VOTED TO CREATE AN EVIDENCE BASED INTERVENTIONS THAT ALSO SHED LIGHT ON THEINATE AND YOU ARE DYNAMICS OF ELDER ABUSE AND I DO THINK NIH CAN PLAY AN ENORMOUS LEADERSHIP ROLE IN THIS AREA: THANKS. >> THANK YOU KARL, NEXT UP IS CATHY WIDOM, SHE STUDIES THE LONG-TERM CONSEQUENCES OF CHILD ABUSE AND NEGLECT AND HAS DONE SO FOR ALMOST 30 YEARS AND SERVED ON PANELS THAT PRODUCE THE 1993 AND 2013 MAGSAL MEDICINE OF RESEARCH COUNCIL REPORTS CHILD MALTREATMENT AND A WHOLE LOT MORE. >> SO IT'S A PLEASURE TO BE HERE AND IT'S DAUNTING IN THE MIDST OF PEOPLE WHO ARE STUDYING ELDER ABUSE FOR SO LONG AND I WANT TO DO SOMETHING MORE CONCRETE THAN OTHERS BUT I WAS ASKED TO TALK ABOUT THE CYCLE OF VIOLENCE, THE TRANSMISSION OF VIOLENCE AND TALK ABOUT MY RESEARCH IN THIS AREA WHICH I THINK HAS RELEVANT MANY OF YOU HAVE MADE REFERENCE TO CHILD ABUSE IN THE BACKGROUNDS OF PERP STRAIGHTERS EVEN THOUGH WE'RE PUT THAT IN QUOTES OF ELDER ABUSE AND I WOULD SUGGEST THAT PROBABLY THAT EVIDENCE IS NOT VERY STRONG BUT IT'S EVIDENCE THAT WE COULD OBLIGATIONS STAIN. SO JUST KEY POINTS, I HAD A SLIDE THAT LISTS A NUMBER OF CHALLENGES, METHOD LOGICAL, REPORTING, ET CETERA, MAYBE WE CAN COME BACK TO THAT LATER, I WON'T USE MY FIVE MINUTES IF ARE THAT BUT CLEARLY THERE ARE MAJOR MATH LOGICAL CHALLENGES, I DO HAVE ONE SLIDE THAT FEELS WITH THAT. THE QUESTION OF PURPLEITRATION AND VICTIMIZATION, I WAS REALLY DELIGHTED TO SEE THAT THAT CAME UP AND I'M GOING TO SHOW YOU SOME INFORMATION ABOUT THAT. ONE THING I WANT TO EMPHASIZE HERE AND IT'S COME UP IN OUR DISCUSSION, IS THE IMPORTANCE OF CONTEXTURAL FACTORS THAT WE REALLY NEED TO PAY ATTENTION TO, POTENTIAL DIFFERENCES BY RACE, ETHNICITY, POVERTY, NEIGHBORHOODS AND IMPACTS THE CAUSES AND CONSEQUENCES OF ELDER ABUSE. WE NEEDS TO PAY ATTENTION AND TO ELDER ABUSE AND MARKERS BUT THERE'S TREMENDOUS NEED FOR VALUE AND LONGITUDIAL STUDIES AND PIGGYBACKING ON EXISTING STUDIES. SO, FOR THOSE OF YOU WHO ARE NOT FAMILIES WITH WHAT IS THE CYCLE OF VIOLENCE, THIS IS THE ATION THAT CHILDREN WHO WERE ABUSED AND NEGLECTED GO ON TO BECOME DELINQUENTS ADULT CRIMINALS OR VIOLENT CRIMINALS, I HAVE A GRANT FROM THE NATIONAL INSTITUTE OF JUSTICE TO DO A 30 YEAR FOLLOW UP ON OUR ORIGINAL CYCLE OF VIOLENCE FINDINGS WHICH WERE PUBLISHED IN SCIENCE AND 1989 AND WE JUST PULLED TOGETHER THIS MEETING SO IT'S NOT PUBLISHED YET BUT I WANT TO YOUR ATTENTION SO WHAT THIS MEANS IF YOU LOOK AT THE FAR LEFT COLUMN WHICH IS OVER ALL WHICH IS A GROUP OF CHILDREN WHO HAVE SUBSTANTIATED CASES OF NEGLECT WHO HAVE BEEN FOLLOWED INTO THE FUTURE AND WE HAVE ASSESSED THEIR ARREST RECORDS AND THEIR VIOLENCE AND IT MATCHED GROUP OF CHILDREN FROM THE SAME TIME PERIOD WHO WE ALSO FOLLOWED UP WHO WERE MATCH INDEED TERMS OF GEMMOGRAPHIC CHARACTERISTIC SO IN THE FIRST COLUMN WE SEE THAT OALL THIS IS SUPPORT FOR THIS NOTION OF A CYCLE OF VIOLENCE THAT IS CHILDREN WHO ARE ABUSED ARE AT RISK FOR BECOMES VIOLENT WHEN THEY GROW UP OVERALL, THAT IS TRUE FOR MALES, IT IS TRUE FOR FEMALES. IT IS TRUE FOR BLACKS, BUT VERY SURPRISINGLY YOU DO NOT SEE AN INCREASED RISK OF ARRESTS OR FOR WHITES AND WE CAN TALK ABOUT LATER WHY THAT MIGHT BE THE CASE. THIS IS ANOTHER PIECES THAT WE DID PUBLISHED SEVERAL YEARS AGO IN BIOLOGICAL PSYCHIATRY AND YOU MAY KNOW THERE WAS EXCITING WORK THAT WAS DONE BY COLLEAGUES WHERE THEY LOOK SAID AT THE EXTENT TO WHICH MALA COULD OR WOULD INTERACT WITH CHILDHOOD ADVERSITY AND TRIALED HOOD MALTRIEWMENT SPORTSMANSHIP PROTECT CHILDREN FROM HIGH LEVELS OF MAOA AND PROTECT CHILDREN FROM BECOMES VIOLENT AND ANTISOCIAL. SO IN THEIR STUDY WHICH WAS DONE IN NUCLEOTIDES NEW ENGLAND WHICH WAS ONLY WHITE, THEY FOUND A PROTECTIVE EFFECT OF HIGH LEVELS OF MAOA. I HAVE BLACK AND WHITE CHILDREN IN NIGH SAMPLE. THEY ESSENTIALLY SAID TO ME--MONOAMINE OXIDASE WHICH IS A POLYMORPHISM THAT EFFECTS PROCESSING IMPULSIVITY, SELF-REGULATION, YEAH. SO THIS WAS VERY, VERY EXCITING WORK, IT SPAWNED A NUMBER OF STUDIES AND WHAT YOU CAN SEE HERE IS WE REPLICATED THE BASIC FINDINGS USING WHITES IN OUR SAMPLE, WE DO NOT REPLICATE IT WITH THE NONWHITES IN THE SAMPLE. SO IN TERMS OF CLASSIFICATION, WE HAVE REPRESENTATION, THIS A CLASSIC CURVE FOR OFFENDERS, ZERO-11, 12-17, AND YOU SEE A PEAK AT THE AGES 18-29 AND BECAUSE OUR SAMPLE IS NOW IN THEIR 50S, I WANTED TO SEE WHAT WOULD HAPPEN FOR THIS GROUP IF IN FACT ABUSE AND NEGLECT WAS A CAUSAL FACTOR IN THEIR ENGAGING IN PERPETRATION OF ELDER ABUSE AND I WOULD HAVE EXPECTED THAT THERE WOULD HAVE BEEN A HIGHER RATE OF VIOLENCE IN THE 50S IF WE SAW THAT THAT WAS OCCURRING. SO THIS SUGGESTS TO ME THAT THIS IS A VERY TRADITIONAL PATTERN OF VIOLENT OFFEND NOTHING OUR SAMPLE BUT WHAT ABOUT VICTIMIZATION? OKAY. SO, WHAT WE ALSO HAVE IS VICTIMIZATION AND WHAT WE'VE BEEN COLLECTING IS THIS PHYSICAL VIOLENCE AND SEXUAL VIOLENCE AND WHAT WE HAVE IF YOU WILL IS THIS LITTLE PIECE OVER HERE WHICH IS INDIVIDUALS WHO HAVE HISTORIES OF ABUSE AND NEGLECT ARE REPORTING HIGHER RATES OF PHYSICAL VIOLENCE IN THEIR 50S. AND I'LL SKIP THAT AND I JUST WANT TO END ON A POSITIVE NOTE CHAMPIONSHIP IS--THIS IS AN ANALYSIS THAT MY FORMER POST DOC DID SHOWING THE ROLE OF SOCIAL SUPPORT PREDICTING ALOE STATIC LOAD, ALOE STATIC LOAD IS A MARKER OF CUMULATIVE STRESS MEASURED AT AGE 41 IN ADULTHOOD, A VARIETY OF INDICATORS, BLOOD PRESSURE, ET CETERA. AND WHAT YOU CAN SEE HERE IS THAT HAVING A SUPPORTIVE PARTNER THROUGHOUT VARIOUS POINTS IN LIFE FOR THESE ABUSED AND NEGLECTED CHILDREN LEADS TO NEGLECTED RISK. >> [INDISCERNIBLE]. >> OKAY. >> [ APPLAUSE ] EMPLOY. >> I'M SURE WE'LL COME BACK TO THAT DURING THE DISCUSSION. >> NEXT UP IS SHERRY HAMBY, EDITOR OF THE, ATA JOURNAL, PSYCHOLOGY VIOLENCE, CO INVESTIGATOROT NATIONAL SURVEY OF CHILDREN'S EXPOSURE TO VIOLENCE, THE MOST COMPREHENSIVE NATIONALLY REPRESENTATIVE VICTIMIZATION SURVEY IN THE U.S. AND HAS PRIOR CLINICAL EXPERIENCE IN GERIATRIC SETTINGS. >> THEY THINK YOU M. T. AND TO EVERYBODY WHO ORGANIZED THIS MEETING TODAY, I THINK IT'S VERY EXCITING TO BE FOCUSING ON ELDER ABUSE AND WHAT OTHER TYPES OF RESEARCH CAN INFORM IT, SO TODAY I REALLY WANT TO--FOR SOME OF YOU HIGHLIGHT AND FOR OTHERS OF YOU INTRODUCE WHAT I THINK ARE TWO OF THE MOST IMPORTANT AND EXCITING TRENDS IN THIS VIOLENCE RESEARCH GOING ON RIGHT NOW AND IN AN ERA THAT HAS REALLY BEEN TRANSFORMATIVE, THERE'S SO MUCH HAPPENING IN THE OTHER STYLE OF VIOLENCE RESEARCH IN THE LAST 10 OR 15 YEARS. THE FIRST TREND IS POLYVICTIMMIZATION WHICH HAS BEEN AN EFFORT TO BUILD BRIDGES ACROSS SOME OF THE LITTLER SILOS, OUR FIELD FOR A VARIETY OF REASONS HAVE BROKEN OUT INTO THESE SPECIALIZED SUBDISCIPLINES BUT UNFORTUNATELY, THAT DOESN'T REALLY CAPTURE PEOPLE'S EXPERIENCES OF VIOLENCE. PEOPLE DON'T--THEY'RE NOT JUST VICTIMS OF INTIMATE PARTNER VIOLENCE OR JUST VICTIMS OF CHILD ABUSE, THEIR--CLOSE IN A RELATIONSHIPS AMONG ALL D TYPES OF VIOLENCE EVEN ONES SUCH AS PROPERTY CRIME AND GENERAL CRIME THAT WE MAY THINK OF AS VERY DISSIMILAR TO FAMILY VIOLENCE AND OTHER TYPES OF INTERPERSONAL VIOLENCE. AND EVEN MORE IMPORTANTLY THAN THE FACT THAT OUR SILOED APPROACH DOESN'T CAPTURE PATTERN AND RATES, IT ALSO REALLY MISSPECIFIES WHAT'S DRIVING ALL OF THE DISTRESS AND ADVERSE EFFECTS IN THESE POPULATIONS. SO HERE'S JUST ONE EXAMPLE, BUT THIS--I COULD SHOW YOU THIS FROM THE ADVERSE CHILDHOOD EXPERIENCES SURVEY, THE WORK ON COMPLEX TRAUMA, THERE'S BEEN THIS HUGE COPPA LESSENS OF ALL OF THESE DIFFERENT FORCES THAT ARE FOCUSING ON THE IMPACT OF THE CUMULATIVE BURDEN ON OUR TOTAL DOSE OF VICTIMIZATION ACROSS ALL SETTINGS AND ALL PERPETRATORS, AND WHAT YOU CAN SEE HERE IS THAT IF YOU IDENTIFY THE POLYVICTIMS, IF THEY STAND HEAD AND HOLDERS ABOVE MONOVICTIM, EVEN OF SOMETHING SEVERE LIKE CAREGIVER MALTREATMENT IN TERMS OF DISTRESS AND NOT ONLY IS THAT TRUE FOR MALTREATMENT BUT IT'S TRUE FOR ALL OF THE MAJOR TYPES OF VIOLENCE THAT WE STUDY THAT IS THE POLYVICTIMS THAT IS THE MOST DISTRESSED PEOPLE IN ANY OF THESE GROUPS AND TOTAL DOSE THAT IS ACCOUNTING FOR THE MAJORITY OF THEIR SYMPTOMS, THE INDIVIDUAL EFFECTS ARE WASHED OUT WHEN YOU CONSIDER POLYVICTIMMIZATION. THIS NEEDS TO BE EXTENDED TO ELDER ABUSE. YOU ARE MISSING A LOT OF ELDER VICTIMIZATION WHEN YOU ARE FOCUSING ON CAREGIVERS OR INTIMATE PARTNERS. THERE'S ALL KINDS OF VICTIMIZATION THAT ELDERS ARE VULNERABLE TOO INCLUDING SOME AS WE'VE HEARD A BIT TODAY SUCH AS FINANCIAL EXPLOITATION AND IDENTITY THEFT THAT ARE ACTUALLY GREAT PERIODS OF RISK IN THE LATER YEARS. THE SECOND SHIFT THAT I WANT TO HIGHLIGHT FOR YOU TODAY IN MY TIME IS A SHIFT TO A STRENGTHS BASED APPROACH AND THE PROMISE THAT HAS FOR DOING SO MUCH MORE TO HELP PEOPLE GET TO TRUE STATES OF WELL BEING DESPITE ADVERSITY, SO ARE OUR OLD APPROACH HAS BEEN A RISK FACTOR APPROACH AND THE POINT I WANT TO HIGHLIGHT ABOUT THIS IS WE KEEP REINVENTING THE WHILE RIGHT HERE AND THE RISK FACTORS FOR ELDER APUCE ARE THE SAME AS THEY ARE FOR ALL OTHER TYPES OF VIOLENCE AND IF FOR EACH OF THESE I SILOS WE KEEP DISCOVERING THESE RISK FACTORS WHEN WE KNOW MUCH LESS ABOUT WHY ONE FORM OF VIOLENCE, MERGES VERSUS ANOTHER. BUT MORE IMPORTANTLY THAN THIS, THIS RISK FACTOR APPROACH MISSES WHAT PEOPLE REALLY WANT OUT OF LIFE. SO IF YOU TALK TO PEOPLE, THEY'LL SAY THINGS LIKE THIS, THEY DO NOT NEVER EVER SAY THINGS LIKE THIS. BUT YET THIS IS STILL THE WAY WE APPROACH THESE PROBLEMS. SO WE'RE TRYING TO SHIFT THE FIELD, ONE OR MANY GROUPS TO A STNGTH BASED APPROACH THESE ARE OUR DOMAINS WE ARE CONCENTRATING ON, I WANT TO POINT OUT TWO FEATURES ON THEM THAT THEY FOCUS ON MULTIPLE LAYERS OF THE ECOLOGY AND THAT WE HAVE CHOSEN TO FOCUS ON MALLEABLE PROTECTIVE FACTORS AND STRECT STRENGTHS THAT CAN BE THE TARGET OF PREVENTION AND INTERVENTION. WE'RE USING A CONCEPT THAT COMPLEMENTS COMPLEMENTIZATION THAT WE CALL POLY-STRENGTH, NO'S GOOD AT EVERYTHING, PRESENT COMPANY INCLUDED EVEN BUT IF YOU HAVE DIVERSITY OF STRENGTH, THEN CAN YOU MUSTER THE RESOURCES TO COPE WITH ADVERSITY. WE NEED TO STOP TALKING ABOUT ADVERSITY AND VICTIMIZATION, LIKE IF SOME SORT OF RARE PHENOMENON, IN FACT IT'S THE NORMATIVE EXPERIENCE AND OUR SAMPLE WHICH ONLY GOES UP TO AGE 45, 98.5% HAD EXPERIENCED IT EVEN IN A RELATIVELY YOUNG SAMPLE, MOST PEOPLE EXPERIENCE VCTIMIZATION. HERE'S OUR MODEL WHICH HELPS TO DEFINE PREVENTION AND INTERVENTION. WE'VE HAD MUCH LUCK ADDING STRENGTH IN TO ACCOUNT FOR GREATER VARIANCE IN WELL BEING AND I JUST WANT TO LEAVE YOU ALSO WITH THESE THREE WORDS, POLYVICTIMMIZATION, POLYSTRENGTH AND RESILIENCE PORTFOLIOS, THANK YOU VERY MUCH. [ APPLAUSE ] >> NEXT UP IS SONIA SALARI, SHE WORKED AT MISTREATMENT OF WOMEN, AND DIADS ON YOUNG, MITLEDZ AND ELDER ADULLEDS AND SHE RECENTLY PUBLISHED FAMILY VIOLENCE ACROSS THE LIFE COURSE, RESEARCH, POLICY AND PREVENTION. THANK YOU. I APPRECIATE THE OPPORTUNITY TO BE HERE TO TALK ABOUT INTERPERSONAL PARTNER VIOLENCE AND AS I WILL POINT OUT IN A BIT IS MUCH OF WHAT I WILL FOCUSED ONECUS ON IS FATAL FAMILY VIOLENCE. SO I WILL TALK ABOUT THAT IN A SECOND. IN TERMS OF SPEAKING ABOUT THE BIG PICTURE WITH REGARD TO THE ISSUE OF FAMILY VIOLENCE ACROSS THE LIFE COURSE, I THINK WHAT MANY PEOPLE HAVE BROUGHT UP IS THE IDEA OF ISOLATION AND CERTAINLY, IF THERE'S A WAY TO LOOK AT PREVENTION, MAYBE IT HAS TO DO WITH PREVENTING ISOLATION BUT ALSO THERE'S A NEED, ESPECIALLY WHEN YOU LOOK ACROSS INTERNATIONAL FAMILY VIOLENCE, YOU CAN SEE SOME PLACES HAVE ENFORCEMENT OF THEIR POLICIES OR PLACES MAY NOT HAVE POLICIES AND SO IT'S IMPORTANT TO HAVE ENFORCEMENT AS WELL AS THE POLICIES THAT EXIST AND JUST THE QUESTION OF WHETHER FAMILY IS CONSIDERED PRIVATE OR PUBLIC AND SOME OF THESE SOLUTION SAYS TEND TO BE PUTTING IT A LITTLE BIT MORE PUBLIC SO THE IDEA OF EVEN SHELTERS, THINGS LIKE THAT WHICH ARE NOT UNIVERSAL. SO ANYWAY, WE HAVE ALSO GENERATIONAL DIFFERENCES RIGHT NOW WITH THE OLDER COHORT WHO TENDS TO HAVE LOWER DISCLOSURE AND MAYBE FEWER POLICE REPORTS, MAYBE EVEN FEWER EMERGENCY ROOM VISITS, THINGS LIKE THAT, PROTECTIVE ORDERS IS ANOTHER THING, THAT THE OLDER COHORT TENDS TO NOT DO AS MUCH AS YOUNGER COHORTS BECAUSE OF PERHAPS A FEAR OF AIRING THE DIRTY LAUNDRY, THINGS LIKE THAT. SO WE CAN ALSO THINK ABOUT THINGS LIKE THIS ISSUE OF MEASUREMENT, AWIVE TIMES PEOPLE TALK ABOUT THE ICEBERG AND WHAT WE KNOW AND WHAT WE DON'T KNOW. I LIKE TO ADD A LITTLE ECOLOGICAL PERSPECTIVE THERE, TO THINK ABOUT THAT IT'S NOT JUST ABOUT INDIVIDUAL ISSUES AND FAMILY ISSUES BUT ALSO CERTAINLY ABOUT THE COMMUNITY AND THE LARGER PERSPECTIVE, THE POLICIES AND THINGS LIKE THAT. AND ONE OF THE THINGS ABOUT THAT IS, YOU CAN SEE THE LARGE UNMEASURED AREA AND CERTAINLY THAT HAS TO DO WITH THE IDEA THAT AS CARL WAS SAYING, THE PREVALENCE STUDIES WERE--THERE'S SO MUCH WE'RE ACTUALLY NOT ABLE TO MEASURE. AND SO, I'M WITH HIM ON THAT, BEING SORT OF DONE WITH THE PREVALENCE AS BEING THE ONLY THING WE HAVE OUT THERE. I ALSO APPRECIATE THE INTIMATE PARTNER VIOLENCE RESEARCH THAT LOOKS AT DISTINCTIONS THAT HAPPEN, SO IT'S NOT JUST YES OR NO, BUT IT'S WHAT'S HAPPENING IN TERMS OF INTIMATE TERRORISM OR SITUATIONAL COUPLE VIOLENCE FROM JOHNSON'S WORK OR IS IT THAT LIFE ALONG IPV PATTERN OR IS IT A LATE ONSET SITUATION. AND ANOTHER THING IS THE ISSUE OF SUICIDE, I'VE BEEN ASKED NOT TO TALK ABOUT SUICIDE BUT I WOULD LIKE PEOPLE TO THINK ABOUT SUICIDE AS FAMILY VIOLENCE AND I DEFINE IT AS FAMILY VIOLENCE, IT'S SOMETHING THAT'S ALSO RELATED TO INTIMATE PARTNER VIOLENCE, A LOT OF FATAL INTIMATE PARTNER VIOLENCE HAS A SUICIDE THAT IS ANOTHER OUTCOME OF THAT. AND I HAVE BEEN DOING RESEARCH ON EPITHELIAL MATE PARTNER VIOLENCE. THIS IS AN IRB ISSUE BECAUSE IT'S IRB EXEMPT BECAUSE THEY'RE ALREADY HURT, SO, THERE O NO WAY I CAN HURT THEM MORE, REALLY SO THAT'S ONE REASON WHY IT MAKES IT A LITTLE BIT EASIER BUT ALSO THERE'S LESS THAT'S HIDDEN ABOUT FATALITIES. SO SUICIDE ALONE, YES THAT IS STILL HIDDEN BUT WHEN IT INCLUDES A HOMICIDE, NOT SO MUCH, SO THERE IS SOME EVIDENCE THERE. AND SO, ONE OF THE THINGS THEY WANTED TO DO WAS POINT OUT THIS RESEARCH THAT I'VE BEEN DOING LOOKS AT FATAL INTIMATE PARTNER VIOLENCE IN THE FORM OF MURDER-SUICIDES. INTIMATE PARTNER HOMICIDE-SUICIDE AND ACTUALLY MY COLLEAGUE KERRY AND I HAVE LOOKED AT YOUNG VERSES MIDDLE AND OLD AND YOU CAN SEE WHEN WE LOOKED AT WHETHER IT WAS PRIMARILY A HOMICIDAL MOTIVE VERSES SUICIDAL, THE DIFFERENCE IS REALLY JUST FLIPPED BY WHICH AGE CATEGORY WE WERE TALKING ABOUT SO IN TERMS OF THE FUTURE, I REALLY DO THINK THAT THE PREVALENCE IS PROBABLY INCREASING BECAUSE OF THE INCREASED POPULATION BUT THAT'S NOT THE WHOLE STORY. I'D LIKE TO SEE MORE TRI AGULATION OF DATA INCLUDING QUALITATIVE LOOK AT THINGS LIKE INTIMATE PARTNER, INTIMATE , INTIMATE TERRORISM WITHIN ELDER CATEGORIES. SO--YES? >> [INDISCERNIBLE] >> SURELY, I THINK WE NEED TO BE CNED ABOUT THESE THINGS WITH REGARD TO THE ELDERLY WHO ARE COMING UP THE PIKE IN TERMS OF BABY BOOMERS WHO WILL BE MORE VERBAL AND MORE PUBLIC, MAYBE GET MORE PROTECTIVE ORDERS AND THINGS LIKE THAT BUT MAY BE LOOK INTO NONPUNITIVE ISSUES AND PREVENTION PLANS. , THANKS. >> NEXT UP, BEAMED IN IS XINQI DONG, DIRECTOR OF HEALTH AND AGENCY POLICY PROGRAM THERE ASSOCIATE DIRECTOR OF RUSSIA'S INSTITUTE FOR HEALTHY AGING RATHER AND HE'S PUBLISHED EXTENSIVELYOT TOPICS OF VIOLENCE, ELDER AND PREVENTION OF ABUSE, AND LEADS EPIDEMIOLOGICAL STUDY OF PINE STUDY OF 33 OLDER CHINESE ADULTINGS. XINQI, YOUR SLIDES ARE UP ON THE SCREEN. >> MY APOLOGIES FOR NOT BEING ABLE TO BE WITH YOU TODAY, THERE'S A LAGOT VIDEO ON THE INTERNET IN CHINA SO I WILL RELY ON YOU FOCUSED ON FORWARD THE SLIDES FOR ME PLEASE. THE FIRST IS THE CDC SLIDES, SECOND SLIDE, PLEASE, I HOPE TODAY TO SHED LIGHT ON SOME OF THE COMPLEXITIES AND CHALLENGE THE SARKS SUSMGZS AND TO MUDDY THE WATER A BIT, THIS A SLIGHT DRIVEN TO MANY MANY YEARS AGO, MY MY ADVISORS MARX AND JIM, AND HAVING SAT ON THE COMMITTEE FOR GLOBAL VIOLENCE PREVENTION AND REALLY DRIB TO ME THE STAGES OF VIOLENCE PREVENTION, DEFINING THE PROBLEM, RISK FACTORS INTERVENTION AND PREVENTION WORK AND I'LL COME BACK TO THE SLIDE AFTER MY TALK. NEXT SLIDE PLEASE, THE DEFINITION, THIS IS A SLIDE WE DID FROM THE PINE STUDY, COHORT STUDY, BASELINE SAMPLE SIZE WHERE WE DID 10 ITEMS SCREENING ON ELDER MISTREATMENT AND SUBSEQUENTLY WE ASKED ANOTHER 56 ITIMES TRYING TO CAPTURE THELEDDER ABUSE AND ON THE X AXIS IS ON DIFFERENT TYPES AND ON THE Y AXIS IS PERCENTAGES. AND WHAT YOU SEE HERE IS DIFFERENT DEFINITIONS OF ELDER MISTREATMENT. FOR PSYCHOLOGICAL ABUSE, FOR EXAMPLE, BASED ON DIFFERENT CRITERIA, CAN YOU GET A HELY SKEWED DIFFERENT PREVALENCE FROM 10% DOWN TO TWO OR THREE%. AND WE LOOK AT CAREGIVER NEGLECT, DEPENDS WHAT DEFINITION, 10%, 11% VERSES FOUR-5 PERCENT AND THE IN OF THE LAST PART OF WHAT ELDER ABUSE, THE THREE DIFFERENT BARS, THE PREVALENCE IS VARY FROM 10% DOWN TO 14% AND YOU LOOK AT THE DEMOGRAPHIC CHARACTERS THEY'RE VARY WIDELY AS WELL. SO THE PREVALENCE SPECIFIC DETAILS ON MATTER AND DEFINITION AND CONCLUSION IN THIS STUDY OF THE CHINESE COHORT STUDY THAT AND MATTER AS WELL. AND NEXT SLIDE, PLEASE? THIS IS A SYSTEMATIC REVIEW WE DID IN AMERICAN GERIATRIC SOCIETY, I DIDN'T WANT YOU TO READ THE TEXT BUT RATHER FOR JUST THE VISUALIZE THE LINES, THE VERTICAL LINE INDICATES 1.0 ODDINGS RADIO, AND THE WIDE RATIO INICATE THERE'S A LOT OF STUDY THAT SUGGEST CERTAIN RISK FACTORS ARE POSITIVE BUT WHEN YOU LOOK AT THE LIFE SIDE OF THAT, WHETHER IT'S A COGNITIVE FUNCTION, PHYSICAL DISABILITY, MENTAL HEALTH ISSUE, THERE'S STUDIES SUGGESTING OTHERWISE AS WELL AND THE REASON WHY THERE'S SUCH A COMPLEXITY IN TERMS OF WAT MAY BE RISK FACTORS AND WHAT NOT BE RISK FACTORS AND PROTECTIVE FACTOR SYSTEM THE DATA WE SEE ON THE NEXT SLIDE PLEASE, THE TITLEs COMPLEX ASSOCIATIONS AND 94 STUDY HERE, WE USED THE 10 ITEM ELDER ABUSE SCREEN AND WE LOOK AT THE Y-AXIS AND THE FIRST ONE SELF-REPORTED PHYSICAL FUNCTION, THE ENTIRE SLIDE IS ABOUT PHYSICAL FUNCTION ASSOCIATION WITH ELDER ABUSE AND WHEN YOU LOOK AT THE FIRST BOX ON THE LEFT UPPER CORNER WHERE ADL IMPAIRMENT AND ELDER ABUSE SCREENER, THAT IS SAYING THE INCREASED NUMBER IS NOT ASSOCIATED WITH INCREASING RISK FOR ELDER ABUSE. BUT WHEN WE ASK A MORE DETAILED ITEMS ABOUT EACH OF THE SUBTYPES OF ELDER ABUSE IN THE FIRST LINE, WHAT YOU'RE SEEING HERE IS THE GREATER IMPAIRMENTS IN ADLs IS ACTUALLY PROTECTIVE AGAINST PSYCHOLOGICAL ABUSE AND WHEN YOU LOOK AT SEXUAL ABUSE, CAREGIVER NEGLECTED, IT IS INDICATING A GREATER IMPAIRMENT, SO WHEN YOU LOOK AT CULMINATION OF THE FIRST BOX, YOU CAN UNDERSTAND THAT IF WE DON'T DISSECT THE WAY, SUBTYPES OF ELDER ABUSE MORE SPECIFICALLY WE GET A SUMMARY MEASURE, THAT'S REALLY MUDDY THE WATER IN TERMS OF UNDERSTANDING THE RELATIONSHIPS, WHEN YOU LOOK AT IADLs, IT'S ALSO PROTECTIVE AGAINST ELDER ABUSE WHEN YOU LOOK AT DEFINITION, WHEN YOU LOOK AT DETAILS TAILED ELDER ABUSE, IT CONSISTENTLY SHOW GREATER IMPAIRMENT AS A RISK FACTOR, FOR CAREGIVER NEGLECT BUT IT MAY NOTE BE FOR THE OTHER FORMS OF ELDER,A BUSES CASES. NEXT SLIDE PLEASE, THIS IS A STUDY WHERE WE ASKED OUR OVER 3000 PARTICIPANTS NOT ONLY IF THEY EXPERIENCED OLDER ABUSE SINCE THE BASELINE STUDY, BUT WE ALSO ASK ABOUT IPV, WHETHER THEY EXPERIENCE ANY FORM OF PARTNER VIOLENCE BEFORE THE AGE OF 60 AND FURTHER MORE WE ASK THEM WHETHER THEY TO THE BEST'VE THEIR RECOLLECTIONS THEY EXPERIENCE THE FORM OF CHILD ABUSE WHEN THEY WERE A CHILD. AS YOU SEE FROM THE TOP BLUE PART OF THE CHART THAT THEY'RE ALL CLOSELY CORRELATED WITH ONE ANOTHER. WE ALSO ASK THE ADULT CHILDREN TO ASK TWO SPECIFIC QUESTIONS, ONE WHETHER THEY AS ADULT CHILDREN HAVE COMMITTED FORMS OF ELDER ABUSE TOWARDS THEIR PARENTS BUT WE ALSO ASK THE ADULT CHILDREN WHETHER THEY WERE THE VICTIM OF CHILD ABUSE IN THEIR LIFETIME AS WELL, I WON'T GO INTO DETAIL BUT CAN YOU SEE THERE'S A LOT OF POSITIVE ASSOCIATIONS HERE AND THEY VERY MUCH CHALLENGE ASSUMPTION OF THE INTERCONNECTEDNESS OF CROSS LIFE SPAN AND ACROSS GENERATIONS HERE. NEXT SLIDE. TO MAKE THE WATER MUDDIER, YOU CAN SEE THE FORMS OF ABUSE HERE, PSYCHOLOGICAL, CAREGIVER, SEXUAL ABUSE, ALL OF THE POSITIVE CORRELATIONS ABOUT YOU THERE'S NEGFIVE CORAALATIONS AS WELL BUT WITHOUT ASKING THOSE QUESTIONS, WE'RE ONLY STUDYING ONE FACET OF THIS PROBLEM. NEXT SLIDE PLEASE. >> BACK TO THE CDC MODEL. YOU KNOW AS--AS I ECHO VERY MUCH SOME OF MY COLLEAGUES SAID ABOUT WHEN WE THINK ABOUT TALK ABOUT GUIDELINES AND PREVENTION, INTERVENTION IT MAKES ME JUST A BIT CAUTIOUS BECAUSE I'M NOT CERTAIN IN PROBLEMS OF IDENTIFYING RISK FACTORS, WE'RE KNOWING OUR FOUNDATION TO TAKE IT THE NEXT LEVEL AND BE CAUTIOUS IN THINKING AND BUT DOESN'T NECESSARILY MEAN STOPPING US FROM DOING WHAT NEEDS TO BE DONE IN EXPLORATORY ANALYSIS AND STUDIES BUT WE DO NEED TO BE CAUTIOUS. AND I WANT TO THANK KATE AND NIDA, AND OFFICERS OF NIA AND NURSING AND MENTAL HEALTH AND MINORITY HEALTH EN--STRATEGIESITUTE FOR SUPPORTING MY WORK. THANK YOU. [ APPLAUSE ] >> GREAT, THANK YOU XINQI, FOR KARL AND XINQI'S PANELIST ARE HEADING TO THE TABLE AND YOU'LL BE WITH US THERE IN SPIRIT. >> THANK YOU IN A PRIOR LIFE WHEN I WORKED FOR THE DEPARTMENT OF JUSTICE ASK WHO CONTRIBUTED SO MUCH AND MY FORMER COLLEAGUES CONTRIBUTED SO MUCH TO US BEING HERE TODAY, I REPRESENTED NIH AS A CLIENT AND HAD MEETINGS IN THIS ROOM WHERE WE STRUGGLED LONG AND HARD TO TRY TO DECIDE TO FILE LAWSUITS AGAINST CERTAIN ENTITIES THAT SHALL PREMAIN NAMELESS RIGHT NOW SO I HAVE MANY FOND FEELINGS ABOUT THIS ROOM EVEN THOUGH IT WAS A VERY CONTROVERSIAL MOMENT IN MY LIFE. SO WHAT WE GENERALLY THOUGHT WE WOULD TRY TO COVER ARE THE THREE POINTS THAT KATE HAD TALKED ABOUT EARLIER, SOME OF THE GREATEST CHALLENGES, SOME OF MOST IMPORTANT LESSONS LEARNED AND SOME SOLUTIONS GOING FORWARD AND I'M SURE WE WILL STRAY FAR BEYOND THAT. EMPLOY BUT I THOUGHT I WOULD STARTED OUT BY ASKING THE PANELISTS IN THE ROOM AND THEN GO TO YOU, CARL AND XINQI AND ABOUT WHAT ARE THE MOST IMPORTANT LESSONS THAT WE IN THE ELDER ABUSE WORLD SHOULD LEARN FROM THE OTHER FIELDS IN YOUR WORK? SHERRY? >> I WOULD JUST REITERATE SOME OF THE POINTS THAT I MADE IN MY TALK THAT I THINK THERE IS A--THIS HAS BEEN AN ENORMOUS AND TRANSFORMATIVE PERIOD WHERE THERE HAVE BEEN A LOT OF BRIDGES BEING BUILT ACROSS THE FIELDS THAT HAVE BEEN HISTORICALLY ISOLATED, I THINK ELDER ABUSE REMAINS THE MOST SILOED OF ALL OF THESE DISCIPLINES OF VIOLENCE RESEARCH BUT PEOPLE ARE STARTING TO SEE THERE ARE A LOT OF INTERCONNECTIONS AND COMMON PATTERNS AND I ALSO THINK THAT PEOPLE ARE VERY MUCH SHIFTING TO A MORE STRENGTH BASED APPROACH TO WORKING WITH VIOLENCE. I WOULD HAVE TO RESPECTFULLY DISAGREE WITH SOME OF THE POINTS SHA HAVE BEEN RAISED EARLIER AND I THINK THERE'S MUCH MORE THAT CAN BE DONE TO FULLY DOCUMENT THE TRUE BURDEN OF ELDER ABUSE AND THAT THERE'S A LOT THAT CAN BE ADAPTED FAIRLY DIRECTLY FROM THE NEW RESEARCH ON THE CUMULATIVE BURDEN OF VIOLENCE AND OTHER FIELDS AND THAT THERE IS A LOT, I MEAN I RECEIPTLY DID A REVIEW OF THIS LITERATURE, THE RANGE OF RISK FACTORS THAT HAVE BEEN STUDY INDEED ELDER ABUSE IS STILL FAIRLY SMALL IN NUMBER COMPARED TO ANY OTHER VIOLENCE DISCIPLINE THAT YOU MIGHT NAME AND THEN ALSO STILL HEAVILY FOCUSES ON DEMOGRAPHICS WHICH ARE REALLY SORT OF A NONSTARTER FOR INSPIRING INTERVENTION AND PREVENTION. I WOULD AGREE ABOUT THE NEED TO HAVE MORE--HAVE BASIC SCIENCE LEFT-SIDE MORE DIRECTLY TO INTERVENTION AND PREVENTION PROGRAMS AND FOR THAT LENGTH TO BE STRONGER AT THE OUTSET AND NOT JUST THE IDEA WILL WE FIGURE IS IT OF OUT MAYBE IT'LL BE USEFUL TO SOMEBODY? WE SHOULD BE THINKING ABOUT THAT ON THE FRONT END. I THINK OTHER FIELDS OF VIOLENCE ARE GETTING BETTER AT THAT AS WELL, AND SOS THAT THERE ARE REALLY SO MUCH TO BE DONE TO BORROW AND ADAPT BECAUSE IN SOME WAYS THERE ARE UNIQUE ISSUES AND SOME DISCONTINUITYS BUT THE A LOT OF THE VULNERABILITIES WILL BE THE SAME. >> OKAY, SO I GUESS TWO POINTS ALTHOUGH THERE ARE A LOT OF OTHERS I COULD TALK ABOUT, THE FIRST IS THE IMPORTANCE OF PROSPECTIVE LONG NUDEINAL STUDIES, IN THE FIELD OF CHILD ABUSE AND NEGLECT, WE--THE FIELD WAS PROMINENTLY, ALMOST EXCLUSIVELY BASED ON CROSS SECTIONAL STUDIES AND RETROSPECTIVE REPORTING ABOUT CHILD ABUSE AND NEGLECT. AND ALTHOUGH THERE'S STILL A LOT OF DEBATE ABOUT THE VALUE OF EACH OF THESE APPROACHES, I THINK THAT THE PROSPECTIVE STUDIES AND THERE HAVE BEEN A NUMBER NOW AND LARGE SCALE, ALL DIFFERENT, WITH DIFFERENT STRENGTHS AND DIFFERENT WEAKNESSES BUT AT LEAST IN TERMS OF THE CYCLE OF VIOLENCE THE RESULTS HAVE BEEN REPLICATED ACROSS THESE DIFFERENT STUDIES LENDING CONFIDENCE TO OUR THINKING ABOUT THIS PHENOMENA AND THE GENERALIZABILITY OF IT IS THE ABILITY WITH THESE STUDIES TO BE ABLE TO DISENTANGLE SOME OF THE CONFOUNDING VARIABLES THAT WE KNOW ARE PREVALENT IN INDIVIDUAL--IN CHILDREN, FAMILIES AND NEIGHBORHOODS WHERE THESE PROBLEMS ARE GOING ON. THE OTHER THING THAT THE PROSPECTIVE STUDIES HAVE BEEN ABLE TO DO IS TO CHALLENGE MANY OF THE ASSUMPTIONS THAT WE MAKE IN THAT THE PUBLIC AND PROFESSIONALS MAKE ABOUT SOME OF THESE RELATIONSHIPS. SO WHEN I STARTED LOOKING AT THE CYCLE OF VIOLENCE, THE ASSUMPTION WAS THAT THE VAST MAJORITY OF MALTREATED CHILDREN WOULD GO ON TO BECOME DELINQUENT AND DRUG ADICS AND ALL OTHER BAD THINGS HAPPENING TO THEM BUT WHEN WE ACTUALLY BEGAN TO DO A LONGITUDINAL STUDIES WHERE WE FOLLOWED THESE CHILDREN INTO THE FUTURE WHERE WE DID NOT SIMPLY RELY ON POPULATIONS DRUG ADICS AND PRISONERS LOOKING BACKWARDS WHERE WE FOLLOWED THEM INTO THE FUTURE, WE FOUND AS YOU SAW THERE'S A INCREASE IN RISK BUT IT'S NOT INEVITABLE IT'S NOT DETERMINISTIC AND WE WOULD NOT HAVE KNOWN THAT IF WE ONLY RELY ON THESE CROSS SECTIONAL LONG NUDEINAL STUDIES. I MEAN CROSS SECTIONAL STUDIES. THE OTHER ISSUE I THINK THAT CAME UP HERE AND IS MEASUREMENT AND I DIDN'T GET TO SHOW YOU A SLIDE BUT THE--BUT THE PERSON WHERE THE INFORMATION IS COMING FROM IS EXTREMELY IMPORTANT. SO WE HAVE SELF-REPORTS BY INDIVIDUALS, WE HAVE OFFICIAL REPORTS WE TALKED ABOUT, EMERGENCY ROOM REPORTS, OTHERS, AND WE HAVE REPORTS OF IN THE CASE OF CHILD ABUSE AND NEGLECT. WE HAVE A CHILD'S REPORT, WE HAVE A PARENT'S REPORT, WE HAVE TEACHER'S REPORT AND WE HAVE OFFICIAL REPORT AND WE JUST PUBLISHED A PAPER IN SCIENCE ON THE TRANSMISSION OF ABUSE AND NEGLECT AND WE THOUGHT WE WOULD COME UP WITH A SINGLE ANSWER OR A SINGLE NUMBER WHAT IS THE IRPT GENERATIONAL TRANSITION AND IT TURNS OUT THAT THE PICTURE, THE RELATIONSHIP VARIES TRAM ENDOUSLY BASED ON THE SOURCE OF THE INFORMATION AND THE TYPE OF ABUSE THAT OCCURRED. SO I THINK THAT FOR THE FIELD OF ABUSE AND NEGLECT WHERE'S THE INFORMATION COMING FROM, ARE WHAT BIASES MIGHT BE ASSOCIATE WIDE THAT INFORMATION HOW CAN WE BEST GET INFORMATION AND IN THE FIELD OF ELDER ABUSE, THE FACT THAT THERE IS THE QUESTION OF COGNITIVE IMPAIRMENT MAKES IT A MORE CHALLENGING PROBLEM BECAUSE WHEN WE'RE BASING THIS ON RESPORTS WE ALREADY HAVE BASIC MEMORY RECALL PROBLEMS AND THEN TO ADD TO THAT, THE ISSUE OF POTENTIAL COGNITIVE DEFICITS MAKE ITS MORE CHALLENGING. >> OKAY, WELL AS I MENTIONED, I THINK WE SHOULD MAYBE MOVE BEYOND PREVENTIVE LEND BECAUSE IT MAY BE SOMEWHAT FLAWED AND WE'RE NOT GETTING AT OLDER POPULATIONS AND POPULATIONS WHO MIGHT BE MORE QUIET ABOUT IT BUT TO LOOK AT WITHIN GROUP ANALYSIS AND DISTINCTION AND ALSO INCLUDING OTHER OPROACHS THAT AREN'T JUST THE NUMBER CRUNCHING APPROACH LIKE WITH THIS NEW SURVEILLANCE WE HAD THE QUANTITATIVE OPPONENT BUT ALSO THINGS LIKE THIS PARTICULAR QUOTE WHICH I FORGOT FROM MY PRESENTATION WHICH IS INTIMATE PARTNER HOMICIDE-SUICIDE AND THE PERPETRATOR DIALED 911 TO REPORT A HOMICIDE PRIOR TO TAKING HIS OWN LIFE, NEIGHBORS REPORTED THEY WERE PRIVATE PEOPLE AND RARELY LEFT THE HOUSE, IT WAS PERCEIVED THAT SHE WAS NOT PERMITTED TO SPEAK TO NEIGHBORS. AND THE NEIGHBOR SAID I TRY TOED TALK TO HER AND SHE WOULD SMILE AND THEN TURN HER FACE, SHE DIDN'T DARE AND THIS IS SOMETHING THAT WENT ON TO BE--THE NEWS MEDIA PERCEIVE INDEED THAT ARTICLE THAT PERHAP ITS WAS CONSENTUAL BECAUSE THERE WAS NO ATTEMPT ON HER PART TO RUN AWAY AND THINGS LIKE THAT WHICH ACTUALLY THAT'S NOT SOMETHING WE SAW FROM ELDERS AND THIS COULD BE LIKE THE FIRST TIME THAT THERE IS SOME SORT OF VIOLENCE BUT BIG AND SERIES VIOLENCE SO DO I WANT TO POINT OUT THAT THE COMMUNITY IS VERY INFLUENCED BY THIS AND THEY ALSO HAVE AN INFLUENCE ON THE SITUATION SO WHEN MIDDLE--WHEN IT'S REPORTED AS A ROW MANDATORYIC EVENT OR SOMETHING LIKE THAT, IT TENDS TO--I DON'T KNOW WHAT'S HAPPENING [AUDIO DISTORTION ] >> FOR THOSE PEOPLE ON THE PHONE, PLEASE MUTE YOUR PHONES, WE CAN HEAR SOMEBODY TYPING VIGNETTESIOUSLY, THANK YOU. GOOD THAT'S WHAT IT WAS. THANK YOU. SO NOT ONLY THAT BUT BY LOOKING AT INTERNATIONAL ELDER ABUSE SITUATIONINGS WE CAN SEE THAT WHAT SOCIETY DOES, DOES MAKE A DIFFERENCE SO MAYBE THAT MEANS THAT POLICY CAN MAKE A DIFFERENCE AND THE PUBLIC RESPONSE AND THAT SORT OF THING AND WHEN YOU LOOK AT MAYBE CHILD ABUSE, POLICY SUCH AS THE HAWAII HEALTHY START PROGRAM, THAT ACTUALLY DECREASED INTIMATE PARTNER VIOLENCE AND ALSO CHILD ABUSE, THEN PERHAPS THERE'S SOME SORT OF HOME VISIT TYPE PROGRAM THAT MIGHT LOOK INTO SOME SUICIDE PREVENTION OR SOME--SOME ELDER ABUSE PREVENTION ISSUES SO BASICALLY I'D LIKE TO SEE SOME TRIANGULATION GOING ON. DID. >> SO WE'LL START WITH YOU KARL, I WANT TO SCU A DIFFERENT QUESTION BECAUSE I THINK YOU TOLD US WHAT THE YOU THINK THE HIGHEST PRIORITIES ARE, WHEN YOU LOOK, IF I'M RATING THE ELDER ABUSE PREVALENCE DATA, DIRECTLY AND THERE ARE A LOT OF PEOPLE WHO WILL CORRECT ME IF I'M WRONG, ABOUT--WELL IT'S LESS THAN 2.5% IS PHYSICAL OR SEXUAL ABUSE LEAVING MORE THAN 97% BEING A COMBINATION OF NEGLECT, FINANCIAL EXPLOITATION AND VERBAL ABUSE AND THERE'S GOOD DATA INCLUDING THE MORTALITY AND MORBIDITY STUDIES THAT ALL OF THOSE HAVE SIGNIFICANT HEALTH, DETRIMENTAL IMPACTS ON HEALTH BUT A LOT OF OF THE CONVERSATION VEERS TOWARD THE MOST IDENTIFIABLE AND CLEAR EVENTINGS AND I THINK THAT HAPPENS WITH HOMICIDES AND YET THE VAST EXPANSE OF THIS PROBLEM IS SOMETHING ELSE. SO, I WOULD LOVE FOR YOU TO TALK A LITTLE BIT ABOUT--ABOUT THAT, AND PARTICULARLY AND I KNOW THAT PEOPLE IN THE ROOM LIKE TERRY HAS DONE A LOT OF WORK AND XINQI YOU HAVE TOO, BUT HOW DO WE CALIBRATE A RESPONSE THAT IS--THAT TARGETS THE PROBLEM AS WE HAVE MEASURE SAID IT. AM. >> SURE. AND JUST IN--I'M SORRY TO KEEP ASKING THIS, BUT FOLKS CAN HEAR OKAY? OKAY. SOUNDS GOOD. I FEEL LIKE THE GREAT AND POWERFUL OZ COMING IN OVER SOMETHING, IF YOU HAVE A CARDBOARD CUT OUT OR ANYTHING OF US? [LAUGHTER] FIRST OF ALL TO BE CLEAR AND LIKE FOR EXAMPLE FOR US HAVING SYNTHESIZED WITH DAVE OUD BURNS AND MARK IS YOUR CO WORK ON THIS, ALL THE PREVALENCE STUDIES WOOY CAN FIND, YOU'RE RIGHT WITH PHYSICAL ABUSE WE COME UP WITH A RATE OF SOMEWHERE AROUND TWO-THREE% HOWEVER THAT'S NOT TWO-THREE% OF ALL THE ABUSE, THAT'S OF THE POPULATION. SO IT'S NOT LIKE 98% OF ALL OTHER MISTREATMENT IS BY SOMETHING ELSE. SO I WANT TO CLARIFY THAT. YOU KNOW I HOPE I DON'T ANSWER THIS TOO OBLIQUELY OR BY ANSWERING QUESTIONS WITH QUESTIONS, BUT I THINK THAT ONE POINT I WOULD MAKE ABOUT YOUR QUESTION, I WOULD LOVE TO HEAR WHAT OTHERS THINK AND I WOULDED LOVE-HAD OF I THINK THAT XINQI MADE THIS POINT EXCELLENTLY, THAT TALKS ABOUT ELDER ABUSE IN GENERAL AND MAKING GENERALIZATIONS ABOUT SOMETHING CALLED ELDER ABUSE OR ELDER MISTREATMENT LIKE OUGHT TO BE BANNED. IT SHOULD BEGIN TO SOUND AS STRANGE TO US AS USING THE TERMS SENILITY, WHICH SEEMS TO CAUSE ALL THE REVERSES OF MEMORY LOSS. SO ONE WAY IS TO LOOK AT THIS AS A SINGLE PHENOMENON AND AS FAR AS IMPERICAL WORK GOES, I WON'T HAMMER THIS TOO MUCH BECAUSE I THINK IT'S PRETTY OBVIOUS, YOU KNOW TALKING ABOUT ELDER ABUSE IS SOME KIND OF UNIVERSAL PHENOMENON THAT ACTUALLY MEANS SOMETHING. SO I THINK THAT'S ONE KEY POINT. YOU KNOW THE OTHER--I GUESS THAT'S ONE THEN I WOULD SAY. YOU KNOW THE OTHER ISSUE YOU HAVE TO TALK ABOUT HAS TO DO WITH THIS AND I FEEL LIKE I CAN SAY THIS, BUT I THINK OUR FINDINGS OF SURVEY BASED POPULATION STUDIES ARE SO DIVERGENT FROM WHAT ANY CLINICIAN ACTUALLY SEES IN OUR DAILY REALM SO THESE ARE STUDIES THAT HAVE BEEN INSULTED OR SWORN AT BY THEIR 65 YEAR-OLD SPOUSE EIGHT TIMES IN THE COURSE OF A YEAR, IT'S SO DRAMATICALLY DIFFERENT FROM THE HIGHLY SERIOUS CASES OF ELDER ABUSE AND LIFE THREATENING ONES THAT I THINK IN TERPS OF PREVALENCE, BUT ONE PROBLEM IS THE DISCONNECT BETWEEN THE KIND OF CASES WE UNCOVER AND CLINICAL REALITIES SO I THINK WE HAVE TO START TO LOOK AT CLINICAL SIGNIFICANCE WITHIN PREVALENCE AND LET ME STOP THERE. I COULD GO ON FOR HOURS. >> [INDISCERNIBLE] >> XINQI, WOULD YOU LIKE TO SPEAK TO THAT. >> SURE. THREE OVERARCHING POINTS AND MANY ARE HIGHLIGHTED IN THE REVIEW PAPER IN JAGS EARLIER THIS YEAR, BUT FIRST IS WITHIN THE CONTEXT OF POPULATION STUDY, REALLY LOOK AT INCIDENCE OF DIFFERENT SUBTYPES OF ELDER ABUSE AND UNDERSTANDING RISK FACTORS TOWARDS ABUSE CASES BECAUSE I THINK WITHOUT THAT, IT'S HARD TO REALLY THINK ABOUT RISK FACTORS PURE SENSE THE SECOND ASK REALLY TO UNDERSTAND CULTURE SUBGROUPS, YOU KNOW MUCH THE WORK DONE BY MANY OF THE FOLKS IN THE ROOM AND HIGHLIGHTS A SIGNIFICANT HEALTH DISPARITY AMONG DIFFERENT SUBTYPES OF ELDER ABUSE, RANGING FROM FINANCIAL ABUSE TO EXPLOITATION AND ANOTHER HAVE DONE, IT'S REALLY IMPORTANT AND IT'S REALLY IMPORTANT TO UNDERSTAND MORE TARGETED AND USING BOTH QUALITATIVE AND UNDERSTANDING THE CULTURE CONTEXT OF THOSE ELDER ABUSE CASES AND USING MIXED METHODS TO DO THAT WELL. AND THE THIRD OF WHICH, I HAVE THE PRIVILEGE FOR THE NATIONAL HEALTH COLLABORATIVE ON REPRESENTING THE AMERICAN ELGT GERIATRICS SOCIETY, AND I ASKED QUESTION YOU JUST ASKED TO MY COLLEAGUES THERE AND DESPITE THE RESEARCH FOUNDATION, THE IT'S DEDICATE FRIDAY THE MECHANISMS, AND WITH US FROM NIH AND FROM FOUNDATIONS THAT REALLY WILL BE A GAME CHANGER IN TERMS OF WORKFORCE ISSUES AND ADVANCE RESEARCH TOPIC ISSUES. >> GREAT THANKS, CATHY I'M INTERESTED IN YOUR RESPONSE BECAUSE AS WE JUST HEARD, ELDER ABUSE IS NOT A MONOLITH AND IT'S REALLY MANY DIFFERENT PRETTY DISTINCT PROBLEMS AND HOW HAVE YOU ALL DEALT WITH THAT IN CHILD MALTREATMENT. >> WELL,--AS I THINK I SUGGESTED THERE IS CONSIDERABLE DEBATE IN THE FIELD OF CHILD MALTREATMENT BETS WHETHER WE FOCUS ON SPECIFIC TYPES, PHYSICAL ABUSE, SEXUAL ABUSE, NEGLECT OR PSYCHOLOGICAL MALTREATMENT WHICH HAS THE WORST OUTCOMES, AND THEN THERE ARE PEOPLE WHO SAY, WE REALLY SHOULDN'T FOCUS ON THE SPECIFIC TYPES THAT THERE'S A LOT OF OVERLAP AND WE SHOULD JUST LOOK AT MALTREATMENT IN GENERAL. IN SOME OF THE WORK, ISM OF THE I CAME TO THAT DECISION BASED ON IMPERICAL EVIDENCE WHERE WE HAVE FOUND THAT THERE ARE DISTINCT DIFFERENCES IN HEALTH OUTCOMES ASSOCIATED WITH DIFFERENT TYPES OF CHILD ABUSE AND NEGLECT 30 YEARS LATER. WE HAVE FOUND DIFFERENCES IN IT PADERNS OF OFFENDING, WE HAVE--SO--SO WE HAVE FOUND MANY DIFFERENCES FOR THESE THREE GROUPS, PHYSICAL ABUSE, SEXUAL ABUSE AND NEGLECT AND THEN IN TERMS OF EVEN--IN TERMS OF THE IRPT GENERATIONAL TRANSMISSION,S WHAT IS TRANSMITTED AND IN FACT, THE PRESUMPTION WAS THAT IF YOU WERE PHYSICALLY ABUSED AS A CHILD, GO ON TO PHYSICALLY ABUSE YOUR KID AND IN FACT WE DO NOT FIND EVIDENCE FOR THAT. WE FIND EVIDENCE THAT THERE IS AN INTERGENERATIONAL TRANSMISSION FOR SEXUAL ABUSE AND FOR NEGLECT AND FOR SEXUAL ABUSE ASTERISKS VERY COMPLICATED BECAUSE IT'S NOT NECESSARILY THE PARENT WHO WAS SEXUALLY ABUSED WHO IS THE PERPETRATOR BUT THEIR CHILD IS AT RISK FOR BEING SEXUALLY ABUSED OR NEGLECTED. SO ON THEIS OF THESE VERY DIFFERENT FINDINGS, USING WHAT I THINK AND PRETTY DECEPT METHODS, I'M CONVINCED THAT IT'S REALLY IMPORTANT. SO I WOULD--I WOULD ENCOURAGE THE FIELD--I HESITATE NOW TO SAY THE FIELD OF ELDER ABUSE BUT--I'LL PUT IT IN QUOTES, TO LOOK BECAUSE IT MAY HAVE WELL BE. LET I MEAN WE ACTUALLY HAVE INFORMATION ABOUT PSYCHOLOGICAL COERCION, OTHER FORMS OF ABUSE IN THE OLDER OR IN OUR SAMPLE AND I PULLED OUT THE SEXUAL VIOLENCE AND THE PHYSICAL VIOLENCE BECAUSE I WASN'T REALLY EVEN THINKING ABOUT SOME OF THESE OTHER THINGS BUT THERE MAY BE VERY DIFFERENT--I WOULD IMAGINE RISK FACTORS AND PROTECTIVE FACTORS. AND CONSEQUENCES. YOU KNOW? >> TONY JINKEDSED THE MICROPHONE. LAWYERS AND SCIENCE, BAD IDEA. [LAUGHTER] BUT I'M STRUCK AT ACTUALLY THE ATTENTION BETWEEN THE MONOLITH BECAUSE IN TALKING ABOUT IT AND WRITING ABOUT IT, IT GOES AGAIN TO NEEDING SCIENTIFIC HUGS WHERE YOU CAN PULL IT APART AND TALK ABOUT IT IN AN EXTREME GRANULARITY AND COMPLEXITY VERSES COMMUNICATIONS AND POLICY REALM WHERE YOU CAN TALK ABOUT IT IN GREATER TERMS SO THAT IT'S ACCESSIBLE BECAUSE REAL PEOPLE CAN'T UNDERSTAND WHAT WE'RE TALKING ABOUT, I CAN'T UNDERSTAND EVERY OTHER WORD HERE SO IT'S--IT'S--BUT WE NEED TO BE ABLE TO FIND WAYS THAT TRANSLATE AND SO I THINK WE PROBABLY NEED TO HAVE SOLUTIONS THAT FIT BOTH. AND I'M COGNIZANT THAT WE WOULD LIKE TO OPEN IT UP TO, YOU KNOW THOSE OF YOU HERE IN THE ROOM AND-- >> YEAH--SORRY, I JUST WANT TO SAY SOMETHING IF YOU DON'T MIND ABOUT THAT POINT AND I THINK THAT IT IS--I THINK YOU'RE RAISING A VERY IMPORTANT POINT BUT I THINK THAT THE TRADITIONAL WAY OF THINK BEING THESE IS REALLY MISSING THE VOTE IN A LOT OF IMPORTANT WAYS SO LET ME TRY OFFERING YOU AN EXAMPLE FROM ANOTHER FIELD, SO FOR EXAMPLE, LIKE THE BULLYING AND THE CYBER BULLYING LITERATURE, SO THERE'S BEEN A LOT OF RESEARCH AND LOTS OF INC. SPILLED ABOUT WHETHER CYBER BULLYING AND WORSE THAN BULLYING AND SOME TYPES OF PEER VICTIMIZATION COUNT AS BULLYING OR DON'T COUNT AS BULLYING AND SORT OF THIS SIMPLISTIC IDEAS ABOUT WHETHER IT'S CYBER BULLYING OR BULLYING OR SOMETHING ELSE, ALTOGETHER, WHAT THE MOST EXCITING NEW RESEARCH THAT'S BEING DONE BY PEOPLE LIKE DOROTHY AND KIM MITCHELL AND MICHELLE O'BARRA AND PEOPLE LIKE THAT ARE TO START TO TEASE OUT LIKE WHAT MAKES AN INCIDENT PROBLEMATIC AND WHAT MAKES AN INCIDENT HARMFUL AND SO SOME OF THE ASPECTS OF IT HAVE TO DO WITH THERE ARE DIFFERENT TYPES OF SEVERE MITRAL ERITY INDICATORS, CERTAIN TYPES OF THREATENED FOR HARM, THERE IS SOME PEOPLE TALK ABOUT THE 24/7 NATURE OF CYBER BULLYING BUT INSTEAD OF JUST CALLING IT SIGN EAR BULLYING TO TRY TO SPECIFICALLY OPERATIONALLIZE WHAT YOU THINK IS DIFFERENT BETWEEN CYBER BULLYING AND OTHER TYPES OF BULLYING AND THAT'S PART OF WHAT'S MISSING. AND ALSO IN TERMS OF THE EXAMPLES THAT HAVE BEEN OFFERED SO FAR, JUST COMPARING NEGLECT AND A RELATIONSHIP BETWEEN NEGLECT AND AN OUTCOME AND A RELATIONSHIP BETWEEN PHYSICAL ABUSE AND AN OUTCOME IS NOT ANSWEING SOME OF THE QUESTIONS THAT YOU ALL ARE ASKING. THAT THAT IS NOT ASKING WHETHER THERE IS SOMETHING THAT'S UNIQUELY BAD ABOUT NEGLECT OR UNIQUELY BAD ABOUT PHYSICAL ABUSE BECAUSE YOU'RE JUST LOOKING AT THESE SIMPLE BI VARIANT RELATIONSHIPS AND I KNOW THIS IS A COMPLICATED STATISTICAL CONCEPT BUT IT'S REALLY IMPORTANT NOT TO LOOK AT AN ASSOCIATION AND GO, OH, WELL, THE ASSOCIATION BETWEEN NEGLECT AND POOR HEALTH AND .2 AND THAT'S SIGNIFICANT AND THE ASSOCIATION BETWEEN PHYSICAL ABUSE AND POOR HEALTH AND .15 IS NOT SIGNIFICANT AND THEN SAY THAT .2 IS DIFFERENT FROM THE .15. THAT'S NOT THE SAME THING AND SO THERE'S ACTUALLY NOT VERY GOOD DATA TO SHOW AND THE POLYVICTIMMIZATION MODEL IS A REAL PARADIGM SHIFT AND I KNOW IT'S HARD TO TALK ABOUT THIS, TOO, PRACTITIONERS AND RESEARCHERS ALL THE TIME AND IT'S HARD FOR THEM TO LET GO OF IT, BUT ANY TYPE OF STUDY THAT IS ONLY LOOKING AT THE IMPACT OF A SINGLE TYPE OF VICTIMIZATION AT A TIME WITH AN OUTCOME CANNOT DRESS THESE QUESTIONS ABOUT WHICH ONE SHOULD BE THE HIGHEST PRIORITY OR WHICH ONE HAS THE GREATEST CLINICAL SIGNIFICANCE AND NOW THERE'S BEEN A LOT OF RESEARCH BY A LARGE NUMBER OF TEAMS IN MULTIPLE COUNTRIES, THAT HAVE SHOWN OVER AND OVER AGAIN THAT THE SPECIFIC TYPE OF VICTIMIZATION ACTUALLY TEND NOT TO MATTER VERY MUCH AT ALL, BUT THERE MIGHT BE A FEW SPECIFIC CHARACTERISTICS LIKE WE RECENTLY DID A STUDY WHERE THERE WAS A GUN INVOLVED DID THAT SEEM TO BE A PARTICULARLY TRAUMATIZING ELEMENT TO--[INDISCERNIBLE]--SOME TOTAL VERDICT AND NOT IMPANT DIFFERENT TYPES OF AND SO THIS--[INDISCERNIBLE]. [MIC CUTS OUT ] >> LIZ IN. >> WELL TO KIND OF PICK UP ON THIS AND MAYBE LINK IT A BIT TO CARL'S POINT AT THE VERY BEGINNING ABOUT DOING SCIENCE EXPERIMENTATION IN FIELD GROUNDED EXPERIMENTS I'M REALLY INTRIGUE BOOED I THIS POLYVICTIMMIZATION MODEL AND THE NOTION THAT WAS RAISED BY SONNIA ABOUT AN INTERVENTION THAT TARGETED ONE FORM OF ABUSE THAT A TRICKLE OVER EFFECT ON ANOTHER FORM AND I WONDER WHETHER ANYBODY OR ALL OF YOU ON THE PANEL HAVE THOUGHT ABOUT THIS HAVE INSIGHT INTO'S A SORT OF ACROSS TYPES OF ABUSE OR TRAUMA ARE THERE MALLEABLE TARGETS THAT SEEM TO REALLY BE SORT OF HIGH POTENTIAL FOR INTERVENTION AND ARE THERE NOVEL WAYS WE CAN BE STUDYING THESE IN THE CONTEXT IN WHICH--WHETHER THEY'RE EXPERIMENTAL CONTEXT OR FIELD CONTEXT WE WERE ENCOUNTERING INDIVIDUALS WHO MIGHT BE AT RISK BECAUSE I THINK THOSE--THOSE SORTS OF TARGETS MAY BE ADDRESSING EXACTLY THE KINDS OF POINTS YOU'RE RAISING HERE THAT IF YOU CAN IDENTIFY THE TARGET AND THE ENVIRONMENT, IS THERE PRESENCE OF A GUN, TARGET AND FAMILIAL INTERACTION THAT WORKS IN ONE CASE, MIGHT IT WORK IN ANOTHER CASE, IT WOULD BE INTERESTING TO HEAR FROM THE PANEL THOUGHTS ON HOW YOU MIGHT PROCEED WITH THAT KIND OF A RESEARCH AGENDA. >> I THINK IT WOULD BE NICE TO BE ABLE TO DO RESEARCH ON FIREARMS AND INJURY CAUSED BY FIREARMS. YES, OKAY. NOW THAT'S AN 800-POUND ELEPHANT OR EACH MORE HEAVY, I DON'T KNOW. SO ONE OF THE THIPGS I'M NOTICING IS THAT MAYBE IN TERMS OF PREVENTION PERHAPS THERE'S AN ISSUE FOR OLDER PEOPLE IF WE COULD REALLY, YOU KNOW BUCKLE DOWN ON THE SUICIDE PREVENTION STUFF, THEN MAYBE WE COULD PREVENT SOME OF THESE HOMOCIDES THAT ARE HAPPENING AND THIS IS RLLY A WOMEN'S ISSUE BECAUSE WE DID FIND IN OUR STUDY THAT IT WAS LIKE 90-SOMETHING PERCENT FOR EACH AGE CATEGORY THAT WOMEN WERE THE VICTIMS AND THEY RANGED IN TERMS OF THEIR AWARENESS OF THAT AND SO PERHAP PES IF YOU'RE--IF YOUR PARTNER IS SUICIDAL, THEN YOU'RE LESS LIKELY TO KNOW THAT YOU'RE IN DANGER. THAN IF YOU'RE PARTNER IS HOMICIDAL AND THEN YOU COULD BE RUNNING AWAY AND THINGS LIKE THAT AND TRYING TO CALL FOR HELP OR GET A PROTECTIVE ORDER OR WHATEVER IT IS. SO THIS IS A WOMAN'S ISSUE. LET MEN ARE SOMETIMES KILLED THIS WAY BUT IT DOES SEEM TO BE VERY, VERY FEMALE VICTIMIZED IN TERMS OF THE FATAL FAMILY VIOLENCE AND WITHIN PARTNERS. AD SO, I WOULD JUST SAY THAT THEY'RE NOT IN ON THE PLAN AND IT'S IMPORTANT TO MAYBE DO SOMETHING WITH REGARD TO SUICIDE PREVENTION THAT IS ALSO [INDISCERNIBLE]. >> MARK, I THINK-- >> [INDISCERNIBLE]. >> KARL DID YOU WANT TO SAY SOMETHING WERE YOU GOING TO GO TO A DIFFERENT TOPIC OR ARE YOU GOING TO STAY ON THIS ONE BECAUSE I WANTED TOSS IN ONE LAST THING. >> I WAS GOING TO DO BOTH. GO AHEAD. >> THE REASON WHY I'M A BIT EMBARRASSED AT MY QUESTION IS IT'S SO MUCH EASIER TO SAY WHAT'S WRONG AND WHAT WE SHOULDN'T DO THAN WHAT WE SHOULD DO AND THAT'S A GREAT QUESTION ON THAT SCORE. IF YOU THINK ABOUT IF WE'RE GOING TO BEGIN TO DO MORE RIGOROUS EXPERIMENTAL RESEARCH ON OTHER VIEWS WHAT ARE THE LIKELY TARGETS TO APPROACH AND YOU KNOW, I DID WANT TO SAY ALSO, IN AS A BACKGROUND POINT THAT I THINK WE NEED TO BACK AWAY FROM WHAT IS A FAIRLY PREVALENT SELF-FULFILLING PROPHECY AND THE RESEARCH NEEDED, WE SORT OF CAN'T DO IT SO WE MENTION IRB OR HIPAA PROBLEMS AND THEN WE RETREAT FROM EXPERIMENTATIONS BEFORE WE FRY AND IN ANSWER THAT THAT WHAT ARE PLACES TO G? THREE THINGS COME TO MIND AS CONCRETE EXPERIMENTAL OR INTERVENTION RESEARCH TOPICS, ONE WOULD BE NEW INCIDENTS OF INTIMATE PARTNER VIOLENCE THAT BEGINS IN OLDER AGE, ANOTHER ONE WOULD BE PREVENTION OF ABUSIVE BEHAVIOR IN ALZHEIMER'S CARE GIVING SITUATIONS AND A THIRD WOULD BE, YOU KNOW PROGRAMS THAT DEAL WITH THIS HIGHLY PREVALENT MUTUAL DEPENDENCY BETWEEN DEVIANT AND DEPENDENT CHILDREN AND PROTECTIVE PARENTS AND WHAT CAN BE DONE TO BREAK DOWN THOSE LONG STANDING AND DYSFUNCTIONAL BINDS. BUT THE MAIN POINT IS I THINK YOU INSPIRE US TO YOU KNOW USE OUR BRAINS TO THINK ABOUT WHERE THESE LIKELY INTERVENTION POINTS MAY BE BECAUSE I THINK THAT'S A GREAT POINT. >> WE HAVE 15 MINUTES LEFT FOR THE SOLUTION SECTION O I URGE YOU TO KEEP YOUR COMMENDS BRIEF. M, WE WILL GO TO YOU AND THEN KERLY YOU HAD SOMETHING? , I WANT TO HEAR FROM KERRY FULLMER ON SOLUTIONS, TOO SO I'M GIVING YOU FAIR WARNING AND THEN I THINK RON AND THEN YOU AND THEN YOU AND THEN--SO, MAKE IT SNAPY. >> I WANT TO COMMENT, I THINK DR. HAMBY'S POINTS ARE EXCELLENT AROUND THE SUBTLYS OF VICTIMIZATION. I'LL PUT THE WHOLE DOCTOR HAT ON AGAIN, A LOT OF THIS FUNDED BY NIH, MOVED TOWARD PATIENT SPECIFIC OUTCOMES AND CARES AND DIFFERENT PEOPLE DESIGN DIFFERENT UTILITIES AND STRESS TO SYMPTOMS AND YOU'RE DESCRIBING THE SORT OF ELDER ABUSE OR DB COUNTERPART OF THAT, I SHOULDN'T JUDGE ALL OUTCOMES OR EVENTS OR EPISODES OR IMPACTING VICTIMS, THE SAME. I THINK THIS IS THE PROBLEM WITH SILOING THE CLINICIANS FROM THE THEORORRISTS, ANOTHER E SENTIAL ARGUMENT BY THE WAY. I'LL STOP NOW WITH THAT AND THEN, I WILL SAY THAT DAVID BURNS, FINAL DAVID HAS JUST DONE AMAZING ANALYSIS LOOKING AT SIMILARITIES IN ELDER ABUSE, NOT LOOKING AT THIS AS AN ON-OFF PHENOMENA BUT HOW THEY RATE THE ABUSE AT THE SELF-REPORTED, IT'S GROUND BREAKING, FOR ME IT'S TAKEN ALMOST 30 YEARS FOR SO DO THAT. IT'S INCREDIBLE I WOULD LIKE TO RESPECTFULLY DISAGREE WITH MY COLLEAGUE KARL, I DON'T BEING WE NEED ANY MORE PREVALENCE STUDIES ON HIGH FUNCTIONS PEOPLE WHO CAN CAN ANSWER ABOUT THEIR EXPERIENCES BUT IF SOMEONE WERE TO DEVELOP A METHODOLOGY TO ACCESS NEW TECHNIQUES OR METHODOLOGIES, I AND WE WERE TO FINALLY GET ON THE ICEBERG THAT SONNIA SHOWED THAT WOULD BE REALLY USEFUL. SO I JUST WOULDN'T BE DRACONIAN ABOUT THAT. THAT'S MY COMMENT. >> AGREED. >> THANK YOU FOR TALKING ABOUT THE SILOS, APPROACHING THIS AS A CIAN BEFORE AS AN EPIDEMIOLOGICAL RESEARCHER, I DIDN'T UNDERSTAND WHY WE WOULD EXCLUDE FOR EXAMPLE, OLDER ADULTS AND STUDY ELDER MISTREATMENT BECAUSE IT'S A RISK FACTOR FOR INTERPERSONAL VIOLENCE WITHIN THE FAMILY. AND NOT LOOKING AT THAT WILL MISINFORM THE INTERVENTIONS THAT YOU TRY TO DEVELOP. SO--BUT AT THE SAME TIME IT'S IMPORTANT TO LOOK AT SUBTYPES AND POLYVICTIMMIZATION IS THE KEY AND WE LOOK AT YOUNGER ADULTS AND OTHER SURVEYS WE'VE DONE AND IT'S THE SAME WITH OLDER ADULTS, THE PROBLEM WITH NOT DOING ANY MORE PREVALENCE STUDIES AND I DON'T THINK WE SHOULD DO PREVALENCE STUDIES BUT WITHOUT DOING THE STOWEDS YOU CAN'T LOOK AT OUTCOMES AND OTHER TAB XINQI, WE HAVEN'T LOOKED AT EPIDEMIOLOGICAL LEVEL OUTCOMES. SO WE ASSUME POLYVICTIMMIZATION IS WORSE, WE DON'T KNOW THAT: WHAT WE DO KNOW, JUST A LITTLE--TO PUT A DIFFERENT SPICE ON WHAT CARL WAS SAYING, THE REPORTED ABUSE TYPE THAT LEADS TO THE MOST DISTRESS IS PSYCHOLOGICAL ABUSE, NOT PHYSICAL ABUSE, SO WE DON'T WANT TO THROW THE BABY OUT WITH THE BATH WATER, IT IS OVERASSESSED IN SOME THINGS BUT THE WAY TO ADDRESS THAT IS TO BREAK OUT THE ELEMENTS, THE DATA ELEMENTS SO THAT YOU WILL KNOW WE WILL INCLUDE THIS OR NOT INCLUDE THAT. BUT IN SO FAR AS--AND TO END THIS LITTLE SIR CUTEUE ISOTOPE THING, IS IMPORTANT, AS XINQI, SAID, THE SUBTYPES OF ABUSE, LOOKING AT ABUSE OUTCOMES AND PROTECTIVE FACTORS ARE IMPORTANT. DON'T LOOK AT IT AS A UNIFORM CONCEPT SO NOW WE HAVE COGNITIVE STATUS AS SORT OF A MODIFIER AND WE HAVE VICTIMIZATION WITH A MODIFIER, AND WE HAVE POLYTRAUMA AS A MODIFIER, AND WE HAVE CONTEXT AS A MODIFIER, MEANING IS IT THE CHILDHOOD, THE NURSING HOME, THE FAMILY AUTOPSY SERIES AND ALL OF THIS STILL HAS ABSOLUTELY NO REAL VELVANCE ON WHAT CLINE IPGZS DO BECAUSE WE DON'T KNOW WHAT THE OUTCOMES AREMENT ONE PROTECTIVE THING WE DO KNOW THAT SOMEBODY ALLUDED TO OR TWO OF ALLUDED TO IS THE TENTIAL BENEFIT OF SOCIAL SUPPORT AND CONNECTION SO WE DO AT LEAST HAVE A CLUE AS TO WHERE TO GO BUT I DO WANT TO CAUTION THAT WE AND I REALLY WANT TO UNDERSCORE DR. HAMBY SAID, LOOKING AT ONLY CARE TAKER VIOLENCE AS OPPOSE TO DOMESTIC ADULTS AND VIOLENCE, LIMITS US TO AN ALTERNATE REALITY. >> I'M LINDA KINCADE WITH THE COALITION--LINDA KINCADE FOR COALITION OF INDEPENDENT AND ELDER ADULT RIGHTS, I SHARE CONCERNS ABOUT THE FOCUS ON VIOLENCE I HEARD THIS MORNING AND I AM VERY CONCERNED ABOUT THE FOCUS ON FAMILY AS ABUSERS. WE REVIEWED THE CASES FOR NCAA NEWS FEED FROM 2012-14, AND LESS THAN A QUARTER OF THE ABUSE OF CASES WERE PERPETRATED BY FAMILY AND SMALL FRACTION INVOLVE VIOLENCE SO THERE ARE A NUMBER OF LARGE ELEPHANTS IN THE ROOM BEING MISSED AND I WOULD STRONG LEER URGE THAT RESEARCHERS AND POLICY MAKERS LOOK BEYOND FAMILY AS THEY CRAFT RESEARCH AND INTERVENTIONS. >> AND I GET TO FOLLOW THAT, RIGHT? >> I'M BILL FROM THE NIHSOBSR OFFICE AND I THERE IS A TECHNOLOGY THAT ACTUALLY IS IN THE ROOM THAT REALLY HASN'T BEEN MENTIONED THAT I THINK WE CAN HARNESS TO ANSWER MANY OF THE QUESTIONS TO MEASURE ALL SORTS OF--ALL PARTS OF THE ICEBERG, ET CETERA AND THAT IS WIRELESS TECHNOLOGY. EVEN SENIORS HAVE CELL PHONES WHETHER THEY'RE SMART PHONES OR WHETHER THEY ARE JITTER BUGS, AND MORE OVER THERE ARE ALL KINDS OF NEW AS WELL AS RETROFITTED SENSORS TO INSTALL IN HOMES TO MEASURE ALL KINDS OF BOTH BIOMEASURES AS WELL AS CERTAIN BEHAVIORIORS AND SO, AS--WHETHER ELDERS ARE LIVING WITH LOVED ONES AND THERE ARE FOUR SENSORS IN THE HOME, WHETHER THERE IS ECOLOGICAL MOMENTARY ASSESSMENTS TO USE THROUGH TEXT MESSAGING FROM MANAGED CARE, ET CETERA, THERE ARE ALL KINDS OF WAYS TO MONITOR HEALTH, WELL BEING AND BEHAVIOR CHALLENGES THAT MAY REFLECT A FALL VERSUS A BATTERY, RIGHT? ALSO THEY COULD EMPOWER FAMILY BECAUSE IF THEY KNOW--THERE WAS AN EXAMPLE EARLIER, I DON'T REMEMBER WHO'S ABOUT A FAMILY PERHAPS BEING AFRAID TO TAKE A LOVED ONE TO A HOSPITAL BECAUSE THEY FEAR THAT THE FALL WOULD BE REPORTED AS ABUSE. THE SENSORS IN A HOME WOULD PICK UP THAT SOMEONE IS NOT WALKING AS REGULARLY OR WOULD PICK UP THE GLUMPh, IN THE BATHROOM TRYING TO GET IN OR OUT OF THE TUB. SO MOBILE TECHNOLOGIES, WIRELESS TECHNOLOGIES PROVIDE THE MEANS FOR EPI-BLASTY, INTERVENTIONS, PREVENTIONS,A A WHOLE RANGE TO EMPOWER RESEARCH TO RESOLVE THIS AND SO MANY OTHER HEALTH ISSUES. I HOPE WE'VE PLUG THAD IN DURING THE BREAKS AND IN THE NEXT STEPS. >> CONGRATULATIONS TO THE PANEL FOR WRESTLING WITH THINGS THAT ARE SO MESSY AND HAVING THE CONSIDERATION OUTLOUD HELPS US BRING ABOUT DIFFERENT SOURCES OF KNOWLEDGE TO BRING TOGETHER AND TO JOHN'S POINT I RECALL SUBMITS INTERVENTION GRANT TO NIH ON ELDER MISTREATMENT BEFORE THERE WERE THESE TECHNOLOGIES AND THE NOTION IS THAT IF I WERE TO ADVERTISE OR GET PEOPLA TO PARTICIPATE THAT I WOULD PUT THEM AT GREAT IRB RISK FOR HARM AND THAT'S THE ROLE TO PEOPLE AND WHAT THE ISSUES ARE TO IRBs, HAVING SAID THAT THE DRUM BEAT FOR A CENTER THAT COULD ENHANCE THE CORE MEASURES THAT I USE AND I SAID BEFORE, MY RECENT EXPERIENCE AT NORTHEASTERN WITH NRMINGS WHO ARE USING THESE SMART TECHNOLOGY SYSTEM VERY EXCITING AND OPENS A NEW CHAPTER FOR US. BUT THE COMPLEXITY DESCRIBED HERE REALLY DOES URPD SCORE THE WAY WE WILL NEED THESE SCORE CENTERS TO DO AND I WILL SAY IT AGAIN, THE DATA HARMONTIONS TO WORK TOGETHER, SO THANKS FOR THE OPPORTUNITY TO COMMENT. >> THANK YOU SO MUCH JASON? >> I WANT TO PICK UP ON A THEME THAT'S RUNNING THROUGH WHICH IS A CREATION OF CENTERS AND THE IT'S A STEP AND SCIENCE THAT REPRESENTS AN EFFORT TO CONSOLIDATE PARTICULARLY AROUND MEASUREMENT AND IN LIGHT OF THE COMMENTS OVER THE COURSE OF THIS MORNING, I WOULD THINK THAT ONE OF THE CHALLENGES OF CREATING A CENTER WOULD BE TO AGROW ON WHAT TO MEASURE AND HOW TO MEASURE IT. SO I WOULD ANTICIPATE THE FIRST THING ONE WOULD HAVE TO ADDRESS IN THE CREATION OF EITHER A SINGLE OR MULTIPLE CENTERS. A MEASUREMENTARRA DIME AND IN THINKING ABOUT A ISSUE THAT WAS TALKED ABOUT OVER THE COURSE OF THE MORRING ABOUT MEASUREMENT, I'M REMINDED OF THE HISTORY OF CHILD ABUSE THAT IN ITS EARLIEST HISTORY IT WAS CREATED, THE CONCEPT BY THE RADIO GRAPH AND BONES IN A PARTICULAR AGE GROUP AND THAT DEFINED CHILD ABUSE AND IT UNDERSTOOD THERE WAS CHILD ABUSE AS WELL BUT THAT MADE IT VERY MEASURABLE, QUANTITATIVE PRECISE AND FRANKLY DEALABLE, SO YOU HAD A WHOLE HOST OF MEASUREMENT, SOCIAL AND ECONOMIC FACTORS ALINING AND THE REST IS HISTORY FOR CHILD ABUSE IN SOME SENSE SO I APPROXIMATE UTR THAT OUT AS WE CREATE THE CONSTRUCTS OF THESE VARIOUS KINDS OF ABUSE AND I SAY CREATE, RECOGNIZING THAT SOUNDS A BIT RUDE BUT THEY ARE TO A DEGREE THINGS WE DECIDE BASED ON WHAT WE'RE MEASURING IT FOR. SO I JUDGIST PUT THAT OUT THERE, I THINK DEPENDING ON WHY YOU THINK YOU'RE STUDYING IT, YOU WILL COME UP MEASURING THE SAME THING IN DIFFERENT WAYS EVEN THOUGH WE'RE PERHAPS TALKING ABOUT THE SAME THING, MEASURING THE SAME WAY BUT YOU ACTUALLY THINK YOU'RE DOING SOMETHING DIFFERENT THAN THE OTHER PERSON AND I OFFER THAT AS AN OBSERVATION OVER THE COURSE OF WHAT I HEARD THIS MORNING. >> LIZ? >> YEAH, A COUPLE TIMES PEOPLE SAID THE STRONGEST DISCONNECT ABOUT WHAT WE'RE TALKING ABOUT AD WHAT THE CLINICIAN HAS TO DO AND IS I THINK IF WE FULLY EMBRACE THIS RESILIENCE MODEL OR STRENGTH MODEL, I THINK WE HAVE TO REALIZE THAT IT'S NOT JUST GOING TO BE CLINICIANS WHO WILL DO SOMETHING AND IF YOU PUT THE PREVENTION AGENDA ON THE TABLE, ON PARWITH WHAT THE CLINICIANS HAVE TO DO IN THE TREATMENT AGENDA THEN MAYBE THE INTERVENTION POINTS ARE FAR, FAR EARLIER BEFORE ANYBODY WALKS INTO A CLINIC SO I JUST DON'T WANT TO LOSE THAT NOTION AND THREAT THAT I THOUGHT WAS NICELY INTRODUCED BY SHERRY'S HAMBY'S COMMENTS AND THE DISCUSSION WITH THIS PANEL. >> TO BUILD ON THAT, BUT TO CONFUSE AS WELL, THE OTHER ANIMAL IN THE ROOM WHO IS YET TO BE SPES SPECIFIED FOR SPECIES OR WEIGHT, IS THAT THE FOLKS ON THIS CAMPUS ALSO HAVE TO COMMUNICATE TO POLICY MAKERS AND THEY HAVE A VERY RADICALLY DIFFERENT VIEW OF REALITY. CHILD MALTREATMENT MAKES SENSE TO A POLICY MAKER, WILD PREVENTION MAKES SENSE TO POLICY MAKER AND BUT WHEN YOU SLICE IS DICE IT IT'S DIFFICULT TO GET COHERENT POLICY MAKING FROM THEM, AND ALSO THE VIOLENCE AGAINST WOMEN ACT SPOKE TO A FORM OF INTIMATE PARTNER VIOLENCE AND THEN THE REAUTHORIZATION WAS HELD UP FOR MONTHS BECAUSE OF THE INTRODUCTION OF DISCUSSIONS ABOUT MALE VICTIMS OF BI-DIRECTIONALITY SO TO GO CIRCULAR AGAIN YOU NEED DIFFERENT LANGUAGE AND DEFINITE TERMS DEPENDING ON WHO YOU ARE WITH THE ANSWERS. >> AGREE TOTALLY I'LL GIVE YOU THE LAST. >> OKAY, TWO VERY QUICK. >> IT'LL BE QUICK, I WAS STRUCK BY THE CONVERSATION ABOUT SENSORS, WE'RE TALKING ABOUT SENSORS IN PEOPLE'S BATHROOMS, THEIR LIVING ROOMS, KITCHENS, THERE'S A LOT OF PRIVACY ISSUES I JUST HAD TO RAISE THE PRIVACY CONCERNED. >> I'M WITH THE FEDERAL PUBLIC POLICIALITION AND IT'S HARD TO GET POLICY MAKERS TO WRAP IT AROUND THIS IN AN EFFECTIVE WAY IF ANYONE WOULD LIKE TO TALK ABOUT HOW TO GET THAT DONE WE CAN USE YOUR EXPERTISE AND YOU CAN USE OURS, LET'S FIND A TIME TO TALK. >> THANK YOU, I THINK THAT'S A GREAT WAY TO SORT OF BRING THINGS HOME AND TALK ABOUT BI-DIRECTIONALITY BETWEEN THE SCIENTIFIC COMMUNITY AND THE POLICY COMMUNITY AND THEN THOSE OF YOU WHO ARE ACTUALLY DOING THE WORK ON THE FRONT LINES, I THINK YOU KNOW IT'S A CONVERSATION WE'VE BEGUN AND NEED TO CONTINUE AND AS A VETERAN OF THE LEGISLATIVE WARS I COULDN'T AGREE MORE. THANK YOU VERY MUCH TO THE PANELS, TOES THOSE WHO BEAMED IN AND THOSE IN THE ROOM. [ APPLAUSE ] >> OKAY, SO, IT IS TIME TO BREAK FOR LUNCH AND TO GO TO THE BREAK OUT SESSIONS. THE BREAK OUT SESSION ROOMS ARE UP ON THE SCREEN AND CAN--SHOW OF HANDS BREAK OUT SESSION ONE NIH-ONE? >> TWO NIH STAFF? LOIS? >> THREE, NIH STAFF? LIS AND JOVIER, AND NUMBER FOUR NIH STAFF ARE BILL AND AMY. SO THEY HELP DIRECT YOU. SO LUNCHES PICK THEM UP OUTSIDE AND THAT YOUR FACILITATORS WILL EXPLAIN THE STRUCTURE OF THE BREAK OUTS AND WE WILL SEE YOU BACK AT WE'RE GOING TO GET TRYING TO GET SOME GROUND RULES STARTED FOR US FOR THE AFTERNOON SESSION SO WE'RE ALL ON THE SAME PAGE ABOUT HOW THIS BREAK-OUT REPORTING WILL GO. WE'RE GOING TO GET THE SLIDES UP THERE. , WILL HELP US KIND OF MAKE SURE ALL OF THE TEAMS GET A CHANCE TO INTEGRATE AND THAT ANY COMMENTS FROM THE AUDIENCE ARE ATTENDED TO AND ADDRESSED. EACH GROUP WILL HAVE 13 MINUTES OF THE HOUR TO PRESENT THEIR FINDINGS AND HAVE A DISCUSSION, SO WEAL GIVE EACH GROUP FIVE MINUTES TO RUN THROUGH THE SLIDES THAT HAVE BEEN PREPARED AND THEN EIGHT MINUTES TO ENGAGE IN FURTHER DISCUSSION, ELABORATION, ANSWER QUESTIONS. AND OUR -- WILL BE KEEPING YOU INFORMED WHERE YOU ARE SO JUST A MOMENT WE'LL HAVE THE SIDES UP AND WE'LL START WITH -- WE'LL GO IN ORDER FOR THE DIFFERENT GROUPS. WHEN YOUR GROUP IS CALLED TO WHENEVER IS GOING TO BE DOING THE REPORTING SHOULD JUST HEAD UP TO THE PODIUM. >> WE'RE GOING TO START WITH GROUP 1. [APPLAUSE] I THOUGHT ABOUT IT FOR THE ENTIRE BREAK OUT AND THAT'S WHAT I THOUGHT WE WOULD DO O. I VIEW MY JOB MAINLY AS STAYING OUT OF THE WAY SO LORI WE'RE STARTING WITH YOU FOR GROUP ONE. >> THANK YOU, LORI, THAT WAS FABULOUS. [APPLAUSE] >> I WANTED TO SAVE TO IT THE DESKTOP SO WE HAVE IT. MY UNDERSTANDING IS I GO TO THE LAST THREE SLIDES, RIGHT? FEEL FREE TO CONTEXTUALIZE IT BRIEFLY, BUT YOU HAVE FIVE MINUTES TO SAY YOUR KEY FINDINGS. >> OKAY. SO OUR GROUP TALKED ABOUT HEALTH DISPARITIES AND CULTURAL UNDERSTANDINGS OF THIS TREATMENT. SO BASICALLY THE LONG AND SHORT, HERE YOU SEE A SLIDE WHAT IS NOW THE ANSWER IS VERY, VERY -- AND THERE'S LOTS OF HEALTH DISPARITIES GROUPS UNDER-REPRESENTED GROUPS IN THIS RESEARCH. SO ESSENTIALLY WHAT ARE THE GREATEST SCIENTIFIC STRUCTURAL BARRIERS TO DEVELOPING AN EVIDENCE BATES AROUND THIS LINE OF RESEARCH? FUNDING, SORRY BUT FUNDING, YEAH. WE HAVE LOTS OF PROBLEMS WITH THAT. IN THIS AREA IN PARTICULAR AS WELL AS OTHER AREAS OF ELDER MISTREATMENT RESEARCH. WE ALSO HAVE SOME DEFINITIONAL ISSUES HERE, WE HAVE SOME ISSUES IN TERMS OF FINDING A DEFINITION THAT WILL WORK ACROSS DIFFERENT UNDER-REPRESENTED GROUPS BUT ALSO IN TERMS OF A DEFINITION THAT WILL WORK WITHIN SOMETHING THAT WORKS WITH THE GENERAL POPULATION BUT WILL ALSO WORK WITH RURAL POPULATIONS, DIFFERENT ETHNIC MINORITIES POPULATIONS ANT OTHER GROUPS CONSIDERED TO BE UNDER-REPRESENTED GROUPS AS WELL. SAME THING WITH MEASUREMENT, WE HAVE MAJOR PROBLEMS HERE. THERE ARE NO MEASURES THAT WORK ACROSS CULTURAL GROUPS SO THAT IS A REAL PROBLEM, TALK ABOUT PREVALENCE STUDIES. PREVALENCE STUDIES ARE NOT SOMETHING THAT ARE DONE WITH WHEN IT COMES TO UNDER-REPRESENTED GROUPS BECAUSE WE DON'T KNOW WHAT THE PREVALENCE IS FOR ANY OF THESE GROUPS. BUT WHAT MEASURING DO WE USE? THERE ARE NONE THAT HAVE BEEN PROVEN TO WORK FOR REALLY ANY OF THESE GROUPS OR ALL OF THESE GROUPS TOGETHER. AGAIN WHEN TALKING RESEARCH HOW DO WE RECRUIT THE GROUP? THAT IS ANOTHER ISSUE THAT WAITS TO BE RESOLVED. AND THEN WE ALSO HAVE THE INSTITUTIONAL REVIEW BOARD PROBLEMS THAT PLAGUE MOST HE WILL KER ABUSE RESEARCH AS WELL. AND WHEN YOU ADD ON FOR INSTANCE WANT TO GO WORK WITH WITH PROTECTED GROUP FOR INSTANCE MY RESEARCH INSTITUTION NATIVE AMERICANS ARE A PROTECT GROUND, WHEN I WANT TO DO ELDER MISTREATMENT AMONG NATIVE AMERICANS ALL THE RED FLAGS GO OFF. THERE ARE ISSUES ABOUT IMPOSING VALUES OF MAINSTREAM CULTURE ON OTHER GROUPS SO THAT'S SOMETHING THAT KIND OF COMES UP. WE DON'T WANT YOUR ENTERSECTIONS, IS ALWAYS A RISK THAT COULD BE THERE. WHAT KEY FINDINGS COULD BE BROADLY APPLIED FROM OTHER RESEARCH ON ELDER MISTREATMENT OR FROM OTHER FIELD? WE KIND OF STRUGGLED A BIT WITH THIS ONE, BUT ONE THING IS CLEAR IS A LOT OF COMMUNITIES ARE QUITE TIRED OF A DEFICIT-BASED PERSPECTIVE AND WANT TO MOVE TOWARD MORE A STRENGTH KIND OF MODEL. SO THAT RESILIENCE PERSPECTIVE IS QUITE APPEALING AS OUR OTHER MORE POSITIVE KINDS OF MODELS AND PERSPECTIVES. CBPR, USING MOLDS AS COLLABORATORS THAT CAN BE SUCCESSFUL IF DONE CORRECTLY. AND CULTURAL GROUPS WANT THEIR CORE VALUES TO BE ACKNOWLEDGED AND SERVICED VALUED AND THIS APPLIES TO RESEARCH SO YOU NEED TO KNOW THE COMMUNITIES YOU'RE WORKING WITH, NOT JUST TO DO THE DROP IN HELICOPTER RESEARCH THAT RESEARCHERS HAVE BEEN ACCUSED OF IN FAR TOO MANY SITUATIONS. A BIG ISSUE THAT CAME OUT IN OUR DISCUSSION, A LOT OF RESEARCH QUESTIONS IN UNDER-REPRESENTED GROUPS REALLY DO CALL FOR QUALITATIVE RESEARCH BECAUSE WE KNOW SO LITTLE. THERE ARE POPULATIONS THAT BASICALLY HAVEN'T HAD ANY ELDER MISTREATMENT RESEARCH DONE WITH THEM. SO TO JUST POP IN THERE AND SAY I'M GOING TO DO A BIG SURVEY, IT'S JUST NOT GOING TO WORK. WE'RE REALLY NOT ANYWHERE NEAR BEING READY TO DO THAT. YES NEED QUALITATIVE RESEARCH, WE NEED TO EXPLORE THOSE QUESTIONS IN AND IN DEPTH MANNER AND ASK PEOPLE ABOUT THEIR PERSPECTIVES ABOUT THEIR CONCEPTS, ABOUT WHAT'S GOING ON WITH THEM AND REALLY KIND OF BASIC FUNDAMENTAL WAY, WE NEED QUALITATIVE RESEARCH BUT THAT IS AN ISSUE BECAUSE A LOT OF TIMES IF YOU GO TO A FUNDING AGENCY WITH QUALITATIVE PROJECT IT'S NOT GOING TO BE MET WITH A LOT OF POSITIVITY. SO WE DO NEED AGAIN REVIEWERS WHO VALUE QUALITATIVE RESEARCH. THEY NOT ALWAYS ON A PANEL. LONGITUDINAL STUDIES ARE SOMETHING THAT ARE REALLY DESIRABLE FOR UNDER-REPRESENTED POPULATIONS. AND FRANKLY VERY SHORT SUPPLY. MEASURES THAT WORK ACROSS CULTURES, THAT'S KIND OF A HOERY GRAIL AND NOT SO EASILY DONE. OR CREATED BUT THAT IS A LINE OF RESEARCH WE CAN BE WORKING ON. MEASURES THAT WORK WITHIN A SINGLE CULTURE WOULD BE USEFUL IF YOU CAN COME WITH SOMETHING THAT WORKS ACROSS CULTURES THAT'S HIGHLY VALUABLE. AND ACROSS UNDER-REPRESENTED GROUPS, IT DOESN'T NECESSARILY HAVE TO BE A CULTURE GROUP, RURAL POPULATIONS IN SES ARE ALSO CONSIDERED HEALTH DISPARITY POPULATIONS, FOR INSTANCE. ALSO ANOTHER JUST IMPORTANT POINT TO KEEP IN MIND, MANY GROUPS HAD NO RESEARCH OR HARDLY ANY RESEARCH SO WE'RE OFTEN TALKING VERY FOUNDATIONAL KINDS OF RESEARCH. AGAIN, THAT KIND OF RELATES TO THE RECOMMENDATION THAT WE NEED CALL FAYTIVE RESEARCH IN MANY CASES. SO WE'RE IN THE TALKING ABOUT LARGE SCALE HIGHLY SOPHISTICATED QUALITATIVE RESEARCH NOT SAYING IT ISN'T SOPHISTICATED BECAUSE I DO IT BUT WE'RE OFTEN TALKING BASELINE INFORMATION WE NEED FOR THESE GROUPS. THAT'S THE STARTING POINT OFTEN. THANK YOU. [APPLAUSE] >> WE HAVE EIGHT MINUTES OF DISCUSSION. SEVEN. SORRY. MINUTES OF DISCUSSION WITH THIS PANEL. EITHER PANELISTS OFFER ADDITIONAL PERSPECTIVES OR QUESTIONS BY OTHERS? >> I THINK IT WOULD BE MORE USEFUL TO GO TO QUESTIONS FOR OTHERS. WE HAD A BROAD RANGING DISCUSSIONS, VERY TOUGH TOPIC IF WE THINK THE MORNING WAS TOUGH AND MIND BLOWING, THE CULTURAL DIVERSITY AND HEALTH DISPARITIES IS MORE DIFFICULT. SO WE TALKED ABOUT TAILORING METHODS TO CULTURES BE ALSO NEED FOR STANDARDIZED METHODS. WE TALKED MIXED METHODS AND CHALLENGES GETTING THIS KIND OF WORK FUNDED AND REVIEWERS UNDERSTANDING IT SO THAT'S ALL -- THAT'S ALL I WOULD ADD. WE HAD GOOD PEOPLE IN THE ROOM, SMALL GROUP, NOT SURPRISING, SAYS SOMETHING IN AND OF ITSELF. >> DID YOU HAVE PEOPLENAL YOUR GROUP REPRESENTING SOME OF THE OTHER FIELDS THAT WE HAVE HERE TODAY? AND IF SO, OR IF THERE ARE OTHER PEOPLE FROM THE OTHER FIELDS WHO WEREN'T IN THE ROOM DO YOU HAVE SOME EXPERIENCES TO SHARE? THAT COULD BE APPLICABLE IN TERMS OF DOING RESEARCH AND HEALTH DISPARITIES POPULATIONS? WE HAVE FOLKS IN CHILD TREATMENT, IT WAS DIFFICULT TO THINK ABOUT WE DEFINITELY HAD GREAT INSIGHTS FROM OTHER RESEARCHERS, IT WAS OFTEN HARD TO THINK OF HOW SOME OF THESE FINDINGS APPLIED, STARTING OUT IN A FOUNDATIONAL PLACE FOR SOME OF THE UNDER-REPRESENTED GROUPS. THAT WAS SOMETHING THAT I FOUND CHALLENGING. DISCUSSING THIS GROUP TODAY. >> I THINK WE COULD LEARN A LOT -- I DID NOT ATTEND THIS GROUP SO I DON'T KNOW WHAT WAS DISCUSSED BUT WE PROBABLY COULD LEARN FROM THE RESEARCH CENTERS FROM MINORITY AGING RESEARCH BECAUSE THEY HAD MEASUREMENT AND METHOD COURSE FOR 20 YEARS AND THEY HAVE REALLY ADVANCED THE FIELD OF MEASUREMENT AMONG OLDER GROUPS. SO THINK METHODOLOGIES THAT CAME OUT OF THAT EFFORT WOULD BE USEFUL FOR THIS EFFORT. >> THAT WAS NEXTED MENTIONED MENTIONED IN OUR GROUP. >> I WOULD SAY THAT CATHY WAS IN THE GROUP, THE REASON I -- YOUR WORK TALKING ABOUT EARLIER WORK ON THIS LIFE-CYCLE VIOLENCE AND HOW IT MAY WORK DIFFERENTLY FOR WHITES AND NON-WHITES, THINGS LIKE THAT ARE QUITE INTERESTING. Z BASED ON SOME OF THE FINDINGS THAT WE HAVE THAT SHOW OUTCOMES CHILDREN WHO HAVE HISTORY OF ABUSE AND NEGLECT DON'T APPEAR TO BE THE SAME. WE THINK CONSEQUENCES ARE ARE THE SAME FOR ALL CHILDREN WHO HAVE THESE EXPERIENCES BUT IN FACT THEY'RE NOT. WE HAVE OFFICIAL REPORTS FROM CPS, ARREST DATA AND SELF-REPORTS FROM THE CHILDREN WHO ARE NOW ADULTS. SOME SUGGESTED THE WAY THESE CHILDREN ARE BEING RESPONDED TO IN THE WORLD MAY DIFFER. SO THAT WAS MY MOTIVATION FOR JOINING THAT GROUP BECAUSE I THINK THAT WE JUST STARTED TO SCRATCH THE SURFACE IN THE FIELD OF CHILD ABUSE. I THINK THESE ARE HUGELY IMPORTANT A QUESTIONS. MANY MY SAMPLE WE HAVE AFRICAN AMERICANS HISPANICS, SMALL SAMPLE AND WHITES AND CLEARLY THAT'S SCRATCHING THE SURFACE, LOOKING AT THESE ISSUES. >> I WAS IN THAT GROUP AND I JUST -- WANT TO SAY TO LORI AND OTHER FACILITATORS GREAT JOB SUMMARIZING A VERY INDEED WIDE RANGING DISCUSSION THAT WE HAD IN THE GROUP. I THINK IN TERMS OF OTHER AREAS OF RESEARCH, THE MAIN ACHIEVEMENTS IN THE LAST 10 OR 15 YEARS HAVE BEEN SOME IMPORTANT WORK STARTING TO AGAIN DONE TO UNPACK THESE SOCIAL ADDRESS MARKERS AND TRY TO UNDERSTAND WHAT'S DRIVING RACIAL DIFFERENCES OR DIFFERENCES BY CULTURE OR ETHNICITY OR GENDER OR SEXUAL ORIENTATION AND PEOPLE ARE STARTING TO BUILD IN MORE DIRECT MEASURES OF WHAT WE THINK ARE THE DIFFERENCES BETWEEN THOSE GROUPS, MOVING BEYOND SES AND INTO THINGS LIKE MICROAGGRESSIONS AND DIFFERENTIAL ACCESS TO SERVICES AND ISSUES LIKE THAT. AND THEN IN TERMS OF WHAT YOU'RE ASKING -- I THINK THE DOMESTIC VIOLENCE MOVEMENT OUT OF OTHER SILOS OF VIOLENCE HAS DONE THE MOST IN TERMS OF MAKING A STRONG EFFORT TO CULTURALLY ADAPT SERVICES AND ON THE SERVICE END ATOM POINT IT DOESN'T MATTER WHICH HEALTH DISPARITIES LED TO THAT PERSON IN FRONT OF YOU ON THAT DAY AND TRYING TO DO THINGS WE TALKED ABOUT ISSUES MAKING SURE OUR SERVICE AGENCIES FEEL WELCOMING TO THE SEGMENTS OF A POPULATION THAT THEY ARE FOCUSING ON VALUES AN ISSUE THIS MORNING BOTH CPS AND ARCPS ARE NOT EVIDENCE BASED SERVICES SO WHEN YOU ENCOUNTER PEOPLE FROM OTHER CULTURAL GROUPS THAT HAVE VERY THAT WANT TO MAINTAIN THE FAMILY INTEGRITY AND OPPOSED TO DIVORCE, THE MAINSTREAM INTERVENTION MIGHT BE TO REMEMBER THAT THEIR VALUE IS JUST AS VALID AS OURS BECAUSE MANY OF OUR VALUES OF OUR CURRENT MAINSTREAM INTERVENTION ARE NOT EMPIRICALLY BASED. AGAIN, IF YOU WANT TO LOOK TO PLACES, I WOULD DEFINITELY RECOMMEND THE WORK OF SOME OF THE FIFSA GRANTEES. DAMIAN WAS IN OUR GROUP THERE, LIKE THE NATIONAL INDIGENOUS WOMEN'S RESOURCE CENTER AND NATIONAL LATINO NETWORK, HAVE DONE FANTASTIC WORK IN THOSE AREAS. >> >> MY APOLOGIES IF YOU COVERED AND I DIP HEAR IT OR MISSED IT. IN YOUR WORK GROUP DISCUSSIONS DID YOU COVER ALL THE UNDERREPRESENTATION OR UNDER-REPRESENTED GROUP OF IDD ELDER ADULT? INTELLECTUAL DEVELOPMENTAL DISABILITIES WITH OR WITHOUT COGNITIVE IMPAIRMENT? IF YOU DIDN'T YOU MIGHT WANT TO. IT'S AN IMPORTANT SUB-POPULATION AND IN THE BREAK-OUT I WAS IN JASON REFERENCED NATIONAL ALZHEIMER MER'S PLAN, THAT IS A SPECIAL POPULATION THERE, ELDERLY ISSUES NEGLECT AND OTHER ISSUES AMONG THE IDD POPULATION. THANKS. >> LINDA KINCAID WITH OLDER INDEPENDENT ADULT RIGHTS. I APPRECIATE THE CULTURAL DIFFERENCES AND HOW THAT CAN ACT ON AN EVALUATION SITUATION WHETHER ABUSIVE OR NOT, ONE PRIMARY ISSUE IS ABUSE OF GUARDIANSHIP AND CONSERVATIVESHIP. SO I GET CONTACTED FROM FAMILIES WHO FEEL THEIR PARENTS WERE WRONGFULLY TAKEN AWAY FROM THEM FREQUENTLY ISOLATED FROM THEM BECAUSE OF ALLEGATIONS OF ABUSE. WHEN I TRY TO TEASE BACK TO FIND OUT HOW THIS CAME ABOUT I WAS STUNNED LOOKING BACK OVER TWO YEARS, HALF THE CASES ARE FIRST GENERATION IMMIGRANT. I THINK THERE WAS A CULTURAL ACCEPTANCE OF CHILDREN LIVING WITH PARENTS INTO ADULTHOOD HAVING CO-MINGLED FINANCES THAT FROM OUR CULTURE PERSPECTIVE MIGHT SEEM INAPPROPRIATE BUT WHERE THEY CAME FROM, THIS WAS JUST THE NORM. THIS WAS THE WAY IT WAS OFTEN DONE. ESPECIALLY WITH UNMARRIED CHILDREN WHO STAYED WITH THEIR PARENTS UNTIL THEY WENT OFF AND STARTED THEIR OWN FAMILY AND OWN HOMES. I HAVE NO NUMBERS TO GIVE YOU IT JUST STRUCK ME THIS WAS A REAL WAKEUP MOMENT FOR ME TO REALIZE HALF THE CASES THAT CAME TO ME WHICH SOUNDED INCREDIBLY ABUSIVE, ABUSE BY GUARDIANS NOT FAMILY, THESE WERE CASES OF FIRST GENERATION IMMIGRANTS, SOME REPORTED TO APS SOME DAUGHTER IS LIVING WITH MOM, SOME DAUGHTER HAS FINANCES CO-MINGLED WITH MOM OR DAD IN SOME CASES. APS SWOOPS MANY, NEXT THICK YOU KNOW PARENTS UNDER GUARDIANSHIP AND ISOLATED FROM FAMILY. JUST THE STORIES I'M HEARING TOO MANY TIMES WITH TOO MANY SIMILARITIES. I THINK THERE'S CLOSER EXAMINATION ON PERHAPS MISUNDERSTANDING DIFFERENT CULTURAL VALUES. >> THANK YOU VERY MUCH. >> I THINK WE'LL CALL UP THE NEXT PANEL. SO LORI (OFF MIC) >> TAKE THIS DOWN BECAUSE IT MAKES PEOPLE CALL ME LORI. THE NEXT ONE. >> WE CAN SKIP TO GROUP 3. >> I THINK WE FOUND THEM. >> JUST TRYING TO MAXIMIZE THE TIME HERE. THE GOAL OF THE BREAK OUT SESSION WAS TO DISCUSS FAMILY AND SOCIAL RISK FACTORS THAT MAY LEAD TO ELDER ABUSE. OUR GROUP WAS BIG AND IT WAS TWO POUNDS OF SEES CANDY IN A ONE POUND BOX SO WE COVERED RISK FACTORS, WE DIDN'T GET TO PROTECTIVE FACTORS. THEN WE FOCUSED ON THE THREE SLIDES WE'RE GOING TO GO THROUGH SO IF YOU WANT TO GO BACK AND FORT AND DO THE FIRST ONE. >> SIMILAR TO OTHER GROUPS WE HAVE THE NO OPERATIONAL VISION OF ELDER ABUSE AND ITS FORMS AS RELATES TO FAMILY. ALSO VICTIMS AN PERPETRATORS ARE HIDDEN AND MEASUREMENT IS DIFFICULT FOR FAMILY PRIVACY, PERCEPTIONS AND NORMS. ALSO THE FIELD IS MISSING ANSWERS TO SOME OF THE MECHANISMS GOING ON FOR PERPETRATION. AND AGAIN, A LACK OF TYPOLOGY, AND SOMETHING TO ADEQUATELY TEST THOSE THINGS. ALSO IT SEEMS THAT IT HASN'T MOVED FROM ISSUE TO PROBLEM BECAUSE OF ELDER ABUSE BEING STILL KIND OF FUZZY COMPARED TO OTHER THINGS. WE HIT ON THAT ON ANOTHER ONE. THE NEXT SLIDE THE FIRST ONE SAYS RESOURCES FROM A FOCUSING EVENT WHERE WE PERCEIVE THAT IPV HAS VALA AND APPROXIMATE NICOLE BROWN SIMPSON CASE, THINGS LIKE THAT AND CAPTA FOR CHILD ABUSE. IT WOULD BE HELPFUL TO HAVE SOME SORT OF PUBLIC AND POLITICAL SUPPORT ALONG WITH COOPERATION OF ADVOCATES, COOPERATE WITH ADVOCATE AND THAT WOULD BE THE IDEAL WAY OF DOING IT. >> SO THIS WAS REALLY ABOUT WHAT WE CAN LEARN FROM CHILD ABUSE EXPERTS AND IPV EXPERTS. WE'RE LUCKY TO HAVE A RICH EXPERIENCE, THAT FIRST ONE AS WE TOUCHED ON ABOUT A FOCUSING EVENT. THE SECOND ONE IS WHAT WE LEARNED FROM THE IPV EXPERT, IT MATTERED WHAT HAPPENED AT THE SCENE AND THE LITERATURE ON THAT IS HELPFUL IN MOVING THEIR FIELD FORWARD. THIRD IS WITH CHILD MALTREATMENT, THE PREVENTION AND EVIDENCE BASED STUDIES ON THE INTERVENTIONS AND THEIR EFFECTIVENESS HAS BEEN REALLY HELPFUL IN IN FACT PREVENTING CHILD MALTREATMENT. >> AND INTERVENTIONS SHOULD LAST PROBABLY SIX MONTHS OR MORE IS WHAT WE HEARD FROM ELIZABETH. >> NEXT SLIDE. FROM AS FAR AS PERPETRATORS GO, MAYBE THERE REALLY AREN'T HAVE MANY INTERVENTIONS OR PREVENTIONS AND THEN ONCE YOU'RE IN THE SYSTEM THERE'S NOT A LOT THAT CAN HELP A PERSON IMPROVE OR GET OUT. ALSO, THERE'S ANOTHER THOUGHT THERE IS THE IDEA THAT THE HELP TENDS TO BE IN THE UNITED STATES, AT LEAST A FORCED ESTRANGEMENT POLICY. SO THE PERSON EARN WOULD BE ESTRANGED FROM THE -- PERSON WOULD BE estranged from the person maybe they were attached to or family relationships especially in family, it's difficult to do that force estrangement. TOMORROW I'M HEADED TO NETHERLANDS TO GO TO A SHELTER CONFERENCE WHERE WHERE THERE THEY BRING FAMILIES TOGETHER AND THEY DEAL WITH THINGS THAT WAY RATHER THAN THE FORCED ESTRANGEMENT MODEL. PEOPLE WILL HAVE LUNCH WITH THEIR FAMILIES AND ATTEMPT TO -- IT MIGHT EVEN MEAN THAT THE FAMILY EVENTUALLY DECIDES TO BREAK UP BUT AT LEAST THEY WOULD HAVE THAT CLOSURE THAT ARE PROBABLY THEN THE FORCED ESTRANGEMENT TYPE MODEL FOR PERPETRATORS. WE ALSO OF COURSE PUT FUNDING DOWN AS MOST IMPORTANT RESEARCH RECOMMENDATIONS AND WE WANT TO MENTION CENTERS. IT WOULD BE IMPORTANT SO WE ALSO WANT TO KNOW WHAT SOURCES OF INTERVENTIONS ACTUALLY WORK. I THINK THERE IS SOME EVIDENCE MAYBE FOR HAWAII HEALTHY START TYPE INTERVENTIONS AND MAYBE THAT COULD BE APPLIED TO ELDER ABUSE. ALSO YOU WOULD HAVE TO INCLUDE A COST ANALYSIS OF THOSE TYPES OF THINGS. WHAT IS THE COST OF KNOW ACTION? THAT IS SOMETHING THAT SOMETIMES IS NOT INCLUDED IN COST ANALYSIS. THE COST OF NO ACTION CAN BE VERY, VERY EXPENSIVE. ALSO LOOKING AT VICTIMIZATION SUBTYPES AND POLYVICTIMMIZATION AND RECOGNIZING THAT MUCH OF THIS OCCURS ALL TOGETHER EVEN WITHIN FAMILIES. YOU MIGHT HAVE CHAOTIC HOUSEHOLDS, THINGS LIKE THAT, AND PERHAPS THERE ARE COMMUNITY RESOURCES THAT COULD BE APPLIED TO FAMILY SITUATIONS. >> ANY OTHER COMMENTS BY THE GROUP OR QUESTIONS FOR THE GROUP? PRODS LUNCH TOOK IT OUT OF YOU. >> SOMETHING WE TALKED ABOUT. NOT ON THE SLIDE. WE TALKED ABOUT NOT KNOWING WHAT IS NOT ELDER ABUSE. IF WE HAVE ELDER ABUSE WHAT ARE OUR EXPECTATIONS FOR ADULT CHILDREN, WHAT IS ACCEPTABLE AND NOT ACCEPTABLE. EVERYBODY THOUGHT IT WAS IMPORTANT. SO A LOT OF CONTINUING ON TRAINING. THIS IS THE QUESTION THAT THE PURCHASERS HAVE, COMPARED TO WHAT? WHAT IS IT NOT KNOWING WHAT THEY'RE COOING AND WE'RE NOT -- DOING AND WHAT'S THE LEVEL OF NOT KNOWING VERSUS SOMETHING BAD. WE PROBLEM SOLVE WITH THEM BUT WE DON'T REALLY KNOW BECAUSE WE HAVEN'T DECIDED WHAT THE IS. -- WHAT THAT IS. >> A REFLECTION POINT ABOUT NETHERLANDS PROGRAM WHICH RUNS A U.S. VALUE TO REMOVE THE PROBLEM RATHER THAN ADDRESSING IN A FAMILIAL CONTEXT RESONATES WITH THE DISCUSSION FROM THE FIRST PANEL ABOUT DIFFERENT CULTURAL VALUES THAT MIGHT INFORM WHAT WE MEASURE AND HOW WE ADDRESS THE PROBLEM. I DON'T KNOW WHETHER THERE WAS DISCUSSION ABOUT THAT BUT ACROSS NATIONAL COMPARISONS OR DIFFERENT CULTURAL VALUES DON'T SPAN RACIAL ETHNIC RURAL URBAN GROUPS WITHIN OUR OWN COUNTRY BUT WE COULD GET INSIGHTS HOW OTHER CULTURES ARE DEALING WITH IT. >> ONE OF THE THINGS I HAVE HEARD IS EVEN WHEN YOU DO THE FORCED ESTRANGEMENT TYPE THING ACTUALLY PEOPLE ABOUT 50% OF THE TIME WILL JUST STAY WITH MAYBE THE ABUSER OR THE FAMILY WILL STAY TOGETHER. OUR MODELS IN THE U.S. SEEMS TO SAY FINE WE'RE NOTS GOING TO HELP YOU THEN. WE NEED TO GET OVER THAT AND SAY WHAT CAN WE GIVE PEOPLE TO WORK WITH THAT ARE RESOURCES EVEN IF THEY'RE GOING TO STAY IN A SITUATION. THAT MIGHT BE A DIFFERENT WAY OF LOOKING AT THINGS. >> THAT HAS RESONANCE WITH WHAT WAS DISCUSSED IN THE FIRST GROUP AS WELL ESPECIALLY CULTURAL COMMUNITIES WHERE FAMILIES ARE CONCEIVED OF DIFFERENTLY SELF-RELIANCE CONCEIVED OF DIFFERENTLY OR OPTIONS FEWER BECAUSE IT'S A RURAL AREA. ANYONE ELSE? WOW. GUYS ARE INCREDIBLY CLEAR. P MORE MONEY. GROUP 3. THE BRAIN MAN. >> ALL RIGHT THEN. >> TOUCHE. BREAK OUT SESSION 3 WAS DEVOTESSED TO DIMINISHED COGNITIVE DECISIONAL CAPACITY. SCIENTIFIC STRUCTURAL BARRIERS TO DEVELOPING EVIDENCE BASED ELDER ABUSE ON THIS TOPIC. FIRST WAS IDENTIFY POINTS OF CONTACT FOR BOTH ASSESSMENT OF RISK AND ACTIVE PREVENTIVE INTERVENTION. THE MEDICAL FUEL WELLNESS VISIT SOCIAL SECURITY ADMINISTRATION ENCOUNTERS ARE POTENTIAL TIMES WHEN ONE CAN IDENTIFY INDIVIDUAL WHOSE HAVE IMPAIRMENTS IN CAPACITY AND POTENTIALLY ALSO VICTIMS OF RISK FOR ELDER ABUSE BUT CHALLENGES FOR DOING THESE THINGS IN THOSE SETTINGS GIVEN THE TIME NEEDED TO DO VISITS. ISSUES WE'LL GET TO IN A MINUTE OPPORTUNITIES FOR TRAINING. INTERVENTIONS IN THIS AREA CAN BE COSTLY. THE TIME EFFORTS AND FUNDS NECESSARY FOR EXAMPLE TO SECURE GUARDIANSHIP AS WELL AS SETTLINGS LIKE FINANCIAL INSTITUTIONS MANY TERMS OF TRAINING AND STRUCTURAL ABILITIES TO ADDRESS ISSUES RELATED TO CAPACITY, THAT LEADS TO OPPORTUNITIES AS WELL. FINDINGS THAT WE THINK ARE KEY AND THAT THEN BE BROADLY APPLIED. FIRST THE FIELD WORKED OUT GOOD CONCEPTUAL FRAMEWORKS FOR WHAT IS CAPACITY HOW IT'S DISTINCT FROM COGNITION, ET CETERA. THE FIELDS ALSO DEVELOPED WELL VALIDATED INSTRUMENTS SO THERE'S A SCIENCE BASE THERE THE SECOND FINDINGS WE THINK CAN BEGIN TO BE BROADLY APPLIED IS REALLY UNDERSTANDING THE RELATIONSHIPS AND THE DISTINCTIONS BETWEEN WHAT'S COGNITION, WHAT'S CAPACITY, PARTICULARLY IN THE PHENOTYPES RELEVANT TO THIS MEETING, NAMELY OLDER ADULTS ON THE AD CONTINUUM PARTICULARLY MCI AND DEMENTIA DATA OF AD. ADVANCES AS WELL IN THE NEUROSCIENCE OF THIS AREA, UNDERSTANDING BETTER THE CORRELATES BETWEEN REGION AND STRUCTURES OF THE BRAIN AND/OR NETWORKS LEAD TO CERTAIN COGNITIVE PROCESSES TO TURN LEAD TO CERTAIN DEFICITS AND ABILITIES AND IMPAIRMENTS IN CAPACITY. SO THE BAY I CAN SCIENCE IS TAKE -- BASIC SCIENCE IS TAKING SHAPE. SO RECOMMENDATIONS GOING FORWARD? WITH THAT BASIC SCIENCE AND SHAPE WHAT IS NOT AS IN SHAPE AND A HUGE OPPORTUNITY IS TO DEVELOP EDUCATION AND TRAINING APPLYING THOSE INSTRUMENTS AND TO THE WORLD. IT'S NOT JUST TAKE AN INSTRUMENT AND PUT INTO ASSESSMENT PACK AND SAY WE'RE GOOD TO GO. IT HAS TO BE COUPLED WITH TRAINING THAT INCLUDES CONCEPTUAL FRAMEWORK AND THE LOGIC AND THE ROLE OF THESE INSTRUMENTS TOGETHER WITH OTHER ASSESSMENTS FOR ASSESSING CAPACITY. THERE'S A ROLE FOR THIS IN THE BROAD RANGE PROFESSIONALS WHO WORK WITH OLDER ADULTS WHO ENCOUNT WE ARE THE VARIOUS FORMS OF ELDER ABUSE WE HAVE BEEN TALKING ABOUT TODAY OVER COURSE OF THE MORNING. SO OBVIOUS ONE ARE APS INVESTIGATORS WHO WILL TELL YOU SORELY NEED OF BETTER WORK -- BETTER TRAINING AND INSTRUMENTS IN THIS AREA. OTHER LONG TERM CARE PROFESSIONALS SUCH AS DAY OR RESIDENTIAL PROGRAMS AND STAFF AND OTHERS IN THE FINANCIAL SERVICES AND BANKING INDUSTRIES. SO ROUGH TRANSLATING INSTRUMENTS AND MATERIALS INTO PRACTICE, THAT'S THE NEXT IMPORTANT RESEARCH RECOMMENDATION. SECOND IS TO BETTER UNDERSTAND ASPECT OF COGNITIVE FUNCTION THAT NOT AS WELL STUDIED ON IMPACT ON DECISION ALEXIAS I AS THOSE CRYSTALIZED ASPECTS OR FLUID ABILITIES. THIS IS SOCIAL COGNITION OR CAPACITY. AND HAVE THAT IMPACTS ON OUR DECISIONAL CAPACITY. AND THE RISKS OF ELDER ABUSE. IF YOU'RE WONDERING WHAT I'M TALK ABOUT, THE PEOPLE WHO START TO SEND MONEY TO OPEN UP THE TAX FLOW TO GET THE LOTTERIES THEY WANT IN JAMAICA. FORMER LAW PARTNER PROMINENT FIRM COME TO ME THIS IS TOTALLY OUT OF CHARACTER. WE DON'T UNDERSTAND THE NEUROSCIENCE OF THAT THE WAY WE UNDERSTAND THE NEUROSCIENCE WITH OTHER ASPECTS. THIS IS A HUGE ISSUE JESSIE IS NODDING BECAUSE WE HAVE OUR CASES OF THAT. BETTER UNDERSTAND HOW APPRECIATION OF IMPAIRMENT CHANGES AND WHAT AFFECTS IT SO THIS RESONATES WITH SOMETHING THAT IS A REAL WORLD PROBLEM. INSTANTIATION OF PROBLEM OF ELDER ABUSE, INDIVIDUAL WHOSE HAVE A PROBLEM, ARE AT RISK BUT JUST DON'T SEE EITHER THE VALUE OF INTERVENTION AND/OR EVEN THE PROBLEM. IT'S THIS ASPECT HOW APPRECIATION CHANGED. BETTER UNDERSTAND TRAJECTORIES OF CAPACITY AND INDIVIDUAL DIFFERENCES IN CAPACITY OVER TIME AND BETTER UNDERSTAND HOW SENSORY DEFICITS OTHER THAN COGNITIVE, PARTICULARLY HEARING, MAY IMPACT UPON CAPACITY. AGAIN, MORE BROADLY AND I'LL WRAP UP, NOT TRAINING AROUND CAPACITY BUT IS PART OF A BROADER CONTEXT OF HAVE ARING SOME CONVERSATIONS ABOUT FAIRLY DIFFICULT ISSUES OFTENTIMES FOR FAMILIES WITH PROFESSIONALS THE DELICATE CONVERSATIONS IF YOU WILL AROUND PLANNING AND/OR WHAT'S GOING WRONG IN THIS FAMILY. OR PARTICULAR OLDER ADULT. I'LL OPEN THE FLOOR TONATE AND DAN TO ADD ANYTHING OR AUGMENT WHAT WE SAID. ANYTHING TO ADD DAN ORNATE? >> I THINK THE ONLY THING TO ADD STRESSED WE STRESSED IN OUR PRESENTATION ROLE NEUROSCIENCE CAN PLAY IN HELPING IDENTIFY EARLY ON PEOPLE WHO MAYBE AT RISK FOR ELDER ABUSE. IN PARTICULAR FINANCIAL ELDER ABUSE BUT ALL KINDS OF ELDER ABUSE. THERE BY MAKING POSSIBLE EARLY DETECTION AND EARLY PROTECTION. PREVENTION IS ONE OF THE BEST APPROACHES WE THINK TO THIS MULTI-DIMENSIONAL PROBLEM OF ELDER ABUSE. >> SO I THINK WHAT'S IMPORTANT TO CONSIDER HERE IS WE TALK ABOUT A LOT OF SITUATIONAL FACTORS AND CONTEXTUAL FACTORS BUT NEED TO LOOK AT LEVEL OF INDIVIDUAL. THERE'S REASON OLDER ADULTS SHOULD DESERVE A CERTAIN DEGREE OF PROTECTED, BECAUSE THERE IS A NORMAL RANGE OF COGNITIVE DECLINE RELATED TO BRAIN CHANGE THAT OCCURS NOT NECESSARILY IN THE SAME TRAJECTORY AT DEMENTIA. SO THERE ARE TWO UNDERLYING BROAD TRENDS OF CHANGE THAT RELATE TO NORMAL AGING, THAT CAN CHANGE COGNITIVE FUNCTION AND RENDER OLDER ADULT VULNERABLE AS WELL AS DEMENTIA RELATED CHANGES THAT INTERACT WITH THAT DEGREE OF VULNERABILITY. >> >> IN ANIMAL MODELS NAB SENSE OF NEURODEGENERATION THE DECLINES YOU SEE IN ABILITIES OF OTHER ANIMAL MODELS INCLUDING HUMAN MODELS. THAT IMPACT ON DECISIONAL CAPACITY. VERY IMPORTANT AREA. UNDERSTUDIED. FLOOR IS OPEN FOR DEBATE. DISCUSSION? >> IF NO ONE ELSE HAS A QUESTION, I DO. SO FIGURING OUT CAPACITY QUESTIONS IS COMPLEX FOR THE VERY, VERY MOST SPECIALIZED AMONG YOU. HOW ARE PEEP GOING TO DO THIS WHETHER ADULT PROTECTIVE SERVICES WORKER OR FINANCIAL ADVISOR OR A PRIMARY CARE PHYSICIAN OR NURSE IN THE EMERGENCY DEPARTMENT, THIS SETS BOUNDS EXTREMELY SUBTLE OR MAYBE I'M MISSING SOMETHING. >> YES AND NO. REMEMBER CAPACITY IS ASSESSED RIGHT NOW. SO RIGHT NOW IN THE MANY APS AROUND THE NATION COUNTY BY COUNTY THEY'RE DOING IT AS WE SPEAK. SO MANAGE IS GOING ON ALREADY SO PRETENDS IT'S HARD, DIFFICULT, YOU CAN'T TEACH IT THEN I DON'T KNOW WHAT THE HELL IS GOING ON RIGHT NOW IN AMERICA. SO RECOGNIZING THAT WE HAVE TO THINK IN A MORE SOPHISTICATED WAY. NOT EVERY CASE OF COGNITIVE IMPAIRMENT THAT WALKS TO MY MEMORY CENTER IS A COMPLEX DIFFICULT CASE OF COGNITIVE IMPAIRMENT SO WE'RE STRAIGHT FORWARD ALZHEIMER'S DISEASE. AND OTHERS ARE MORE SUBTLE, I THINK WE HAVE TO BEGIN OUR TRAINING MATERIALS AREN'T JUST HERE IS HOW YOU USE THIS INSTRUMENT, GO AHEAD, YOU'RE GOOD. BUT TRAINING MATERIALS WHEN SHOULD I USE THIS INSTRUMENT OR OUT MY LEAGUE, BETTER SOPHISTICATION OF IN THE CASE OF APS WORKERS, IS THIS SOMETHING TO CROSS MY SKILL SET OR NOT ACROSS MY SKILL SET? MAYBE WE SHOULD THINK APS WORKERS AND INVESTIGATORS THAT THERE ARE DIFFERENT IF YOU WILL DESIGNATIONS LIKE IF YOU DON'T HAVE THIS LEVEL OF TRAINING OR THIS LEVEL OF SKILL YOU CAN'T BE DOING THIS LEVEL OF ASSESSMENT. SO THERE'S SOME DEGREE HERE AROUND BETTER MATCHING THE PERSON INSTRUMENT AND METHOD TO THE PROBLEM I THINK IS MY RESPONSE TO THAT -- THE COMPLEXITY OF THE CAPACITY ELEMENT. >> >> I THINK THAT'S A VERY GOOD QUESTION AND A DAUNTING ONE. BUT WE CAN'T -- WE CAN'T SHIRK IT EITHER. WE WANT TO HAVE -- WE LIVE IN AN AGING SOCIETY WHERE CAPACITY ISSUES ARE UBIQUITOUS AND WE'RE CALLED UPON TO TRY TO ANSWER THEM. MY RESPONSE TO YOUR QUESTION IS THAT WE HAVE TO FIRST AND FOREMOST PUT GREAT EMPHASIS ON SOUND TRAINING AND WHATEVER LEVEL IT IS IN THE ASSESSMENT OF DIMINISHED CAPACITY WHETHER APS WORKER OR A NURSE AND THAT NEEDS TO BE JUST PART OF TRAINING EFFORTS AND THESE INSTRUMENTS ARE SIMPLY TOOLS THAT ARE WELL TRAINED PROFESSIONAL WILL USE, STARTING POINT IS HAVING PEOPLE UNDERSTAND THAT CAPACITY ASSESSMENT DOESN'T MEAN THAT I ADMINISTER MINI MENTAL STATE AND GET A SCORE AND THEN USE THE SCORE TO DETERMINE WHAT CAPACITY STATUS IS, TO UNDERSTAND YOU'RE LOOKING AT SPECIFIC SET OF ABILITIES RELATIVE TO CAPACITY. HOW CONGRUENT OR UNINCONGRUENT IS THAT. IT'S A COMPLEX UNDERTAKING BUT IT CAN BE TAUGHT. >> SO YOU BOTH ADDRESSED ISSUE WHEN A PERSON COMES THE ADULT PROTECTIVE SERVICES OR SOMEICALLY MIC. BUT I'LL BRING UP AGAIN OUTSIDE THEDLY IN THIS CASE CHALLENGE FAMILIES ARE FACING. SO CERTAINLY MIDDLE AGE AND OLDER ADULTS POSSESS MAJORITY OF THE WEALTH AND PARTICULARLY VULNERABLE TO EXPLOITATION. DAN GAVE AN EXAM POFFLE THE GROUP, LIST OF EARLY WARNING SIGNS OF DIMINISHED DECISIONAL CAPACITY AND SLOWNESS COMPLETING FANS FINANCIAL IT IS TAKES, MISSING KEY DETAILS IN THE DOCUMENT, DECREASED UNDERSTANDING OF FINANCIAL CONCEPTS. FAMILIES ARE DEALING WITH MEMBERS WHO ARE EXHIBITING SYMPTOMS. AND IT 'NOT NECESSARILY THE THING THAT TRIGGERS THE TRIP TO ADULT PROTECTIVE SERVICES AND NOT THE THING THAT TRIGGERS A TRIP TO THE DOCTOR. OTHER POINTS OF CONTACT, WE TALKED ABOUT THAT NAOMI FROM CONSUMER FINANCIAL PROTECTION BUREAU IN OUR GROUP DISCUSSING SOME NEEDS FOR INTERVENTIONS WITH OTHER -- LIKE FINANCIAL INSTITUTION, BUT IS A REAL CHALLENGE WHEN YOU DON'T HAVE A PROVIDER NECESSARILY OR PROFESSIONAL DOING THE ASSESSMENT FOR FAMILIES OR INDIVIDUALS WHO MAYBE EXPERIENCING THEIR OWN DECISIONAL DEFICITS TO QUITE KNOW WHAT TO DO ABOUT IT. >> ANOTHER AREA FOR TRAINING AS WELL. >> LAURA. MARK. >> THE OTHER THING IS CAPACITY ISN'T ALL ABOUT FINANCIAL ABUSE. OTHER ISSUES THAT COME UP IS THE SO WHAT QUESTION. IF SOMEBODY IS HOME AND BEING PHYSICALLY ABUSED, AND HAS ALZHEIMER'S DISEASE, DO THEY CHOOSE TO STAY AT HOME? OR IF THEY LACK DECISION MAKING CAPACITY, WHAT HAPPENS THEN? >> WE DEFINITELY TALKED ABOUT THE PRIOR SLIDE ABOUT ISSUE OF THE NEED TO BETTER UNDERSTAND APPRECIATION. THAT'S -- THAT WAS A TELESCOPIC WAY TO FOCUS ON IT ISN'T JUST FINANCIAL CAPACITY, THE ISSUE THAT WE WERE COVERING WAS GIVEN A PARTICULAR PROBLEM DO YOU HAVE THE ABILITY TO SOLVE THAT PROBLEM? SO THE PROBLEM MIGHT BE THAT YOUR MEALS BECOME INCREASINGLY SIMPLIFIED AND THERE ARE ERRORS AND I PRESENT THE OPTION HOW WE CAN SOLVE THAT WITH SAY MEALS ON WHEELS. YOU'RE RIGHT MORE HEM LET'S BRING THEM IN, YOU HAVE THE SERVICE VERSUS EVERYTHING IS FINE LEAVE ME ALONE. THAT'S THE CAPACITY FROM,UP SOLVING THAT PARTICULAR FUNCTION, INSTRUMENTS ARE DEVELOPED IN THAT SPACE. THEY NEED TO BE DISSEMINATED OUT P TYPE THE WORLD. BUT THAT'S ABSOLUTELY ONE OF THE ISSUES OF CAPACITY AS IT RELATES TO ELDER ABUSE, SOLVING YOUR PARTICULAR FUNCTIONAL PROBLEM OR NOT. >> THE OTHER PIECE IN REAL WORLD SITUATIONS, SOMEWHAT IF SOMEBODY DOESN'T LIKE YOUR SOLUTION. THOUGH THEY LACK CAPACITY TO DISAGREE WITH YOU HOW ARE WE ABLE TO THEN -- SO IT'S VERY INTERESTING ON THE RESEARCH STANDS POINT TO GET THIS IN TRANSITION TO REAL WORLD. >> IS IT A MATTER OF TASTE AND VALUE? THE CHALLENGE APPRECIATION I DO, ULTIMATELY APPRECIATION IS EITHER ULTIMATELY, STRIKE THAT. IT IS -- COULD BE A MATTER OF TASTE, I JUST DON'T -- AND VALUES. I DON'T THINK THAT BLOOD TRANSFUSIONSES ARE FOR ME GIVEN MY RELIGIOUS VIEW, FOR EXAMPLE COULD BE A VIEW VERSUS DISTORTIONS OF REALITY AND MISPERCEPTIONS OF A PROBLEM. THAT'S THE -- ONE OF THE BIG CHALLENGES AROUND THIS APPRECIATION, THAT NEEDS TO BE BETTER STUDIED. >> I HATE TO CUT OFF, WE ONLY (INAUDIBLE). (OFF MIC) >> YOU'RE PART OF THE FOURTH BREAK-OUT GROUP SO MAKE YOU CAN DO THAT. SEGUE. >> I WAS GOING TO DUMB DOWN THIS DISCUSSION CONSIDERABLY AND ASK A QUESTION THAT'S UNRELATED TO THE NEUROSCIENCE BUT I THINK THE POST IMPORTANT -- I WONDER IF THIS CAME UP, THE MOST IMPORTANT QUESTION TO ADVANCE RESEARCH IN THE NEUROSCIENCE REALM IS HOW DO I GET NEUROSCIENTISTS INTERESTED IN OTHER AREAS, INTERESTED IN THIS AREA? I MEAN, DID HA COME UP AT ALL? HOW DO I GET SOMEONE STUDYING HUNTINGTON'S DISEASE OR APRAXIA OR FRONTAL TEMPORAL DYSMENTIA, TO LEAVE LAVISHLY FUNDED AIREDIA TO ELDER ABUSE. NIH HAS A LONG HISTORY OF GETTING NUCLEAR SCIENTISTS TO TRANSITION TO ANOTHER AREA WITH A WHOLE VARIETY OF OTHER RFAs. DID THAT COME UP AT ALL? I THINK THAT WOULD REALLY ADVANCE RESEARCH IN THIS FIELD. WAS THAT AT ALL PART OF THE DISCUSSION? >> IT IS NOW. >> I WILL SAY WE DID TALK ABOUT THE DECISION NEUROSCIENCE OF AGING AND DECISION SCIENCE OF AGING EFFORTS THAT WE HAVE BEEN TRYING TO PROMOTE GROUND -- GRASSROOTS. IT'S A GROWING INTEREST IN THIS BOTH FOR THE COGNITIVE AND THE SOCIAL AND AFFECTIVE COMPONENTS OF DECISION MAKING SO WE HAVE A STRONG INTEREST IN THIS AND IT'S CERTAINLY RELATED TO ELDER ABUSE. >> MARK AND MIRIAM? FOURTH GROUP. SO OUR GROUP IS BIOETHICS AND LAW IN ELDER ABUSE RESEARCH. OUR DISCUSSIONS MOVED BETWEEN DISCUSSION OF SCIENCE AND DISCUSSIONS OF LEGAL AND ETHICAL ISSUES. >> THIS IS NOT THE RIGHT ONE. OH THAT IS. OKAY. SO FIRST WE SAID ELDER ABUSE RESEARCH RAIDSES CAPACITY AND OTHER VULNERABILITY ISSUES. ONE OF THE ETHICAL CHALLENGES WE NEED TO DEAL WITH IS BALANCING AUTONOMY OF SOMEBODY WHO HAS NOT BEEN DECLARED TO LACK DECISIONAL CAPACITY AND THE NEED TO PROTECT VULNERABLE GROUPS. THIS IS AN ISSUE FOR RESEARCHERS, FOR INSTITUTIONS, AND FOR IRBs. THERE ARE A NUMBER OF IRB ISSUES THAT CONCERN ETHICAL OR LEGAL CONCERNS ABOUT THE ABILITY OF VICTIMS AND PERPETRATORS AND OTHERS ASSOCIATED WITH ELDERS TO PARTICIPATE IN RESEARCH, WHETHER THEY SHOULD, WHETHER THEY CAN ETHICALLY, ALSO CONSERVED ON THE PART OF THE INSTITUTION, LEGAL CONCERNS ABOUT WHETHER THEY ARE GOING TO GET IN TROUBLE FOR PUTTING PEOPLE AT RISK FOR VIOLATING LAWS. AND FOR VIOLATING LAWS. THIRDLY MANDATORY REPORTING REQUIREMENTS MAY CREATE CONFLICT BETWEEN PROTECTING SUBJECTS AND INVOLVING SUBJECTS OF ELDER ABUSE AND THEIR ASSOCIATES IN RESEARCH. WHAT ARE KEY FINDINGS THAT WE HAVE LEARNED FROM OTHER FIELDS INCLUDING OTHER FIELDS WE HAVE LEARNED IT'S POSSIBLE TO ETHICALLY CONDUCT RESEARCH ON PARTICIPANTS THAT HAVE COGNITIVE IMPAIRMENTS AND OTHER FRAILTIES. WE TALKED A LOT ABOUT RESEARCH WITH PEOPLE THAT HAVE ALZHEIMER'S DISEASE, OTHER KINDS OF COGNITIVE IMPAIRMENT, INTELLECTUAL DISABILITIES AND ALTHOUGH WE MAY VACILLATE BETWEEN THE NEED TO PROTECT PEOPLE AND PREVENT THEM FROM SURVEY -- FROM PARTICIPATING RESEARCH WE FLIPPED SOCIALLY TO A PHILOSOPHY OF INCLUSION OF ALL KINDS OF PEOPLE IN RESEARCH. THIS IS PARTLY BECAUSE OF SOCIAL PRESSURE FROM THE BREAST CANCER ADVOCACY GROUP FROM THE ACT UP GROUP AND FROM THE FACT THAT OUR DEMOGRAPHICS ARE WHAT THEY ARE AND WE HAVE INCREASING CONCERN ABOUT INCREASING KNOWLEDGE ABOUT ALL KINDS OF PEOPLE WHO CONSTITUTE THE ELDER POPULATION. WHAT ARE MOST IMPORTANT RESEARCH RECOMMENDATIONS GOING FORWARD? INCLUDE VICTIMS AND ALL INVOLVED SHAREHOLDERS AND ELDER ABUSE RESEARCH, INCLUDING IRB MEMBERS. AND OTHER GROUPS HAVE ALREADY TALKED ABOUT THE NEED TO EDUCATE EVERYBODY FROM THE PUBLIC TO THE FUNDING ORGANIZATIONS TO IRB MEMBERS AND RESEARCH COMMUNITY. ABOUT GROWING IMPORTANCE OF THIS AREA. SECOND, COMMUNICATE IMPORTANCE OF ELDER ABUSE PROBLEM TO A WIDE RANGE OF CONSTITUENCIES, CREATE AN ON GOING COMMUNITY OF RESEARCHERS AND PRACTITIONERS WHO INTERACT REGULARLY AND CAN SHARE KNOWLEDGE AND SUPPORT ONE ANOTHER. FOURTH, EXPLORE THE POSSIBILITIES OF DEVELOPING GUIDELINES FOR ELDER ABUSE RESEARCH. WITH REGARD TO IRBs, WITH REGARD TO HOW TO HANDLE DIFFICULT ISSUES IN RESEARCH PROTOCOLS AND IN MED DOGS THAT CAN BE SHARED -- METHODOLOGIES THAT CAN BE SHARED THAT ARE MORE APPROPRIATE FOR LARGE SCALE STUDY, SMALLER SCALE INTERVENTION AND PREVENTION STUDIES, ET CETERA. QUESTIONS AND COMMENTS? DO YOU WANT TO SAY SOMETHING? >> NO. >> YOU'RE JUST COMING BACK. >> TRYING NOT TO INTERRUPT. >> YES. >> KERRY DID YOU WANT TO MAKE A COMMENT? >> NO I THINK (INAUDIBLE). (OFF MIC) LIKE THE NIH TOOL KITS THINKING PRACTICE PROTOCOLS THAT CAN BE INFORMED BY RESEARCH AND ALL THE EVIDENCE BASE WE HAVE AND THINKING OF WAYS TO STREAMLINE OUR WORK SO THAT WE CAN DO MULTI-CENTER STUDIES WITH THESE COMPLEX INDIVIDUAL WHOSE ARE PROBABLY MORE AT RISK THAN ANY OTHER GROUP OF OLDER PEOPLE. THANKS. >> MARK DID YOU WANT TO ADD ANYTHING? >> NO. >> ANYBODY ELSE IN THE GROUP WANT TO ADD SOMETHING? >> LINDA KINCAID COALITION FOR OLDER AND INDEPENDENT RIGHTS. THANK YOU SO MUCH FOR ONE. I UNDERSTAND INCLUDING VICTIMS MAY NOT ALWAYS BE POSSIBLE, MY MOM DIED OF ALZHEIMER'S I FULLY UNDERSTAND THE DIFFICULTIES OF INTERVIEWING, GETTING INFORMATION FROM SOMEONE COGNITIVELY IMPAIRED. SHE WAS WORRIED ABOUT MILKING THE COWS BEFORE IT GOT DARK, THAT'S WHEN SHE COULD ARTICULATE HER CONCERNS. HOWEVER YOU MIGHT WANT TO THINK ABOUT INCLUDING FAMILIES. WE ARE THE ONES WHO SAW OUR PARENTS BE ABUSED. WE ARE THE ONES THAT REPORTED THAT ABUSE TO EVERY AGENCY ON THE FACE OF THE EARTH IT FELT LIKE AT TIMES AND WERE UNABLE TO GET ASSISTANCE WHATSOEVER FOR ABUSED PARENTS. THERE ARE A NUMBER OF US WHO HAVE EXCEEDINGLY WELL DOCUMENTED CASES AND THOSE OF US WHOSE PARENTS ARE DECEASED WOULD BE HAPPY TO MAKE THE COMPLETE RECORDS INCLUDING THE MEDICAL RECORDS AVAILABLE FOR RESEARCH. >> THANK YOU FOR MAKING THAT POINT. WE DID TALK FAMILIES AND SORT OF LUMPED THEM IN AMONG THE SHAREHOLDER GROUP. >> I'M SORRY. >> WE ALSO ACTUALLY DISCUSSED THE POSSIBILITY OF INCLUDING PERPETRATORS. SOME WHOM ARE NOT ALL EVIL, STRESSED OUT DEMENTIA CAREGIVERS, PEOPLE WITH MENTAL HEALTH DISORDERS WHO ARE NOW BACK ON THEIR ANTIPSYCHOTIC MEDICATIONS PERHAPS. THERE'S THE OPPORTUNITIES, EVERYBODY SHOULD HAVE IN THIS, SO WONDERFUL POINT. >> THANK YOU. I HAVE A HARD TIME SEEING THE FACILITIES THAT ABUSE MY MOM ANYTHING OTHER THAN DEVIL SPAWN BUT I UNDERSTAND THERE ARE MANY FAMILIES WHO MIGHT HAVE MADE SIMPLE ERRORS IN JUDGMENT, SIMPLE MISTAKES AND REALLY SHOULD NOT BE TREATED AS CRIMINALS. ANY WAY WE CAN BE INVOLVED WE WOULD LOVE TO HELP YOU. >> THANK YOU. >> COMMENTS? >> THIS IS KATE. SO I'M CURIOUS IF WE COULD QUICKLY BRAINSTORM WHAT WITH THE -- WHO SHOULD BE IN THE ROOM TO TALK ABOUT THE -- WHAT WE WERE DISCUSSING IN THE BREAK-OUT THE TWO SEPARATE ISSUES OF CAPACITY ISSUES, FOR PARTICIPATING IN RESEARCH AND THEN THE LEGAL ISSUES AND ETHICAL ISSUES RELATED TO PEOPLE WHO ARE POTENTIAL VICTIMS OF CRIMES. FOR CAPACITY ISSUES, THAT'S NEUROSCIENTISTS, PEOPLE WHO -- GERIATRICIANS. PEOPLE WHO WORK WITH PEOPLE WITH DEVELOPMENTAL DISORDERS, AND WHO ELSE SHOULD BE CONTRIBUTING TO THE CONVERSATION IN TERMS OF HOW WE ETHICALLY APPROPRIATELY INCLUDE PEOPLE WITH COGNITIVE CAPACITY ISSUES IN VERGE AND SECOND THE OTHER HALF. >> IS THERE A PRAYER OF INCLUDING PEOPLE THAT WE ARE DOING RESEARCH ON IN THE DIALOGUE? IN YOUR LIST OF WHO MIGHT BE IN THAT? I COME FROM A DISABILITIES PERSPECTIVE. NO PLANNING ABOUT US WITHOUT US. IS IT POSSIBLE WE COULD IMAGINE PEOPLE THEMSELVES SHAPING THAT CONVERSATION? >> YES, THE COMMENT FOR VIDEOCAST PEOPLE IS CAN WE ALSO INCLUDE THE PEOPLE FROM -- WHO -- >> PEOPLE WITH IMPAIRMENT IN THE CONVERSATION. >> THAT IS SOMETHING THAT WE HAVE TALKED ABOUT AND IT'S VERY COMMON HERE AT NIH TO INCLUDE MEMBERS OF THE GROUPS BEING STUDIED IN THE RESEARCH. SOME KIND OF RESEARCH IS REQUIRED. >> GREAT POINT. ANY OTHER GROUPS WE ARE MISSING? >> I WOULD LIKE TO JUST EXPLICITLY POINT OUT ADULT PROTECTIVE SERVICE WORKSERS WHO ARE THERE, I THINK THEY'RE THE NEW VISITING NURSE SERVICE FRANKLY FOR THIS GROUP. THEY SEE THEM SOMETIMES FOUR THE SIX TIME AS YEAR AND COULD TELL US A LOT ABOUT NOT ONLY CAPACITY BUT ALSO THE FLUCTUATIONS THROUGHOUT THE DAY AND THE WAY THEY RESPOND TO IT. THANKS. >> LET ME -- I WANT TO -- TWO ISSUES THAT ARE -- COUPLE OF ISSUES TO THE TABLE. I THINK ON THE MATTER OF DECIDING THE APPROPRIATE RISK AND KNOWLEDGE BALANCE AND RESEARCH AND RISK AND POTENTIAL BENEFIT BALANCE, THE ARGUMENTS FOR INCLUDING A BROAD SET OF PEOPLE WHO CAN INFORM THAT CONVERSATION ARE VERY COMPELLING. VERY COMPELLING. SO THERE'S A REAL ARGUMENT FOR BRINGING IN FOR EXAMPLE INDIVIDUAL WHOSE HAVE THE DISORDER BECAUSE THE WAY THEY INTERPRET WHAT IS A RISK IS VERY DIFFERENT THAN THOSE WHO ARE ON THE PROFESSIONAL SIDE OF CARING. INDEED IN SOME DISEASES THERE'S MANDATES. AREAS OF RESEARCH TO DO THAT, FOR EXAMPLE EMERGENCY RESEARCH THERE'S FDA MANDATES WHICH YOU RECRUIT. ON MATTERS OF DECIDING ABOUT ASSESSMENT OF CAPACITY, THE CONSTRUCTED, I WOULD HAVE TO THINK MORE ABOUT THE ROLE OF BROADENING OF PARTICIPANTS IN THAT. IT IS A CONCEPTUAL CONSTRUCT HA COMES OUT OF LAW, NEUROSCIENCE, PSYCHOLOGY, AND SO I JUST WANT TO UNDERSTAND WHAT OTHER DISCIPLINES AND NON-DISCIPLINARYIAS PERSPECTIVES BRING TO THAT CONCEPTUAL BASE AND ITS MEASUREMENT. >> I THINK WE'RE ABOUT THE END OF OUR TIME. DID YOU WANT CLOSING REMARKS? >> COUPLE OF THINGS TO WRAP UP. A COUPLE OF REPEATING THEMES IS LOOKING AT THINGS FROM A RESILIENCE OR STRENGTH BASED FOCUS. NOT JUST CULTURALLY BUT I'M STRUCK BY COLLEAGUE MS. THE DOMESTIC VIOLENCE FIELD WHO HAVE DONE FOCUS GROUPS WITH OLDER WOMEN AND HAVE AGAIN SAID WE DON'T WANT POSTERS WITH BRUISES AN BROKEN GLASSES WE WANT TO SEE A YOU CAN DO IT MESSAGE TO RESONATE WITH US SO WE HAVE A LOT TO LEARN IN TERMS OF HOW WE APPROACH THINGS. IN TERMS OF THE CAPACITY ISSUES IN NEUROSCIENCE, I HAVE COME AROUND ON THIS ISSUE TO THINK OF IT AS THE CANARY IN THE COAL MINE, IT'S A PLACE WE CAN GO FINANCIAL INCAPACITY AND/OR BRAIN CHANGES SOMETHING WE CAN REALLY LEARN FROM IN TERMS OF EARLY WARNING SIGNALS THAT PREVENT A HOLD LOT WORSE TROUBLE. SO IT'S AN OPPORTUNITY TO ASSESS AND INTERVENE EARLY ON. THERE'S HUGE ETHICAL ISSUES, AMONG THEM WHEN CAN YOU CHOOSE TO BE ABUSED? THAT'S A MUCH CLEAR OR ASSESSMENT TALKING A CHILD PRESUMPTIVELY INCOMPETENT OR A PERSON FULL CAPACITY. AND THE VARIABLE CAPACITIES THAT ARE PART OF OLD AGE QUESTIONS GETS INCREDIBLY COMPLICATED AND DESERVES A LOT OF ATTENTION. WE TALKED ON GOING GROUPS TO MEET AND I THINK THERE ARE THREE ANSWERS TO THIS IN TERMS OF FOCUS ON SCIENCE, ONE IS THAT A GROUP THAT INCLUDES CLEARLY FAMILY MEMBERS AND PEOPLE WITH DEMENTIA AND/OR OTHER DISABILITIES WHO HAVE BEEN VICTIMIZED AND WHO MIGHT BE AT RISK. AS WELL AS EXPERTS. ANOTHER GROUP, DAMIAN RAISED THIS IN ONE OF THE SMALL GROUPS, IS A FEDERAL GROUP. THE CHILDREN'S BUREAU HAS ORGANIZED A GROUP, A DISCUSSION GROUP THAT HAS METS, WHAT, FOR DECADES I THINK, UNDER THE JUVENILE JUSTICE COORDINATING COUNCIL. THAT CONVERSATION PROVIDES A FORUM FOR DIFFERENT PARTS OF THE GOVERNMENT TO HAVE CONVERSATIONS HOW TO FUND WHAT ARE THE PRIORITIES. PEOPLE WHO ARE INVOLVED IN THIS FORUM TODAY HADN'T MET ONE ANOTHER BEFORE AND THAT INCLUDES THE FEDERAL SIDE WHICH MEANS A LOT OF SILOS TO BREAK DOWN EVEN IN THE GOVERNMENT AND HAVING FORMED ONE OF THOSE IN 2000, WITH MY FRIEND SUSAN LYNCH, IT DOESN'T NEED TO BE FORMAL, IT COULD BE PART OF THE JUSTICE COORDINATING COUNCIL, IT COULD BE A JUSTICE GROUP TO DISCUSS OPPORTUNITIES, YOU CAN HE BELIEVE KATE ONE ANOTHER AND YOU CAN DISCUSS OPPORTUNITIES FOR JOINT FUNDING IT'S A POWERFUL THING TO START HEARING WHAT OTHER INSTITUTES AND AGENCIES ARE DOING. SO I WOULD -- I THINK ONE OF THE THINGS THAT CAME OUT OF THE GROUP, THAT I SAT IN ON LAST WAS A GROUP SPECIFICALLY DEDICATED TO RESEARCH CONVERSATIONS AMONG FEDERAL PARTICIPANTS OR FEDERAL AGENCIES THAT HAVE AN INTEREST IN RESEARCH IN THIS AREA. LASTLY, I KNOW THIS IS GOING TO COME AS A SHOCK TO YOU BUT THE LAST KIND OF FORUM THAT SEEMED TO COME UP AGAIN AND AGAIN, WOULD BE A CENTERS TO FOCUS AND JUMP START THE EFFORT. THANK YOU. [APPLAUSE] >> THANK YOU TO THE PRESENTERS FOR THAT AND ALL THE CONTRIBUTIONS REPRESENTED IN THE PRESENTATIONS GIVEN HERE. WHILE WE'RE TRANSITIONING TO THE NEXT PANEL I WOULD LIKE TO TAKE A BRIEF MOMENT TO INTRODUCE THE DIRECTOR OF THE NATIONAL INSTITUTES ON AGING RICHARD HODES WHO JOINED US FOR THE DISCUSSION THIS AFTERNOON. >> LET'S QUEUE UP THE THIRD PANEL WHICH IS ON NOVEL INTERVENTION AND PREVENTION STRATEGIES. WHILE THEY ARE GETTING UP THERE, IF ANYONE WANTS TO TAKE A LITTLE STRETCH, I RECOMMEND IT. WE WILL BE SITTING HERE A LITTLE WHILE. BUT DON'T TRAVEL FAR. I ALSO IN THE FIRST COUPLE OF PANELS, WE WERE RUNNING OUT OF TIME FOR EVERYONE TO GET THEIR COMMENTS IN SO I WANTED TO MAKE SURE THAT EVERYONE IN THE ROOM HAD THE CHANCE TO COMMENT. SO EVERYONE KEEP YOUR QUESTIONS AND RESPONSES REALLY BRIEF AND THEN IF YOU HAVE ADDITIONAL THINGS THAT YOU WOULD LIKE TO SHARE WITH US I PUT SOME NOTE PADS UP THERE SO FEEL FREE TO WRITE US A NOTE AND LEAVE IT WITH IDA AT THE REGISTRATION TABLE. PANEL THREE NOVEL INTERVENTION AND PREVENTION STRATEGIES. LOOKS LIKE WE MIGHT NEED TO TAKE A COUPLE MINUTES TO LET PEOPLE USE THE FACILITIES. OKAY. WE'LL START AT 3:30. WELCOME TO PANEL 3. NOVEL INTERVENTION AND PREVENTION STRATEGIES. WE HAVE FOUR PANELISTS TODAY. AND WE'RE VERY EXCITED TO HAVE THESE PANELISTS HERE. SO LAURA -- AT THE CONNECT SCHOOL OF MEDICINE USC AND DIRECTOR OF THE NATIONAL CENTER ON ELDER ABUSE. DAVID BURNS IS ASSISTANT PROFESSOR OF TORONTO, AFFILIATE SCIENTIST AT RESEARCH INSTITUTE AT BAY CREST. MARYANN DUTTON, PROFESSOR DEPARTMENT OF PSYCHIATRY GEORGETOWN UNIVERSITY AND ASSOCIATE CENTER FOR TRAUMA AND COMMUNITY. AND ELIZABETH SKOWRON IS PROFESSOR OF COUNSELING PSYCHOLOGY AND RESEARCH SCIENTIST PREVENTION SCIENTISTS INSTITUTE UNIVERSITY OF OREGON. BY WAY T ORDER OF PRESENTATION IS GOING TO BE DAVID FIRST, MARYANN BUTT DUTTON, ELIZABETH THEN ENDING WITH YOU, LAW R. THE PANEL THREE GOAL WAS TO DISCUSS FINDINGS FROM EVIDENCE BASED PROGRAMS TO REDUCE ELDER ABUSE. AND ALSO TO DRAW FINANCIAL INSIGHTINGS FROM THE CHILD ABUSE LITERATURE THAT MIGHT INFORM ELDER ABUSE INTERVENTION RESEARCH. SO THE FIRST QUESTION RELATES TO SUCCESSFUL STRATEGIES FOR PREVENTING ABUSE AND RECURRENCE AND ALSO ARE THERE SPECIFIC MODES OF INTERVENTION THAT HAVE FOUND TO BE SUCCESSFUL IN THE CHILD ABUSE LIT TRAY WHICH YOU HAVE SUCH AS HOME VISITATION OR COMMUNITY BASED INTERVENTIONS OR COMPUTER MOGUL TECHNOLOGY THAT'S USEFUL IN TERMS OF ELDER ABUSE. THEN WE HAVE THESE QUESTIONS AS WELL. WHAT STRATEGIES ARE GOING TO BE SUCCESSFUL FOR GETTING TO -- PEOPLE TO PARTICIPATE IN INTERVENTIONS AND STAY ENGAGED OVER TIME. AND FINALLY, HOW DO WE MEASURE WHETHER INTERVENTIONS ARE SUCCESSFUL? SO I HAVE HERE JUST A FEW BRIEF SUMMARY SLIDES TO START US THINKING ABOUT THE FIELD. SO IN CHILD MALTREATMENT, THERE ARE A NUMBER OF INTERVENTIONS THAT TEND TO TARGET THOSE AT RISK AND FOCUS ON PARENTAL RISK FACTORS SUCH AS ALCOHOL SUBSTANCE ABUSE, ET CETERA AND PARENTS SCREENING THE SOCIAL WORKERS IS IMPORTANT. THEORY DRIVEN INTERVENTIONS THAT TARGET A LIMITED NUMBER OF CAUSAL FACTORS FOUND TO BE MORE SUCCESSFUL. THERE'S EDUCATIONAL BEHAVIORAL SUCH AS COGNITIVE BEHAVIORAL, HOME VISITS AND SPECIALIST, TECHNOLOGY. AND DOMESTIC VIOLENCE AND IPV A NUMBER OF TRAINING PROGRAMS SUCH AS ASSERTIVENESS, RESISTANCE TRAINING, TEAM DATING VIOLENCE HAVE BEEN SUCCESSFUL. AND IT'S IMPORTANT TO LOOK AT VIOLENCE PREVENTION ACROSS THE LIFE STAGE. IN THE COMMUNITY, WE HAVE VERY FEW EVIDENCE BASED PREVENTION INTERVENTIONS STRATEGIES. THE LITERATURE SUGGESTS WE FOCUS INTERVENTION ON THE DYAD, INITIATOR AND THE VICTIM, TARGET SCREENING THOSE AT RISK. HAVE A MULTI-DISCIPLINARY, MULTI-DIMENSIONAL APPROACH AND INTERVENTIONS TARGETED TO DIFFERENT TYPES OF ABUSE AND NEGLECT, CONSIDERATION OF SETTING CHARACTERISTICS OF INITIATOR AND VICTIM AND RELATIONSHIP ROLE AND CULTURAL FACTORS. SO HERE ARE EXISTING PROGRAMS, DAY CARE SHELTERS FOR COMMUNITY RESIDENTS, HOTLINES HELP LINES. MULTI-DISCIPLINARY TEAMS. I HAVE BEEN INVOLVED IN SOME PRERIMNARY EVALUATION OF THE NEW YORK MDT LOOKING USING A KIRKPATRICK MODEL TO LOOK ATLANTA TUESDAYS PERFORMANCE IMPACT. AND THERE WE HAD A GROUP THAT GOT MDT AND CASES THAT DIDN'T GET MDT AND WE HAD TO USE COMPLEX MODELING BECAUSE THE GROUPS ARE TYPICALLY NOT BALANCED. WE SHOWED IMPACT IN TERMS OF SERVICES SECURED AND LEGAL SERVICES. AND INSTITUTIONS I HAVE BEEN INVOLVED WITH EVALUATION OF RESIDENT TO RESIDENT TRAINING PROGRAM, EVIDENCE BASIS IS AVAILABLE FOR CM, CREDITS MANY NURSING AND FOUND TO INCREASE RECOGNITION REPORTING AND KNOWLEDGE. IS WHAT ARE THE PROBLEMS? FEW DESIGN, SMALL RCTs, NO -- POOR MEASURES INADEQUATE ANALYSIS, POOR COMPLIANCE RESPONSE AND RETENTION RATES THAT'S ALL. FINALLY MY LAST SLIDE MEASURING SUCCESS, WEAL DISCUSS PROCESS AND OUTCOME MEASURES. FOR EXAMPLE, RECOGNITION DOCUMENTATION, ALSO SERVICE ACCEPTANCE, GOAL DEVELOPMENT FOR GOAL ATTAINMENT SCALING. AND ALSO ACTION OUTCOMES REDUCTIONS AND RECURRENCE. REDUCTIONS AND ADVERSE EVENTS AND COST EFFECTIVENESS. SO THE ONLY THING I WILL SAY INTERESTING IS TWO STUDIES THAT FOUND RECURRENCE IN THE INTERVENTION GROUP CONTRASTED WITH THE USUAL CARE. WE NEED TO THINK ABOUT IT. IS THE THIS REALLY GREATER RECURRENCE OR BETTER REPORT SOMETHING SOMETHING TO DISCUSSED SONOID LIKE TO HAVE DAVID BURNS COME UP. >> THANKS FOR HAVING ME HERE TODAY, VERY EXCITING TO BE HERE. I WILL FOCUS MY TALK TODAY ON DIRECT RESPONSE PROGRAM INTERVENTION RESEARCH, THESE ARE PROGRAMS IN THE COMMUNITY THAT RESPOND AND WORK DIRECTLY WITH ELDER MISTREATMENT VICTIMS MANY A SECONDARY PREVENTION ROLE. INCLUDING FOR MOST OF THE COUNTRY PROTECTIVE SERVICES, HOWEVER IN SELECT AREAS SUCH AS NEW YORK STATE THERE ARE ALSO OTHER SEPARATE COMMUNITY BASED PROGRAMS THAT WORK WITH ELDER ABUSE CASES, REGARDLESS OF ADMINISTRATIVE STRUCTURE, THESE PROGRAMS SHARE AN OVERALL CENTRAL GOAL OF TO PREVENT OR REDUCE RISK OF VICTIMIZATION AND THE EXTENT TO WHICH A PROGRAM REDUCES THIS RISK OF REVICTIMMIZATION REPRESENTS THE KEY PROGRAM CASE OUTCOME AND RESEARCH WHICH IS GIVEN VARY YOURS NAMES INCLUDING LEVEL OF CASE RESOLUTION OR RISK ALLEVIATION. I WOULD LIKE TO DRAW YOUR ATTENTION BRIEFLY TO A CONCEPTUAL PRACTICE MODEL, THAT IS IN PERHAPS THE GERONTOLOGY GIST RIGHT NOW, JUST TO HIGHLIGHT SOME KEY IDEAS THAT OUGHT TO SHAPE SOME OF THE WAY WE DESIGN RESEARCH IN THIS AREA TO BEGIN UNLIKE CHILD PROTECTIVE SERVICES THESE ARE VOLUNTARY. OLDER ADULT WHOSE ARE COGNITIVE LY INTACT AND THIS MODEL THAT WAS WORKING WITH COGNITIVE INTACT WITH OLDER ADULTS. THEY CAN CHOOSE TO ACCEPT SERVICES COMPLETELY PARTIALLY OR REFUSE SERVICES ALL TOGETHER. AND UNDERUTILIZATION OR REFUSAL OF SERVICES IS MAJOR PROBLEM. SECOND, OLDER ADULTS HAVE A RIGHT TO SELF-DETERMINATION. WHICH MEANS THAT OLDER ADULTS HAVE THE RIGHT TO DETERMINE THEIR OWN COURSE OF ACTION AND MAKE THEIR OWN DECISIONS EVEN IF THEY IMPEDE OR COUNTER ACT THE GOAL OF RISK OF ALLEVIATION. AND TO APPLY A EPIDEMIOLOGICAL DIRECT RESPONSE PROGRAMS OPERATE WITHIN A POST MODERN OR CONSTRUCTIVIST PRACTICE PARADIGM. A PARADIGM THAT ACCEPTS MULTIPLE AND INDIVIDUALLY CONSTRUCTED REALITIES. IN THIS PRACTICE PARADIGM WE ACCEPT VARYING SELF-CONSTRUCTED VERSIONS OF WHAT THE PROBLEM MEANS WHAT AN APPROPRIATE SOLUTION OR CONSTRUCT OF CASE RESOLUTION LOOKS LIKE AND WHAT PASSIVE INTERVENTION OR MEANS OF REACHING THAT SOLUTION MIGHT LOOK LIKE. I WILL EXPLAIN THIS A LITTLE MORE. >> IN SOME OTHER AREAS OF RESEARCH THAT DEAL WITH DIFFERENT PROBLEMS THIS IS HOW WE MIGHT APPROACH AN INTERVENTION DEVELOPMENT THROUGH A STANDARDIZED PROCESS INVOLVING A PRE-FIXED DEFINITION WHAT THE PROBLEM MEANS THAT DIRECTS THE CLIENT THROUGH A MANUALIZED SERIES OF STEPS THAT ASSUME AS PREDICTABLE STOVAINES AND TRAJECTORY OF CHANGE AND DIRECT IT IS CLIENT TOWARDS A UNIFORMLY DEFINED OUTCOME CAUSE OF SUCCESS AND MANUALIZED TREATMENT PROCESS IS MEANT TO BE REPLICATED ACROSS CASES, HOWEVER THOSE OF US DOING RESEARCH IN THIS CONTEXT WE KNOW A LINEAR APPROACH SIMPLY DOESN'T FIT. IN THE ELK DERMIS TREATMENT CONTACT THERE'S A NEED FOR RESPONSE PROGRAM MODEL ACCOMMODATING DIFFERENT NON-LINEAR INTERVENTION PATH AND TRAJECTORY OF CHANGE AND DIFFERENT SETS OF NEEDS ACROSS CASES. SERVICE PLANS ARE UNIQUELY DEVELOPED AROUND CLIENT SPECIFIC NEEDS AND SERVICE PLANS ACROSS CASES ARE MORE DIFFERENT THAN SIMILAR. AND THAT'S NOT TO SAY THAT SOME CASES DO NOT SHARE SIMILAR NEEDS. AND THIS IS WHERE I SEE AN OPPORTUNITY TO DEVELOP MORE STANDARDIZED INTERVENTIONS, INTERVENTIONS THAT TARGET SPECIFIC ISSUES, NOT THE CLIENT POPULATION IN GENERAL. IN OTHER WORDS, ANY ONE INTERVENTION CANNOT BE APPLIED TO ALL CASES, HOWEVER, SELECT INTERVENTIONS COULD BE APPLIED AS A COMPONENT IN SEVERAL CLIENT SERVICE PLANS THAT SHARE A SIMILAR NEEDS. AGAIN WITH MANY PROBLEMS IN OTHER -- IN OTHER AREAS OF CENTRAL CONSTRUCT VIEWED AS UNIFORM ACROSS CLIENTS. AND WHEN WE DEAL WITH UNIFORM OUTCOME CONSTRUCT ACROSS CLIENTS IT MAKES SENSE TO USE STANDARDS SCALES OR MEASURES THAT APPLY THE SAME ITEMS ACROSS CLIENTS. I'M A QUANTITATIVE GUY WITH A DEGREE IN MATH I LOVE SKILL DEVELOPMENT BUT I HAVE TO RESTRAIN MYSELF IN THIS CONTEXT BECAUSE IT MIGHT NOT BE THE RIGHT FIT IN CASE OF ELDER MISTREATMENT RESPONSE PROGRAMS WE DEAL WITH HETEROGENEOUS CONSTRUCT, IN TERMS OF HOW SUCCESS IS DEFINED AND DIFFERENCE ACE CROSS CASES IN REGARDS TO THE SALIENT CIRCUMSTANCES AND INDICATORS OF RISK INFORMING THE CONDUCT OF RISK ALLEVIATION. SO THIS IS A NEED FOR CLIENT CENTERED OUTCOME MEASURES DETECTING AND TRACKING INDIVIDUALLY RELEVANT RISK INDICATORS CAPTURING INDIVIDUALIZED TRAJECTORIES OF CHANGE AND CAPABLE OF ACCOMMODATING OUTCOME FLEXIBILITY AND GOAL ATTAINMENT IS ONE SUCH STRATEGY THAT ADDRESSES THESE NEEDS, FEASIBILITY RELIABILITY VALIDITY AND RESPONSIVENESS IN SEVERAL FEELS INCLUDING GERIATRIC TRICK ASSESSMENT AND REHABILITATION. THE IDEA OF ADAPTING SCALING INTO THIS CONTEXT WAS ORIGINALLY CONCEIVED BY DR. MARK LACHS. WE ARE CURRENTLY INVOLVED IN A PROJECT NOW TO IMPLEMENT THIS IN A DIRECT RESPONSE PROGRAM. THANK YOU. [APPLAUSE] >> CAN YOU RETRIEVE MY SIGN UP THERE? OKAY. I WOULD LIKE TO INTRODUCE MARYANN NOW IF YOU COULD COME UP. >> DAVID, I WANT TO SAY ALTHOUGH YOU ARE APPLYING THAT TO GERONTOLOGY I WOULD HAVE LOVEED THAT TALK IF YOU WERE TALKING ABOUT IPB AS WELL. MY AIM HERE IS TO TAKE SOME OF WHAT I THINK WE HAVE LEARNED IN THE IPV WORLD AND SUGGEST WHAT WE MIGHT LEARN IN THE ELDER ABUSE WORLD. SO IN -- GOING TO GIVE YOU THE OVERVIEW FIRST, I THINK THAT IN THE SCREENING CONTEXT NAMING THE PROBLEM CAN ACTUALLY BE THE FIRST STEP TO CHANGE AND BY SCREENING WE'RE ESSENTIALLY PUTTING A LABEL ON, WE'RE ASKING PEOPLE ABOUT A PHENOMENA THAT ACTUALLY EXISTS AND FOR SOME PEOPLE CERTAINLY IN THE IPV WORLD THE FACT THAT SOMEBODY KNEW TO ASK, KNEW THERE WAS A NAME, ACTUALLY MADE A DIFFERENCE AND STARTED A CHANGE PROCESS, I'LL TALK MORE ABOUT THAT IN A MINUTE. LIKE IPV, MANY PEOPLE SAID THIS ALREADY BUT ELDER ABUSE AND NEGLECT CERTAINLY WITHIN FAMILY AND PROBABLY GENERALLY, IS BOTH A PATTERN OF INTERACTION, NOT DISCRETE EVENTS, AND IT OCCURS WITHIN COMPLEX RELATIONSHIPS. THAT CERTAINLY APPLIES TO THE FAMILY BUT PERHAPS ALSO IN LONG TERM CARE FACILITIES. INCORPORATING ATTENTION TO THE TRAUMATIC EFFECTS OF ABUSE AND NEGLECT, ARE KEY TO INTERSECTION FOR BOTH VICTIM AND THE PERPETRATOR. I'LL TALK MORE ABOUT THAT. FINALLY COORDINATING COMMUNITY RESPONSE A CONCEPT WITHIN IPV INTEGRATED CARE OR INTERDISCIPLINARY WORK MIGHT BE ANOTHER WAY TO THINKABLE OF IT, BEST PRACTICE WITHIN THE IPV WORLD EQUALLY APPLIES HERE. SO IN TERMS OF THE NAMING THE PROBLEM, UNIVERSAL SCREENING HAS BECOME THE AT LEAST IN NAME ON PAPER THE STANDARD OF CARE, NOT EXACTLY IN PUBMED THAT WAY ALWAYS. BUT UNIVERSAL SCREENING AS INTERVENTION HELPS TO IDENTIFY BUT ALSO EDUCATE. I BELIEVE REALLY NEEDS TO BE THOUGHT OF NOT SIMPLY THE IDENTIFICATION PART OF ASSESSMENT OR SIMPLY SCREENING BUT IS ITSELF AN INTERVENTION. THIS EMPIRICAL STUDY SUGGESTS SCREENING ALONE HELPS REDUCE RECURRENCE OF VIOLENCE IN IPV. IT MAY BE THE CASE WITH ELDER ABUSE AN IN THE IPV WORLD THERE'S MUCH LESS PROGRESS IN SCREENING, QUOTE, PERPETRATORS BUT CERTAINLY I THINK IT'S POSSIBLE TO CONCEIVE BY ASSESSING SCREENING CAREGIVERS AS WELL AS, QUOTE, VICTIMS MAY WELL SERVE SIMILAR EDUCATIONAL PURPOSE AS WELL. SCREENING PROVIDES A VALIDATION CERTAINLY FOR THE VICTIM. THAT THIS BEHAVIOR, THIS PROBLEM IS CONCERN SOMEONE CARES ABOUT IT. IT HAS AN OPPORTUNITY NOT ALWAYS IN PRACTICE BUT CERTAINLY THE OPPORTUNITY TO PROVIDE SUPPORT AND CERTAINLY PRESENT THE DOORWAY TO INTERVENTION. AND IT'S BEEN MENTIONED BUT I WANT TO SAY IT AGAIN BECAUSE IT'S SO IMPORTANT, SCREENING ALONE MAY WELL BE HARMFUL OR CERTAINLY MAY NOT BE HELPFUL AND I THINK THAT LIKE IN THE IPV WORLD WITH ELDER ABUSE, IT'S ESSENTIAL TO PROVIDE AN ENTRE TO THE NEXT STEP, DOESN'T MEAN THAT THE ER DOC OR PRIMARY CARE PHYSICIAN OR THAT PERSON CAN HIM OR HERSELF PROVIDE THAT INTERVENTION BUT I BELIEVE THAT THAT MAY BE THE ONE OPPORTUNITY TO GET INTERVENTION TO THIS INDIVIDUAL. ELDER ABUSE AND NEGLECT IS A COMPLEX PHENOMENON. WE HEARD THAT. CERTAINLY. IT MAY INCLUDE SOME COMBINATION OF PHYSICAL ABUSE, SEXUAL VIOLENCE, PSYCHOLOGICAL ABUSE NEGLECT. BUT IF THE IPV WORLD, MORE ATTENTION NOW TO THE CONCEPT OF COERCION, THE NOTION THAT ONE CAN IN ESSENCE MAINTAIN THE LEVEL OF CONTROL OR INFLUENCE, IF YOU WILL, BASED ON MAYBE EVEN JUST ONE ACT OF A PHYSICAL ABUSE OR ONE ACT OF NEGLECT. IF WE NEGLECT TO CONSIDER COERCION AS PART OF THAT PATTERN WE MAY WELL MISS MUCH OF THE ICEBERG WE SAW BELOW. WE HAVE ALSO IN OUR OWN RESEARCH FOUND COERCION INDEPENDENT OF THESE OTHER TYPES OF IPV IN THE PATTERN CONTRIBUTE TO INCREASE MENTAL HEALTH OUTCOMES. SO NOT JUST ANOTHER NAME FOR THE SAME THING, NOT I HAVE KIND OF PSYCHOLOGICAL ABUSE BUT IT CONTRIBUTES INDEPENDENTLY TO THE OUTCOME. THIS PATTERN CERTAINLY IN THE FAMILY EXISTS A COMPLEX INTERACTIONAL CONTEXT SO IF WE DON'T GO OUTSIDE THE FAMILY, THE ATTACHMENT RELATIONSHIP, THE DEPENDENCY ON THE CAREGIVER PERHAPS AND HISTORY OF POTENTIAL PRIOR ABUSE AND NEGLECT ALL WHICH MAKE THE THIS WHOLE PHENOMENA AS WE WILL RECOGNIZE, MUCH MORE COMPLEX. IT IS IN THAT CONTEXT THAT IN THE IPV WORLD WE ASK THE QUESTION WHY DIP SHE JUST LEAVE? WHY DIDN'T SHE REPORT IT TO THE ER DOC WITH THAT BROKEN ARM? I THINK THE ANSWER TO THIS REST WITNESS SOME OF THIS COMPLEXITY. WHAT ABOUT INTERVENTION? IN THE IPV WORLD WE KNOW THERE NEEDS TO BE SEVERAL KINDS OF INTERVENTIONS OR INTERVENTIONS THAT TARGET SEVERAL DIFFERENT OUTCOMES AT THE SAME TIME. PHYSICAL SAFETY IS A CONCERN, FOR VICTIMS THAT'S NOT THE FRY MARE CONCERN BECAUSE KEEPING THE FAMILY TOGETHER, PROTECTING THEIR CHILDREN, MAINTAINING A PLACE TO LIVE SOMETIMES IS MORE IMPORTANT THAN THE NEXT BEATING, AS DIFFICULT AS THAT MAY BE TO RECOGNIZE. THERE HAS TO BE ATTENTION TO THAT ACTUAL PHYSICAL SAFETY. THE HOW OF THAT, I THINK THERE ARE MANY ANSWERS TO THAT, BUT I LOVE THE IDEA OF TECHNOLOGICAL MONITORINGS. Q. I SEE THAT. YES. FINALLY EMBEDDING THE CARE WITHIN INTEGRATED APPROACH, THE COMMUNE THETY COORDINATED RESPONSE, THE COMMUNITY AUDITS IN THE IPV WORLD HAVE SHOWN WHERE THERE ARE GAFFE ARE GAPS IN SERVICE, IT'S USEFUL TO FIND BY LOOKING AT NETWORK OF SERVICES THAT COULD HAVE BEEN PROVIDED ACROSS SETTINGS. [APPLAUSE] >> THANK YOU. >> THANKS SO MUCH FOR INVITING ME TO COME TALK AT THIS CONFERENCE, I LEARNED A GREAT DEAL ABOUT THIS AREA THAT I HAVE KNOWN LITTLE ABOUT. ARE'S GET STARTED BECAUSE MY TIME HAS STARTED. LET ME JUST SUMMARIZE FROM FIELD OF CHILD TREATMENT RESEARCH WHAT WE LEARNED THAT MAY OR MAY NOT BE USEFUL TO YOU, YOU EXTRAPOLATE HERE WITH ME, FIRST OF ALL IN THIS SLIDE I'M SHOWING YOU THE FIELD OF CHILD MALTREATMENT PREVENTION INTERVENTION HAS A NUMBER OF VERY, VERY EFFECTIVE EVIDENCE BASED PROGRAMS THAT RESULTED FROM A LONG PROGRAM OF RESEARCH. THE EFFECTIVE PROGRAMS THAT PREVENT CHILD ABUSE AND NEGLECT, THE FOUR -- BEFORE IT OCCURS HAVE THESE COMPONENTS AT THEIR CORE. SO THERE ARE A LOT OF DIFFERENT PREVENTIVE INTERVENTIONS, ALL OF THEM HAVE THESE -- THE MOST EFFECTIVE ONES HAVE THESE COMPONENTS, SO THEY FACILITATE KNOWLEDGE OF CHILD DEVELOPMENT, PROMOTE PARTS' EMOTIONAL COMPETENCE, FOSTER STRONG SOCIAL CONNECTIONS FOR PARENTS, THEY PROVIDE TANGIBLE CONCRETE SUPPORTS FOR PARENTS AND FAMILIES AND TYPICALLY LAST AT LEAST SIX MONTHS OR LONGER. SOP LET'S MOVE ON TO CHILD ABUSE OR NEGLECT HAS OCCURRED. IN THE FIELD WE KNOW WE HAVE A NUMBER OF GREAT EFFECTIVE INTERVENTIONS FOR CHILDREN EXPOSED TO ABUSE AND NEGLECT. THERE MAYBE THINGS LEARNED FROM THESE EFFECTIVE INTERVENTION, THIS IS A SMALL SLICE OF THE KINDS OF CHILD PROBLEMS THAT GET RESOLVED AMELIORATED AND PROVED AS A FUNCTION OF THESE VARIETY OF INTERVENTIONS. HOWEVER, I WOULD SAY THAT THERE ARE VERY FEW INTERVENTIONS DEVELOPED IN OUR FIELD TO WORK EFFECTIVELY WITH PERPETRATORS OF CHILD ABUSE AND NEGLECT AFTER THEY HAVE ALREADY BEGUN TO ABUSE AND NEGLECT. SO MY KNOWLEDGE THERE'S ONE FOUND TO BE EFFECTIVE, IN A COUPLE OF RANDOMIZED CONTROL TRIALS, THAT WOULD BE THE LATE MARK CHAFFIN AND HIS COLLEAGUES AND THEIR RCTs OF PARENT CHILD INTERACTIONTHER THERAPY, CAUCASIAN FAMILIES AFRICAN AMERICAN LATINO AND NATIVE FAMILIES AS WELL. SO WHY ARE OUR INTERVENTIONS NOT EFFECTIVE FOR PERPETRATORS AFTER THEY PERPETRATED? THERE ARE A NUMBER OF RISK FACTORS THAT WE KNOW ARE PRESENT FOR PEOPLE AT RISK FOR ABUSING AND NEGLECTING THEIR KID DOES, THIS IS A SMALL SAMPLING OF RISK FACTORS MENTAL HEALTH PROBLEMS, NEGATIVE CHILD ATTRIBUTIONS WHICH I WON'T GO INTO NOW. ALSO WE SEE EMOTIONAL REACTIVITY AND ACTUALLY AUTONOMIC PHYSIOLOGICAL REACTIVITY IN THESE PARENTS. THIS IS A LIST THAT PARALLELS THE LIST I THINK THAT I HAVE SEEN FOR RISK FACTORS FOR PERPETRATING ELDER MALL TREATMENT. I THINK IN MY OPINION RISK FACTORS CLUSTER IN THIS UNDERLYING DIFFICULTY OR DEFICITS IN SELF-REGULATION. AND I THINK THIS KIND OF PERSPECTIVE ALIGNS NICELY WITH RDOC APPROACH THAT NIMH IS TAKING. SO I WILL DEEP DIVE INTO A LITTLE BIT OF OUR RESEARCH, LET ME BACK UP A LITTLE BIT OF OUR RESEARCH THAT'S TRIED TO UNDERSTAND SOME CAUSAL PATHWAYS TO PERPETRATION OF CHILD MALL TREATMENT, SO WE HAVE BEEN DOING SOME WORK AT OUR LAB WHERE WE ARE MONITORING IN A MOMENT BY MOMENT WAY MOTHER MALL TREATING MOTHER AND CHILD INTERACTIONS THESE ARE PRE-SCHOOLERS AND THEIR MOTHERS WHO HAVE DOCUMENTED CASES OF ABUSE AND/OR NEGLECT AND WE MONITOR INTERACTIONS AND SIMULTANEOUSLY MONITOR AUTONOMIC PHYSIOLOGY. I WANT TO SHOW YOU A COUPLE OF FINDINGS HERE, ONE THING WE FIND IN PHYSICALLY ABUSIVE MOTHERS WHO PHYSICALLY ABUSE, THEY MAY ALSO BE NEGLECTING EMOTIONALLY MALL TREATING BUT PHYSICALLY ABUSIVE WE FIND A LINK BETWEEN INCREASES IN POSITIVE PARENTING MANY THE MOMENT AND SIMULTANEOUS INCREASES IN PHYSIOLOGICAL AROUSAL. IF I'M PHYSICALLY ABUSIVE MOM AND I'M DOING MORE THAT GOOD POSITIVE PARENTING I'M GETTING MORE PHYSIOLOGICALLY AROUSED AS I'M I'M DOING THIS. THE SECOND PIECE WE SEE IS WHEN I GET MORE ROWED, THE IF I'M PHYSICALLY ABUSIVE AS A PARENT THEN 30 SECONDS LATER YOU CAN SEE ME GET MORE HARSHLY CONTROLLING TOWARD MY CHILD. THE SECOND THING -- SO THIS IS A PROFILE THAT IS SHOWING THESE PARENTS MAY HAVE A PHYSIOLOGY THAT WORKS AGAINST OUR EFFORTS AT INTERVENTION BUT I HAVE A POSITIVE SIDE OF THING, A HOPEFUL SIDE, THAT IS A DIFFERENT PATTERN WE HAVE SEEN IN PHYSICALLY NEGLECTING PARENT WHOSE ARE NOT PHYSICALLY ABUSIVE BUT NEGLECTING, THAT'S THE VAST MAJORITY OF THE CHILD WELFARE POPULATION WE SEE PHYSIOLOGY BEHAVIOR LINK THAT ACTUALLY WORKS WITH US IN TERMS OF OUR INTERVENTIONS WHAT WE SEE HERE IS WHEN WE SEE NEGLECTING MOTHERS SHOW MORE POSITIVE PARENTING RIGHT NOW, 30 SECONDS LATER THEIR PHYSIOLOGY LOOKS CALMER. LIKE THEY ARE REINFORCED IF YOU WILL, PHYSIOLOGICALLY DOING MORE GOOD STUFF AND CONVERSELY WHEN THEY SHOW INCREASES IN THE MOMENT IN THEIR HARSH AVERSIVE PARENTING, 30 SECONDS LATER THEIR PHYSIOLOGY GETS MORE AROUSED. THEY'RE GETTING MOBILIZED. THIS IS A PATTERN THAT SUGGESTS FOR A LARGE PORTION OF FAMILIES WE WORK IN W IN THE CHILD WELFARE SYSTEM, THAT WE SEE A PATTERN OF PHYSIOLOGY AND BEHAVIOR THAT WOULD SUPPORT THE INTERVENTIONS WE WANT TO USE WITH THEY WILL. I'M DONE. THAT'S IT. [APPLAUSE] >> OKAY. LAW REMARKS READY? >> NO SLIDES. AS A NOD TO THE ATTORNEY GENERAL AND IN MY NEVER ENDING QUEST TO PREVENT PRESSURE SORES OF ANYBODY WE SHOULD STAND WHILE I'M SPEAKING YOU'RE WELCOME TO DO SO. I HEARD THE QUESTION WHAT ARE WE GOING TO DO ONCE WE IDENTIFY VICTIMS AND PERPETRATORS WHICH IS A GREAT QUESTION TO ASK. BUT WHAT I CAN TELL YOU IS ALL ACROSS THE COUNTRY, PEOPLE HAVE COME UP WITH HOME GROWN RESPONSES AN INTERVENTIONS SO WHAT'S HAPPENING WHETHER WE KNOW IT OR LIKE IT OR NOT. SO SOME OF THE RESPONSE VERSUS CAUGHT ON, WE HAVE FIDUCIARY ABUSE SPECIALIST ACROSS THE COUNTRY, ELDER ABUSE CENTERS OR VARIATIONS THEREOF, THERE ARE ELDER DEATH REVIEW TEAMS SOMETIMED CALLED FATALITY RESUE TEAMS BUT I DON'T LIKE THE WAY THAT SOUNDS WHEN YOU SAY IT OUTLOUD. THINK ABOUT IT. THEN THERE ARE OTHER THINGS MORE SINGULAR. SO THERE ARE FRIENDLY VISITORS, THE SERVICE CORPS, THAT KERRY BURNIGHT DEVELOPED BUT EVEN FAST TEAMS, THE SPECIALIST TEAMS THEY'RE ALL SINGULAR TOO, WE HAVE NO COMMON WAY THAT EVERYONE OF THEM OPERATES WHICH MEANS IF YOU STUDY ONE YOU STUDY ONE. AND ACTUALLY NONE OF THEM HAVE REALLY BEEN PROVEN TO BE EFFECTIVE AND EFFICIENT. BUT THE FACT THAT SO MANY OF THEM HAVE POPPED UP ALL ACROSS THE COUNTRY, IS SOMEWHAT SIMILAR WAYS TELLS US SOMETHING AND TELLS US THERE'S A NEED TO BE FULFILLED. HAS MARIE THERESE CONNOLLY SAID YOU CAN HAVE FERVENT CONVICTIONS BUT THESE ARE NOT GOOD PRACTICES OR POLICY AND IN FACT AS WE LEARNED FROM COLLEAGUES IN IPV AND CHILD ABUSE, WITH THE BEST OF INTENTIONS, WE MAY END UP WITH BAD PRACTICE AND BAD POLICY WHICH CAN BE VERY HARD TO CHANGE. SO YOU NEED INFRASTRUCTURE TO STUDY CURRENT AND REALLY HELP IN ANY PROPOSED NEW MODELS SO WE UNDERSTAND WHETHER OR NOT THESE INTERVENTIONS ARE MEETING THEIR GOALS. ALSO AS WAS SAID EARLIER, ELDER ABUSE IS OFTEN NOT AN OFF AND ON ALL OR NONE PRESENCE OR ABSENCE PHENOMENON, SOME CASES ARE REALLY CLEAR, DISCREET EVENTS BUT THOSE IN THE FIELD KNOW CASES OF ELDER ABUSE ARE ONGOING MONTHS OR YEARS AND THE DEGREE, THE FREQUENCY, THE MAGNITUDE VARIES AS A DYNAMIC PROCESS. AND THEREFORE, I ARGUE THAT WE DO NEED LONGITUDINAL STUDIES IN ORDER TO UNDERSTAND THIS PHENOMENON ESPECIALLY IF YOU WANT TO GET TOWARD PREVENTION AND INTERVENTION. I ALSO WANT TO MENTION THERE'S A TOOL WE USE CALLED THE ABUSE INTERVENTION MODEL. AND IT LOOKS AT KNOWN OR KIND OF BEST GUESS RISK FACTORS AND PROTECTIVE FACTORS IN THREE DOMAINS. THE DOMAIN OF OLDER ADULT BEING VICTIMIZED OR AT RISK, THE DOMAIN OF TRUSTED OTHER, AND THE CONTEXT OF THEIR SITUATION. WHAT WE THEN DO IS WE LOOK FOR ALL OF THOSE RISK FACTORS THAT ARE EITHER MODIFIABLE, AMENABLE TO CHANGE, THIS IS HOW WE LOOK AT PRY MAY RECALL AND SECONDARY PREVENTION OF ABUSE. BUT I WILL TELL YOU, THIS HAS BEEN A VERY TOUGH PILOT STUDY TO DO, IT'S HARD TO ENROLL PEOPLE, ENROLLING DYADS OF PEOPLE WITH DEMENTIA AND CAREGIVERS AND THE UPTAKE OF INTERVENTION HAS BEEN VERY DIFFICULT EVEN THOUGH EXTREMELY INDIVIDUALIZED. INTERESTINGLY THE NUMBER ONE UPTAKE INTERVENTION IS LEGAL AID. MORE SO THAN THE CARE GIVER COURSE OR ALZHEIMER'S ASSOCIATION, THEY USED THE REACH TOOL KIT, ET CETERA. I THINK THERE ARE MANY OPPORTUNITIES TO USE TECHNOLOGY, I'M TALKING WITH FOLK AT USC CAREGIVERS HOOK UP WITH MONITORS THAT GIVE FEEDBACK REGARDING PULSE AND BLOOD PRESSURE SO FEEDBACK WHEN THEY'RE IN A STRESSFUL SITUATION THAT PERHAPS ARE GOING TO TAKE IT OUT ON A LOVED ONE. SO WE WILL SEE IF THOSE THINGS WORK BUT THERE'S GREAT -- AS STATED EARLIER, GREAT PROMISE WITH USE OF TECHNOLOGY. I THINK WE HAVE TO BE CAUTIOUS THAT MANY OF OUR SUCCESSFUL INTERVENTIONS NEED TO BE DONE BY OTHERS. THESE OTHERS ARE GENERALLY FOLKS LIKE AP S, PHYSICIANS, I HAVE DONE SOME WORK WITH CORONERS AND MEDICAL EXAMINERS, THESE PEOPLE ALREADY FEEL OVERBURDENED. SO IT IS GREATS TO COME UP WITH INTERVENTION BUS THEY HAVE TO BE PRACTICAL DOABLE AND FIGURE WHAT WE TAKE OFF BEFORE WE ADD MORE TO IT. THE OTHER REALLY IMPORTANT PIECE I THINK IS INVOLVEMENT OF COMMUNITY PARTNERS, IT'S ABSOLUTELY KEY IF WE WANT TO DEVELOP PRACTICAL REPLY CASH BALANCE PREVENTION AND INTERVENTION STRATEGIES, THESE PARTNERS ARE GOING TO INCLUDE HEALTH PLANS, ADULT PROTECTIVE SERVICES, MEALS ON WHEELS, HOME AND COMMUNITY BASED SERVICES FOLKS. THIS ISN'T EASY, IT ISN'T EASY TO DO. I MADE THE ANALOGY OF GODZILLA LA VERSUS -- WHEN YOU HAVE A UNIVERSITY LEGAL DEPARTMENT WITH A COUNTY LEGAL DEPARTMENT SO WE NEED HELP WITH GUIDELINES ON THAT, AND I THINK CENTERS ARE ARE THE WAY TO GO IN ORDER TO MAKE THIS WORK. FINALLY I KNOW I'M OUT OF TIME, I WANT TO SAY I HEARD THE FOLLOWING TWO COMMENTS IN THE PAST WEEK. THIS WAS -- WHEN I WAS STANDENING LINE AT THE AIRPORT AT LOS ANGELES INTERNATIONAL, SOMEBODY WAS TALKING OR FRIEND AND SAID REFERRING TO MOTHER, SHE HAS END STAGE DEMENTIA, SHE'S ESSENTIALLY BEEN DEAD THE PAST YEAR. AND THEN THE OTHER COMMENT I HEARD AND THIS WAS BY AN ELECTED FIRM, IT DOESN'T -- OFFICIAL, IT DOESN'T MATTER IF A PERSON WITH ALZHEIMERS IS ABUSED AS MUCH AS A KID IS ABUSED BECAUSE THEY WON'T REMEMBER IT. SO WHAT I WANT TO SAY, HOW WE VIEW OLDER ADULTS MATTERS. AND I THINK IT INFLUENCES THE LIKELIHOOD OF ABUSE AND INFLUENCES OUR RESPONSE TO ABUSE AND I DON'T WANT US TO FORGET THAT. THANK YOU. [APPLAUSE] >> PANELISTS CAN TAKE YOUR SEAT AT THE PANEL TABLE AND TAKE YOUR TABLE WITH YOU. >> LET ME JUST FOR POINT OF INFORMATION, WE ARE A LITTLE BEHIND SCHEDULE. >> I THINK WHAT WE SHOULD DO IS GO UNTIL FIVE O'CLOCK ON THE PANEL AND WE'LL USE THE LAST 30 MINUTES FOR THE WRAP UP SESSION. >> THAT SOUNDS FINE. FIRST QUESTION WE'LL START WITH, I THINK WE'RE GOING TO HAVE MAYBE ELIZABETH OR MARYANN START OFF ON THAT. IT HAS TO DO WITH WHAT ARE SUCCESSFUL STRATEGIES FOR PREVENTING ABUSE BEFORE IT OCCURS, AND PREVENTING RECURRENCE OF ABUSE. AND SO I WAS THINKING THAT PERHAPS WE COULD START WITH A CHILD DOMESTIC VIOLENCE IPP LITERATURE AND GO FROM THERE. >> SO SUCCESSFUL PREVENTATIVE INTERVENTIONS IN THE FIELD OF CHILD MAL TREATMENT. SO THERE ARE A NUMBER OF -- I'M CERTAINLY NOT AN EXPERT IN TERMS OF HAVING ADMINISTERED THESE VARIOUS PROGRAMS MYSELF BUT THERE ARE UNIVERSEAL AND UNIVERSAL PROGRAMS LIKE TRIPLE P POSITIVE PARENTING PROGRAM, THERE'S DAVID OLD NURSE FAMILY PARTNERSHIP. HEALTHY FAMILIES AMERICA. EARLY HEAD START AND HOME VISITATION COMPONENT CHILD FIRST STRENGTHENING FAMILIES, INITIATIVE. WE HAVE EXPERTS HERE IN THE ROOM WHO MIGHT BE ABLE TO WHO MIGHT BE ABLE TO KIEM IN AND ADD SOME OF THEIR EXPERIENCE AS WELL. >> I THINK WE HAVE FEWER KINDS OF INTERVENTIONS TO PREVENT IPV IN THE FIRST PLACE BUT LOOK AT TEEN DATING VIOLENCE LITERATURE THAT'S PROBABLY THE MOST -- THE RICHEST AREA, I DON'T THINK WE HAVE ENOUGH LONGITUDINAL WORK THERE TO KNOW HOW THAT TRANSLATES OVER THE COURSE OF RELATIONSHIP. BUT I DO THINK THERE HAVE BEEN SUCCESSES AND PROXY YOU THINK LONG TERM ADULT RELATIONSHIP PROXY OUTCOMES THAT HAVE INDICATED LIKELY SUCCESS IN AT LEAST HAVING KNOWLEDGE ABOUT PARTNER VIOLENCE AND SO IN TERMS OF HOW THAT GETS PLAYED OUT IN THE COURSE OF THE RELATIONSHIP, AND ALL THE CHALLENGES THAT COME IN REAL LIFE RELATIONSHIP, I THINK WE KNOW LESS ABOUT BUT THAT IS A MODEL WE CAN TAKE SOME LESSONS FROM. >> OKAY. I'M ACTUALLY GOING TO OPEN IT TO THE AUDIENCE. IF ANYBODY HAS ANYTHING THEY WANT TO ADD TO THAT. >> JUST ASPECT ABOUT THE CHILD INTERVENTIONS. SO YOU GAVE AN EXAMPLE OF ONE THAT TARGETED SELF-REGULATION STRATEGIES, AND DYADIC CONTEXT HAVE MOTHER OF CHILD INTERACTING, IS THAT A COMMON PRINCIPLE ACROSS THE EXAMPLES THAT YOU GAVE? ARE THERE COMMON PRINCIPLES OF OR TARGETS ACROSS THE EXAMPLES THAT YOU GAVE THATTING UP SHARE? >> INTERVENING WITH CHILD ABUSE AND NEGLECT AFTER IT OCCURRED IT DEPENDS ON THE TYPE OF MAL TREATMENT, CHILD SEX ABUSE IS DIFFERENT BEAST OFTENTIMES, IT MAY BE LESS LIKELY THAT THERE'S A FAMILY PERPETRATOR, MIGHT BE A PERPETRATOR OUTSIDE THE HOME, WHEREAS THINGS LIKE PHYSICAL ABUSE AND NEGLECT ARE MORE OFTEN PERPETRATED IN THE HOME, PARENTS ARE INVOLVED IN 75, 80% OF THOSE CASES SO DEPENDS NATURE OF THE ABUSE AND WHAT YOU TARGET: WHEN YOU FOCUS ON PHYSICAL ABUSE, AND NEGLECT, WORKING ON PARENTING AND TRYING TO SOFTEN HARSH AVERSIVE PARENTING IS IMPORTANT, PROMOTING MORE POSITIVE GENTLE KINDS OF INTERACTIONS, THOSE KINDS OF THINGS ARE MORE IMPORTANT AND MIGHT NOT BE AS RELEVANT FOR TREATING CHILD SEXUAL ABUSE. I WAS REFERRING TO THE SELF-REGULATION, THE NOTION THAT SELF-REGULATION MAY UNDERLIE SOME OF THE DIFFICULTIES THAT PARENTS AT RISK FOR MAL TREATMENT ARE EXPERIENCING. THERE REALLY ISN'T A LOT OF RESEARCH YET THAT HAS BEEN PUBLISHED THAT DOCUMENTS THE EXTENT TO WHICH THAT'S ACTUALLY THE CASE WE HAVE PROXIES FOR THAT KIND OF INFORMATION. IN TERMS -- AM I TALKING TOO --? SO IN TERMS OF THE -- IN TERMS OF PARENT CHILD INTERACTION THERAPY WHICH IS SHOWN TO ACTUALLY IN FAMILIES WHERE THERE HAVE BEEN MULTIPLE REPORTS, PHYSICAL ABUSE AND PARENT CHILD INTERACTION THERAPY HAS SHOWN THE ABILITY TO REDUCE REABUSE RATES. IN CHAIR SON SERVICES AS USUAL KINDS OF INTERVENTIONS. WE HAVE NIH FUNDING RIGHT NOW TO STUDY PCIT AND EXAMINING UNDERLYING MECHANISMS OF CHANGE, IS IT MOVING PARENT CAPACITIES FOR SELF-REGULATION ON A BEHAVIORAL LEVEL, BIOLOGICAL LEVEL, IS THAT WHY IT'S PRODUCING THESE EFFECTS? SO I DON'T THINK WITH WE HAVE THE ANSWER TO THAT YET BUT I THINK PCIT IS EFFECTIVE IN PART BECAUSE IT IS WORKING WITH FAMILY WHOSE NEED MORE THAN JUST PARENT EDUCATION, THEY NEED MORE THAN A LIGHT TOUCH INTERVENTION AND IT ESSENTIALLY THROUGH A BUG IN THE EAR PROCESS WHERE THE THERAPIST RIGHT THERE, IT INTERRUPTS THE THERAPIST IS INTERRUPTING HARSH AVERSIVE PARENTING RIGHT WHEN IT'S ROLLING OUT THE PARENTS' MOUTH AND SCAFFOLDING AND SUPPORTING THE PARENT IN HELPING PROVIDE POSITIVE PARENTING ALTERNATIVES TO THE PARENT IN THE MOMENT WHILE INTERACTING WITH THE CHILD. IN THAT WAY, I WILL STOP AFTER THIS SENTENCE, IN THAT WAY IT IS IN OUR OPINION AN INTERVENTION THAT IS ACTUALLY STRENGTHENING INHIBITOR CONTROL CAPACITY IN THE ACT OF PARENTING. THAT IS WHY IT IS EFFECTIVE BUT WE DON'T KNOW, WE KNOW IT IS POWERFULLY EFFECTIVE. >> DO YOU SEE ANY APPLICATIONS FOR SAY ELDER ABECAUSE IN >> WE WERE TALK ABOUT THIS IN OUR GROPE FOCUSING THE FAMILY EXAMPLES WHERE ELDER MAL TREATMENT IS HAPPENING. I'M -- IN CERTAIN CASES WHERE CAREGIVERS ARE RELATED FAMILY MEMBERS AND STRUGGLING WITH SOME KIND OF ELDER NEGLECT OR ELDER ABUSE, IT MAYBE -- THIS IS REALLY DRAWING INFERENCES HERE BASED ON A FEW STEPS FROM THE DATA. I THINK IT'S POSSIBLE THAT INTERVENTIONS THAT FACILITATE AND SUPPORT CAREGIVER STRENGTHENING SELF-REGULATION CAPACITY. IN THE CONTEXT RELATION SHILLS WITH IMPORTANT OTHERS, MAY FACILITATE MORE SUPPORTIVE CARE GIVING AND BETTER MANAGEMENT OF FRUSTRATION AND LOSING YOUR TEMPER, I THINK IT MAY HELP WITH NEGATIVE ATTRIBUTIONS THAT YOU MAY MAKE ABOUT ELDER ADULT. DAPHNE BUGENTHAL HAS DONE A LOT OF WORK STUDYING PARENT ATTRIBUTIONS IN MAL TREATING FAMILIES. THESE THREAT BIASED ATTRIBUTIONS THAT PARENTS HAVE THEY SEE THEIR CHILDREN AS MORE POWERFUL CONTROL AND IF CHARGE AND MORE NEGATIVELY FOCUSED THAT PERHAPS DRIVING SOME OF THE HARSH BEHAVIOR YOU SEE, IT MAYBE POSSIBLE THAT'S HAPPENING AS WELL IN SOME ELDER ABUSE. >> CAN I COMMENT ON THE BROADER ISSUE? PREVENTION FROM DRAWING FROM OTHER FIELDS I AGREE WHAT ELIZABETH IS SAYING, SELF-REGULATION IS A PROMISING AREA, MOST MORE PROMISING VIOLENCE PREVENTION PROGRAMS OUT THERE ARE FOCUSING ON SELF-AWARENESS, SELF-REGULATION AND EMPATHY. I WOULD HIGHLIGHT THE ONES THAT HAVE PROBABLY THE BEST OUTCOMES RIGHT NOW. THAT INCLUDES SOCIAL EMOTIONAL LEARNING WHICH INCLUDES THE PROGRAMS YOU WERE TALKING ABOUT BUT IT'S ALSO USED WITH YOUNGER PEOPLE TO TRY TO INTERRUPT CYCLES OR KEEP FROM BEGINNING SEXUAL OFFENDERS OR TEEN DATING VIOLENCE PERPETRATORS SUCCESSFULLY, SOCIAL MARKETING CAMPAIGNS ARE -- CAN BE EFFECTIVE IN TRYING TO INSTEAD OF DO THESE MORE CURRICULUM BASED THINGS MORE COMMUNITY MESSAGING BUT THOSE REALLY ONLY EFFECTIVE IF YOU GET TARGET AUDIENCE INVOLVED IN CREATION OF MATERIALS, THAT IS SLAPPING OF POSTERS AROUND, DON'T BEAT UP ELDERS. BUT IF THERE'S A PROCESS WHERE THAT COMMUNITY GETS INVOLVED THAT CAN HELP REINFORCE VALUES. MINDFULNESS IS TAKING OFF LIKE CRAZY WITH GOOD BEHAVIORAL OUTCOMES FOR AGGRESSION AND NUMBER OF OTHER TARGET AREAS. PROBABLY ONE THAT MIGHT BE ESPECIALLY IMPORTANT FOR THINKING ABOUT FOR ELDER ABUSE ONE OF THE BIGGEST TRENDS IN VIOLENCE PREVENTION IS BYSTANDER PREVENTION. SO IT'S AN IMPORTANT ISSUE THAT SIDE STEP IT IS PROBLEM THAT ALL THIS PSYCHOEDUCATIONAL ROOK OUT FOR BAD GUYS KIND OF STUFF WHICH DOESN'T WORK WELL, PEOPLE DON'T REALLY IDENTIFY WITH THE ROLE VICTIM OR PERPETRATOR MUCH. WE'RE SITTING HERE AND NONE OF US ARE THINKING YEAH, THAT MIGHT BE ME. EVERYBODY FEELS DISTANT FROM THAT, SO THE BYSTANDER PREVENTION IS HELPFUL BECAUSE IT TRIES TO GET PEOPLE TO TAKE OTHER ROLES TO INTERVENE SEEING SOMETHING PROBLEMATIC OR A SPOKESPERSON FOR RESPECTIVE ELDERS THE EQUIVALENT VALUE. SOY THINK THOSE ARE ARE DEFINITELY THINGS THAT COULD BE DRAWN FROM AND ELDER ABUSE PREVENTION AS WELL. >> THANK YOU, ANYBODY ELSE ON THE PANEL WANT THE ADD TO THIS DISCUSSION? >> IN THE IPV WORLD REDUCING POST TRAUMATIC STRESS SYMPTOMS HELPS TO PREVENT REVICTIMMIZATION. SO THAT THE EXTENT -- AND WE ALSO KNOW THAT THE WAY IT DOES IS ACTUALLY THROUGH THE REDUCING AVOIDANCE STRATEGY. SO PERHAPS ADDRESSING SOME OF THE IMPACT OF THE ABUSE ACTUALLY HELPS CREATE GREATER CAPACITY TO PREVENT REVICTIMMIZATION AND ALTHOUGH I DON'T HAVE ANY ACTUAL -- I DON'T THINK EVIDENCE THAT SUPPORTS THIS, JUST SCREENING MANY THE IPV WORLD EXTENT TO WHICH VICTIMS WOULD SAY I NOW KNOW IT'S WRONG, MY DOCTOR ASKED ME AND JUST THAT KNOWLEDGE AND AWARENESS THAT SOMEBODY ELSE IS SAYING THIS ISN'T OKAY, I THINK MIGHT SIMPLE AS IT SOUNDS, BE SOMEWHAT >> MIGHT HAVE SOME EFFECT IN TERMS OF ELDERS WHO MIGHT OTHERWISE THINK THEY LITERALLY HAVE NO OPTIONS BECAUSE THEY'RE DEPENDENT. >> CAN I ADD -- YOU HAVE ASKED ELIZABETH ABOUT APPLICATIONS FOR ELDER ABUSE, THE TECHNOLOGY MONITORING WHAT'S GOING ON. JUST WANT A QUICK EXAMPLE NOT DIRECTLY RELATED TO ELDER ABUSE BUT COLLEAGUE OF MINE JUDY MATTHEW AND RICH SCHULTZ RECEIVED AN R-21, A LITTLE MONEY USING FIRST PERSON VISION TECHNOLOGY AMONG DEMENTIA CAREGIVERS SO WE ENROLL -- IT WAS TOUGH TO GET PEOPLE TO ENROLL BUT THEY WORE A DEVICE WHERE YOU CAN SEE FROM THE CAREGIVER PERSPECTIVE WHAT WAS GOING ON TRYING TO HELP DEMENTIA PATIENT. IT WAS -- THE IDEA WAS TO RECORD THOSE VIDEOS AND THE PERSON SITS DOWN WITH A NURSE PRACTITIONER AND REVIEW IT IS VIDEOS AND TALKS STRATEGIES BECAUSE ONE MAIN THING WITH DEMENTIA IS PROBLEM BEHAVIOR WHEN THEY GET IRRITATED SO CAUSES FRICTION SO IT'S JUST ANOTHER EXAMPLE OF USING TECHNOLOGY REAL TIME. JUST WANT TO MAKE THAT. >> ONE LAST -- GO AHEAD, LAURA. CULTURAL VARIATIONS HERE FOR WHAT WE TALK ANT SO RIGHT NOW WE'RE -- WE HAVEN'T ANALYZED THE DATA BUT WE'RE DOING WORK WITH CAREGIVERS OF PEOPLE WITH DEMENTIA, IN ENGLISH AND SPANISH AND FINDING VERY DIFFERENT PERCEPTIONS WHEN WE TALK ABOUT ISSUES LIKE ELDER ABUSE OR THE WORD CAREGIVER. THERE'S SOME GROUPS THAT DON'T LIKE THE WORD CAREGIVER. SEE THEIR ROLE AS MUCH MORE HOLISTIC AND THEY WANT ADVOCATES. OTHER SEE IT AS A NATURAL CAREGIVER, SOME GROUPS WERE FINDING CAN UNDERSTAND THEY MIGHT BE ABUSERS AND SOME PEOPLE SAY BOY, THAT'S REALLY A PROBLEM, ASHAME THAT'S HAPPENING TO OTHER PEOPLE. SO WE'RE TRYING TO GET A BETTER UNDERSTANDING AGAIN OF WHO IS AT RISK. JUST ONE OTHER COMMENT IN TERMS OF I THINK INTERVENTION OPPORTUNITIES. WE HAVE ALZHEIMER'S CENTERS ALL OVER THE COUNTRY. AND NOW I WILL SAY ROUTINELY IN MY PRACTICE WHEN MAKING A DIAGNOSIS OF DEMENTIA SITTING WITH THE FAMILY, I ASSESS FOR RISK OF ABUSE, THERE'S A LOT WE CAN DO TO PREVENT THAT STAGE AND SOMETIMES EVEN ACTUALLY DETECT IT BECAUSE IT'S ALREADY HAPPENING. PERHAPS BECAUSE DAUGHTER WITH UNCONTROLLED BIPOLAR DISORDER DOESN'T HOLD A JOB, THAT DOESN'T MAKE HER THE IDEAL CANDIDATE TO TAKE CARE OF MOM WITH ALZHEIMER'S DISEASE IS A REAL LIFE EXAMPLE. >> ALL RIGHT. SO IS THERE ANY LAST COMMENT? OTHERWISE WE'RE GOING TO MOVE TO THE NEXT QUESTION. >> OKAY. SORRY. >> I WAS GOING TO PICK UP P ON THE COMMENTS ABOUT EFFECTIVE PROGRAMS. TWO PARADOXES TO THROW AT YOU. ONE IS RELATIVELY SIMPLE. ALL FORMS OF INTIMATE PARTNER VIOLENCE FOR EVERY AGE GROUP EXCEPT WOMEN OVER 50 HAVE DECLINED BY 20% IN THE LAST 20 YEARS. YET WE ONLY HAVE ARREST AS DEMONSTRABLY EFFECTIVE INTERVENTION. IN CHILD MAL TREATMENT WE HAVE SEEN THE SAME 20% DECLINE IN NON-FATAL FORMS OF MAL TREATMENT. AND ALTHOUGH WE HAVE EVIDENCE BASED PROGRAMS THE VAST MAJORITY OF CHILD WELFARE AGENCIES ARE ROLLING OUT AND EMPLOYING PROGRAMS TO WHICH THERE'S ABSOLUTELY NO DATA THEY'RE EFFECTIVE OR P INTENSIVE FAMILY PRESERVATION PROGRAM THERE'S GOOD DATA THAT THEY'RE NOT EFFECTIVE. WE HAVE A DECLINE WE CAN'T EXPLAIN THOUGH WE USE THE INTERVENTIONS, MINIMALLY UNPROVEN OR PROVEN TO BE EFFECTIVE. ANY COMMENTS FROM YOUR EXPERTISE TO WHAT THAT PORTENDS FOR ELDER ABUSE? BY THE WAY THE NATIONAL CRIME SURVEY ELDER ABUSE FLOATED RIGHT ALONG AT EXACTLY THE SAME LEVEL APPARENTLY NO INTERVENTION, NO THOUGHT, NO SOCIAL PROGRAMS NO CHANGE. >> ANYBODY HAVE ANY THOUGHTS ABOUT THAT? >> WE NEED AN EPIDEMIOLOGIST IN THE ROOM TO TALK ABOUT THIS. I DON'T HAVE GOOD IDEAS. I SEE THE PROBLEMS. SO THE EXTENT WHICH WE'RE SUCCESSFUL AT IMPLEMENTING THESE EFFECTIVE INTERVENTIONS ARE -- IS THAT LOWERING THE RATES WHILE WE'RE ACTUALLY DOING A BETTER JOB OF IDENTIFYING NEW CASES OR OVERIDENTIFYING, BRINGING PEOPLE INTO THE SYSTEM THAT DON'T NECESSARILY NEED TO BE IN THE SYSTEM, THEY NEED SUPPORT AND STUFF THEY DON'T NEED TO BE IN THE SYSTEM. MY EXPERIENCE WORKING WITH CHILD WELFARE, THERE'S A LOW PERCENTAGE OF SUBSTANTIATION BUT A LOT OF FAMILIES ENGAGED FOR AT RISK KINDS OF REASONS. I WOULD LOVE TO HEAR WHAT OTHERS THINK, GREAT QUESTION. ANYBODY HAVE ANY THOUGHTS ON THIS? >> I ALSO DON'T KNOW -- NOT CLEAR ON HOW WELL THE NATIONAL CRIME VICTIM SURVEY REALLY PICKS UP ELDER ABUSE. SO -- >> IT PICKS UP WOMEN REPORTING BEING VICTIMIZED BY PARTNERS BY WOMEN 50 YEARS OF AGE OR OLDER. >> THAT'S WHY I WANT TO BE CAREFUL, -- >> IT'S IS THE ONLY TREND DATA WE HAVE. SO SO I DON'T THINK WE WANT TO SAY IT REFLECTS A TREND TO ELDER ABUSE BECAUSE THAT'S NOT WHAT IT'S MEASURING SO I WANT TO BE CAUTIOUS. SO I'M INTERESTED, I DID NOT REALIZE THAT ARREST HAS BEEN DEMONSTRABLY EFFECTIVE INTERVENTION IN DOMESTIC VIOLENCE. I WOULD BE INTERESTED TO LEARN MORE ABOUT THAT. >> I WILL ANSWER THAT. SO THERE'S BEEN SIX RANDOMIZED EXPERIMENTS. AND WHEN YOU COMBINE EXPERIMENTS AND PULL THE DATA TOGETHER YOU SIGN -- ASK THE VICTIMS, THERE'S A 25% REDUCTION IN INTIMATE PARTNER VIOLENCE VICTIMIZATION, FOR THOSE WHO HAVE BEEN ASSIGNED TO THE ARREST GROUP VERSUS THOSE ASSIGNED TO NON-ARREST GROUP SO IT'S BEEN -- EFFECT IS THE SAME WHETHER YOU DO IT IN MINNEAPOLIS MILWAUKEE, CHARLOTTE, DADE COUNTY, COLORADO SPRINGS. SO CONSISTENT REDUCTION. IT MIGHT BE HIGHER AMONG SOME GROUPS AN LOWER AMONG OTHERS BUT THE AVERAGE SIT'S CONSISTENT IS IT'S CONSISTENT ACROSS SITES AT 25%. IN OTHER NON-PROBABILITY SAMPLES NON-RANDOMIZE SAMPLES NCVS EXAMPLE, EFFECTS ARE THE SAME IN NON-RANDOMIZED -- THE EFFECT SIZES AREN'T QUITE THE SAME AS THE LARGE AS WHEN YOU DO A RANDOMIZED EXPERIMENT BUT THEY TEND TO ALL REPORT AS DAN NAGAN SAID THE GRIP OF ANY SERIES REGULARITY EFFECTS BOTH NON-RANDOMIZED, RANDOMIZED EFFECTS WE FIND -- IF YOU DO ANYTHING ELSE BESIDES THAT, YOU MIGHT MAKE THE EFFECT DISAPPEAR. >> IS THIS FOUND IN CHILD ABUSE? >> THERE ARE RANDOMIZED EXPERIMENTS. >> NO O. RATHER ODD ASPECT OF CHILD ABUSE IS NONE OF THE SYSTEMS ARE USING EVIDENCE BASED PROGRAMS. NONE OF THE LARGE ONES. I'M TALKING ABOUT NEW YORK, CALIFORNIA, >> ACTUALLY -- I THINK THAT'S -- I'M 95% IN AGREEMENT WITH YOU, LA COUNTY IS A 20 MILLION-DOLLAR CONTRACT TO TRAIN THEIR WORKERS IN PARENT CHILD INTERACTION THERAPY SO THAT IS ROLLING OUT BUT IS NOT NEW. >> END OF THE DAY THEY'RE PRIMARILY UNITING PARENTING CRASSES, INTENSIVE FAMILY PRESERVATION AND CONFERENCING NONE WHICH HAVE ANY -- THAT SAID, SINCE 1993, THE NUMBERS ARE ALL THE DATA ARE CONSISTENT, NO MATTER HOW YOU CHECK IT, THE NUMBER OF CONFIRMED RECOGNIZE REPORTED CHILD ABUSE INCIDENCE INCLUDING HOMICIDES HAVE GONE DOWN. SO THAT'S MY PARADOX. USING NON-EVIDENCE BASED INTERVENTIONS, MASSIVELY. >> BUT -- >> I DON'T KNOW WHAT IT IS. >> CAN I JUST AGREE THOUGH? THERE IS DEBATE ABOUT WHAT RICHARD JUST SAID. AND THERE IS -- THERE ARE SOME PEOPLE WHO ARE ARGUING THAT PHYSICAL ABUSE AND SEXUAL ABUSE HAS GONE DOWN, THERE WERE TREND DATA SUGGESTING THAT IT HAS GONE DOWN, NEGLECT HAS NOT CHANGED AT ALL AND THERE'S DEBATE ABOUT IF IN FACT IF YOU LOOK AT THAT AVERAGE RATES NATIONALLY BUT THERE ARE MANY STATES WHERE RATES HAVE GONE UP AND STATES WHERE RATES HAVE GONE DOWN. THE CRITICAL ISSUE IS PEOPLE HAVE TRIED TO SPECULATE ON WHAT IS CHANGING IT BUT WHAT IT REALLY NEEDED IN THE CHILD ABUSE FIELD ARE EXAMINATIONS EMPIRICAL EXAMINATIONS OF HYPOTHESES THAT SAY IF THE RATES HAVE GONE DOWN, IF THIS IS THE REASON FOR WHY THEY HAVE GONE DOWN, LET'S TEST IT. BUT AGAIN, IT'S REALLY MESSY BECAUSE IF YOU LOOK AT THE PLUS UNIVERSITY OF ST. LOUIS SOCIOLOGIST WHO HAS A BACKGROUND IN CHILD WELFARE WHO IS DOING ANALYSIS OF THESE DATA LOOKING AT STATE VARIATIONS, STATE CHANGES IN POLICY, ALL THIS REALLY ELEGANT STUFF. BUT IT IS NOT DONE YET. I DON'T THINK IT'S A DONE DEAL, THAT THERE'S DEFINITELY A REDUCTION. >> THERE'S COMPLEXITY WITH THE ISSUE OF ARRESTS. WITH INTIMATE PARTNER VIOLENCE, THERE'S MANDATORY ARREST VERSUS PRO ARREST AND VIOLENCE AGAINST WOMEN -- SONYA SALARI RIGHT HERE. SO WE'RE GOING TO JUST I AM OZ. SO ANYWAY, WHAT THEY HAVE DONE WITH VIOLENCE AGAINST WOMEN ACT THEY MOVEED FROM THE MANDATORY ARREST POLICIES AND MORE TOWARD A PRO-ARREST POLICY TO ALLOW OFFICERS TO HAVE SOME DISCRETION IN THE MATTER, A LITTLE MORE DISCRETION. RIGID POLICIES HAVE KICK BACK OR SOME UNINTENDEDS CONSEQUENCES. THE SITUATION WITH MANDATORY ARREST WAS THAT VICTIMS STOP CALLED THE POLICE SO YOU DON'T WANT A POLICY THAT HAS VICTIMS STOP CALLING THE POLICE. SO THAT'S WHY THEY -- THEY'RE STARTING TO REALIZE IT NEEDS TO NOT BE THAT RIGID. SO ALSO WE GOT A LOT OF PEOPLE IN PRISON AND THAT MIGHT BE WHY OUR VIOLENT CRIME HAS GONE DOWN IN THE PAST TWO DECADES. WE ARE THE MOST INCARCERATED NATION ON EARTH. SO NOW THEY'RE TRYING TO START THINKING ABOUT WAYS WITHOUT DOING THAT INCARCERATION. I THINK THE AGING OF THE BABY BOOM HAS LED TO A DECLINE IN VIOLENT CRIME BECAUSE THEY HAVE GOTTEN A LITTLE BIT OLDER. EITHER THEY'RE INCARCERATED ALREADY OR DECIDED TO STOP BEING CRIMINALS. SO THE NEXT QUESTION HAS TO DO WITH ENGAGEMENT IN INTERVENTIONS AND HOW WE GET PEOPLE TO PARTICIPATE AND STAY INVOLVED WITH THE INTERVENTION. ANYBODY WANT TO COMMENT ON THAT FROM THE PANEL? >> JUST A PITCH, THE QUESTION OF ENGAGEMENT IS A RESEARCH QUESTION, NOT JUST PART OF WHAT WE SKIP OVER TO GET O THE RESEARCH QUESTION. >> I THINK THAT'S A REAL NEED TO UNDERSTAND ELDER MISTREATMENT RESPONSE PROGRAM SPECIFIC CONTEXT ENGAGEMENT STRATEGIES, STRATEGIES ATTRIBUTE -- A QUALITY OF CLINICIAN CLIENT RELATIONSHIP. AND FINDINGS FROM OTHER DOMAINS SOCIAL SERVICE DOMAINS, IT MIGHT ACTUALLY BE A CRITICAL SHORT TERM OUTCOME THAT CAN LEAD TO SUCCESS ON OTHER OUTCOMES ALONG THE INTERVENTION PROCESS SUCH AS RATES OF RETENTION ACCEPTANCE OF SERVICES, EXTENDED SERVICES AND ULTIMATELY THAT ALLEVIATION OF RISK. BUT I AM CURIOUS PERSONAL VIOLENCE AND PARTICULARLY IPV HOW HAVE YOU DEALT WITH THE NATURE OF VOLUNTARY SERVICES? COULD WE -- WE STRUGGLE WITH THAT A LOT. FIRST THE VAST MAJORITY OF VICTIM ELDER MISTREATMENT DON'T COME OR HELP SEEK BUT IF THEY DO WE HAVE FAIRLY POOR RATES OF RETENTION. SO HOW HAVE YOU THOUGHT ABOUT THAT OR DEALT WITH THAT? >> I WANT TO ADD SOMETHING BRIEFLY ABOUT MARK CHAFIN AND COLLEAGUE AT UNIVERSITY OF OKLAHOMA ADDED A BRIEF COMPONENT FOR PARENTS TO GO THROUGH BEFORE THEY GO THROUGH PARENT CHILD INTERACTION THERAPY, IT'S A MOTIVATIONAL ENHANCEMENT COMPONENT SO LIKE MOTIVATIONAL INTERVIEWING, A LITTLE BIT DIFFERENT, AND WITHOUT THAT MOTIVATIONAL ENHANCEMENT PIECE, THE DROP OUT RATE IN PCIP IS ROUGHLY 40%. WITH MOTIVATIONAL ENHANCEMENT PIECE P THEY GO THROUGH THAT SUCCESSFULLY A COUPLE OF SESSIONS THEN IT'S A 75, 80% RETENTION THROUGH THE INTERVENTION WITH FOLKS INVOLVED WITH CHILD WELFARE FOR ABUSE AND NEGLECT. IT'S POWERFUL. ANYBODY ELSE? >> GOING TO ANSWER THE QUESTION FOR IPV. WE HAVE IT. IT'S A PROBLEM WE'RE TRYING SOMETHING OUT NOW, WE'RE BASICALLY TELLING WOMEN WHO ARE VICTIMS PEOPLE LIKE YOU HAVE BEEN KILLED. THAT'S THE STUDY SEE WHETHER THEY ACTUALLY NOTICE SERVICES MORE OFTEN THAN OTHERS PRIOR DATA. SO BUT THE ANSWER IS THERE'S THE NO REALLY. TRIAL. THIS WAS SOMETHING JACKIE CAMPBELL SUGGESTED WE TRY. THAT SORT OF PROTOCOL, SO WE TRIED PROTOCOL OUT TO SEE IF IT WORKS. >> ARE THEY MANDATED TO PARTICIPATE IN THAT CLASS IN ORDER TO GET THEIR CHILD BACK OR IS THERE SOME MANDATORY EDUCATIONAL INTERVENTION THEY HAVE TO DO? THAT WOULD BE VERY DIFFERENT FOR US IN OUR AREA. >> BUT MY UNDERSTANDING IS THAT FOLKS ARE MANDATED TO RECEIVE SERVICES, BUT THERE IS THE OPTION OF RECEIVE THE VARIETY OF SERVICES AS USUAL OR TO GO INTO THIS PARTICULAR PARENTING INTERVENTION SO IF YOU'RE NOT GOING INTO THAT YOU HAVE THE OPTION TO GO INTO SOMETHING ELSE NOT BE PART OF THE STUDY, SO IT ISN'T EXACTLY THE CASE WITH THESE TRIALS PCIT THEY WERE MANDATED TO DO THIS OR ELSE AND THERE ARE BIG CONSEQUENCES, IT'S -- WELL YOU CAN DO SOMETHING ELSE. I BELIEVE SO. THE AVERAGE NUMBER OF SUBSTANTIATED REPORTS IN THESE SAMPLES WAS 5 OR 6 REPORTS. >> I WOULD AGREE WE DON'T KNOW EMPIRICALLY THE ANSWER TO THAT QUESTION. BEST PRACTICES APPROACH REASONABLY WELL ACCEPTED IN THE FIELD KEEP IN MIND THE WORD VOLUNTARY SOMEONE ENDORSES ON THE SCREEN WHAT HAPPENS ISN'T THEN THEY LOSE CONTROL OVER THEIR LIFE. IN A WELL-MEANING CAREGIVER -- WELL MEANING PROVIDERS OF ALL KINDS MAY WELL AND HAVE ENGAGED OTHER RESOURCES, BROKEN CONFIDENTIALITY MANY THE NAME OF HELPING. SO I THINK THAT LONG-TERM ENGAGEMENT AND PROVIDING RESOURCES AND ALLOWING THE VOLUNTARINESS TO PLAY OUT AS IT WILL. SOMEONE MENTIONED EARLIER WE DON'T 2002 D&O WHAT YOU SAY IF YOU DON'T LEAVE WE DON'T WANT TO HELP YOU IS THE OPPOSITE OF THAT BUT RATHER CONTINUE -- IN IPV IT'S SHOWN THAT MULTIPLE -- SOMETIMES IT TAKES MULTIPLE SCREENINGS FOR THE PERSON TO IDENTIFY TO DISCLOSES. SO NOT JUST DOING IT ONCE BUT HAVING REGULAR MAINTAINING OPEN DOORS, HERE ARE THE RESOURCES. AND REMEMBERING IT WAS VOLUNTARY. >> ELIZABETH HAS TO LEAVE EARLY SO WHAT I WOULD LIKE TO DO IS ASK THE PANEL, OPENING UP TO THE REST OF YOU TOO, BEFORE WE GET TO THE LAST QUESTION LET'S DISCUSS A RESEARCH AGENDA WITH RESPECT TO THE QUESTIONS WE HAVE BEEN DISCUSSING WHICH PREVENTION AS WELL AS ENGAGEMENT AND AND SO FORTH. SO ANY RESEARCH IDEAS THAT YOU WOULD LIKE TO PROPOSE AT THIS POINT WOULD BE WELCOME. >> SURE THIS WAS COMES AS A SHOCK MEDIA CENTER WOULD BE A GOOD IDEA. I THINK WE HEARD THAT. >> THAT'S NOT A RESEARCH IDEA. IT IS A WAY TO GET INFRASTRUCTURE IN ORDER TO HAVE RESEARCH. SO YOU MIGHT NOT CALL IT A RESEARCH IDEA BUT WE HAVE GOT INFRASTRUCTURE TO MAKE THIS WORK AND WORK WELL. WE HAVE TO SOLVE THE PIPELINE ISSUE, YOU NEED TO HAVE GOOD STUDIES. WE LACK GOOD SCIENCE RIGHT NOW. AND SO -- YOU DON'T WANT TO HEAR WE WANT FUNDING I KNOW BUT WE NEED TO LURE PEOPLE IN TO THE FIELD AND WE HAVE ALL THIS CONCENTRATION OF EXCELLENT RESEARCH GOING ON IN BRAIN SCIENCE, THERE'S CERTAINLY AN OPPORTUNITY PIGGY BACK ELDERS RELATED TO MITTS TREATMENT THERE. WE LOOK ABOUT OPPORTUNITIES, WE TALK ABOUT RICK MARS AS WELL. WE NEED LONGITUDINAL STUDIES, CAREFUL ABOUT THE GARBAGE IN AND OUT PHENOMENON LOOKING AT DATA SETS THAT EXIST IF THEY'RE NOT MEASURING WHAT WE THINK THEY'RE MEASURING. WHICH NOT SOMETIMES, OFTEN HAPPENS SO I THINK WE REALLY HAVE TO GUARD AGAINST THAT AND INSIST ON HAVING RIGOROUS SCIENCE BEHIND WHAT WE'RE DOING. WE HAVE QUESTIONS, LOTS OF NATURAL EXPERIMENTS GOING ON RIGHT NOW AROUND THE COUNTRY. ALL WE HAVE TO DO IS LATCH ON TO THEM AND FROM THE GET GO, BEFORE THEY GET IT GOING, HAVE SOME DEGREE OF RIGOR INVOLVED IN EVALUATION TO SEE IF IT'S REALLY WORKING. I THINK SOME OF THE WORK THAT DAVID IS DOING TO HELP US FIGURE OUT OUTCOMES, IS EXTREMELY IMPORTANT, THAT'S WHAT INFRASTRUCTURE TO DO, YOU CAN'T REINVENT THE WHEEL TO FIGURE OUT EVERY TIME, YOU HAVE PRAISES TO GO AND GET HELP TO GET FIGURED OUT TO KNOW WHAT WE'RE DOING IS EFFICIENT AND EFFECTIVE AND IMPROVES QUALITY OF LIFE. >> YES, I WOULD LIKE TO ADD TO THAT, EARLIER YOU DISCUSSED THE END TEAMS OR MDT TYPE TEAMS AND YOU ARE SAYING THAT WHAT WE NEED TO DO IS HAVE SOME COMMONNALTY. SO PERHAPS WE NEED MULTI-SITE TRIALS OF THE SAME INTERVENTIONS, NOT HAVING APPLES AND ORANGES AND PRUNES AND WHATEVER ELSE WE'RE LOOKING AT. THAT'S ANOTHER GENERAL STATEMENT, WHATEVER THE INTERVENTION IS, WE HAVE TO THINK ABOUT HAVING A MULTI-SITE PROJECT AND DEFINING THE INTERVENTION CAREFULLY. >> THE OTHER THING WE DIDN'T TALK ABOUT TODAY BUT IS CRITICALLY IMPORTANT, WE DIDN'T TALK ABOUT ABUSE GOING ON IN ASSISTED LIVING FACILITIES AND NURSING HOMES. SO I DON'T WANT THAT TO GET MISSED. >> I WAS GOING TO SAY THAT MYSELF BUT I WAS THINKING WAIT A MINUTE, THAT'S NOT PREVENTION YET BECAUSE I THINK THERE NEEDS TO BE MORE PREVALENCE STUDIES, MAYBE PROSPECTIVE STUDIES. AL EXAMPLE WE DON'T KNOW TOO MUCH, SO I THINK IT WOULD BE -- WE STILL NEED TO DO THAT. SO IS THERE ANYTHING MORE IN THIS? WE'RE GOING TO BE MOVING TO THE LAST QUESTION VERY SOON. >> YES. >> INFRASTRUCTURE AND WAYS TO GROW FUTURE GENERATIONS, BUILD DISCIPLINES, IT'S VERY EASY IN A GLOBAL LARGE UMBRELLA MEETING TO THINK IN TERMS OF GLOBAL FUNDING MECHANISMS REGARDLESS OF WHO YOU THINK MIGHT PROVIDE THEM. THERE ARE ALL KINDS OF OTHER WAYS TO BRIDGE THAT. THERE ARE OF COURSE THE INDIVIDUAL FELLOWSHIPS WITH YOUNG PEOPLE, THERE ARE CAREER TRAINING AWARDS, IF YOU YOURSELF ESTABLISH INVESTIGATORS WANT TO BUILD A BRIDGE AND CARVE PART OF YOUR TIME, IF YOU'RE INTERESTED IN BRAIN SCIENCE YOU CAN LEARN THEM YOU CAN LEARN THOSE DISCIPLINES. I DON'T KNOW WHO IF ANYONE DOES THIS BUT CONCERNED ABOUT NEXT GENERATIONS TO FOLLOW FOOTSTEPS, ARE THERE TRAINING FROM ALL THESE CLINICAL PRACTICES IN THESE CLINICAL PHYSICIANS IS ANY ONE RUNNING TRAINING ON PROGRAMS FOR RESIDENTS AND FUTURE PHYSICIAN SCIENTISTS AND PUBLIC HEALTH RESEARCHERS AND NEUROSCIENTISTS, TO WORK IN THIS AREA, YOU COVERED ALMOST THE ENTIRE WATER FRONT OF ABUSES, PREVENTION AND TREATMENT AND KEEP TALKING ABOUT INFRASTRUCTURE, I LIKE TO HEAR MORE ABOUT REACHING ACROSS DISCIPLINES, REACHING ACROSS RESEARCH GENERATIONS. >> IF I CAN FOLLOW UP ON THAT. EVERYBODY KEEPS TALKING ABOUT THESE CENTERS WE BROUGHT TOGETHER NOW THREE DIFFERENT FIELDS MAYBE FOUR IF YOU INCLUDE EMERGENCY MEDICINE AS A SEPARATE FIELD, AT THE END OF THIS MEETING IT WOULD BE A TRAGEDY IF WE SET UP CENTERS FOR ELDER ABUSE RESEARCH THAT DIDN'T INTEGRATE THOSE PERSPECTIVES. I THINK WE UNDERSTAND CLEARLY THAT FUNDING CHALLENGES EXIST AND THAT THE PIPELINE IS VERY IMPORTANT TO KEEP DEVELOPING BUT WHAT WE REALLY NEED TO HEAR FROM YOU TODAY BEFORE WE LEAVE AT 5:30 ARE THE LOW-HANGING FRUIT RESEARCH QUESTIONS THAT COULD BE TACKLED NOW, THE INSIGHTS THAT YOU HAVE GOTTEN FROM HEARING NOVEL IDEAS FROM THE OTHER DISCIPLINES THAT SUGGEST THE NEW STUDY DESIGNS WE MIGHT CONSIDER IN ELDER ABUSE, WAYS OF LEVERAGING PARTNERSHIPS ACROSS THESE DIVIDES WHERE THE SUCCESS IN ONE AREA THAT MAYBE COULD BE TRANSLATED, THAT'S EXCEPTIONALLY HELPFUL FOR US AT THE RECEIVING END TO HEAR THAT BUT I DIDN'T WANT TO LOSE THE POINT ABOUT INTERDISCIPLINARITY OF THE OUTCOMES AS WELL AS THE INPUTS TO THIS MEETING. >> TO THOSE POINTS, I'M REASONABLY SUCCESSFULFUL RESEARCH CAREER TAKING EXISTING NIH MECHANISMS K AWARDS AND OTHER MECHANISMS PARADIGM ONE OF THE THINGS THAT I HAVE DONE RECENTLY BE CALLED FROM GERIATRIC DEPARTMENTS ACROSS THE COUNTRY WITH A PARTICULAR PERSON INTEREST IN ELDER ABUSE WHO COULDN'T FIND ENTERING ENCOURAGED TO STUDY ALZHEIMER'S DISEASE OR INCONTINENCE OR FALLING SO THE MOST RECENT ITERATION OF K-24 ENDING SHORTLY, I CREATED A VIRTUAL MENTORING PROGRAM THAT OCCURRED NATIONALLY AND VIRTUALLY. SO DAVID FOR EXAMPLE COMES FROM DAVID COMES FROM SOCIAL WORK AND TONY FROM EMERGENCY MEDICINE GOTTEN FUNDED PARTICIPATE IN THAT. THAT WAS AN EXAMPLE OF USING AN EXISTING NIH MECHANISM K-24, MAKING IT OUTSIDE THE BOUNDS OF THE INSTITUTION. T-32s COULD BE USED FOR THIS PURPOSE. BUT HARD TO GET A CONCENTRATION OF PEOPLE WANT TO COME TO ONE PLACE GIVEN SUCH A SMALL FIELD. SO WE TALKED ABOUT THE K-7 MECHANISM FOR STUFF LIKE THIS. >> RIGHT. GO AHEAD. >> SORRY. ONE THING I HADN'T HEARD AND I THINK IS SOMETHING OF INTEREST WHEN WE THINK ABOUT INTERVENTIONS AND REVICTIMMIZATION IS THAT WHEN WE'RE LUCKY ENOUGH FOR A SITUATION TO COME TO OUR ATTENTION AND WE ADDRESS IT, A LOT OF TIME THE PERSON WHO IS INFLICTING THE HARM THEN JUST LEAVES. SO THEN YOU'RE LEFT WITH AN OLDER ADULT WHO IS OFTEN IMPAIRED AND DOESN'T HAVE ANYBODY AND A LOT OF THE AGENCIES ARE WE STOP THE ABUSE, YEAH, WE'RE DONE, LET'S MOVE ON. THAT PERSON IS STILL REALLY SUFFERING AND ALONE, THOUGH WE'RE NOT TALKING SELF-NEGLECT HERE TODAY, A LOT OF TIMES I SEE IT GO INTO SELF-NEGLECT AFTERWARDS. SO I WOULD BE INTERESTED AS A RESEARCH TOPIC TO THINK ABOUT INTERVENTIONS BOTH FOR PREVENTION AND FOR SECONDARY PREVENTION OR REVICTIMMIZATION THAT ADDRESS OLDER ADULT WHOSE ARE ALONE. THAT'S MY TWO CENTS. >> BUILDING ON WHAT DAVID HAD TO SAY, THRESHOLD ISSUE, I'M NOT SURE IT'S LOW HANGING FRUIT BUT WE DON'T KNOW HOW TO MEASURE SUCCESS BECAUSE DECREASING MORTALITY ISN'T NECESSARILY SUCCESS, PLACEMENT ISN'T NECESSARILY SUCCESS. SO IT DOES NEED TO BE GOAL ATTAINMENT UNTIL WE CRACK THAT NUT WE AREN'T ABLE TO MEASURE THE EFFICACY OF THE ENTER ENTERSECTION. IT AIN'T LOW HANGING FRUIT BUT IN TERMS OF SEQUENCING ISSUE A THRESHOLD ONE. THAT'S THE PERFECT SEGUE, TO THE LAST QUESTION. WHICH I WAS ABOUT TO INTRODUCE. SO PERFECT. I'M GOING TO LET -- SO SOMETHING SOMEONE JUST SAID REMINDED ME OF ONE OF THE THINGS THAT CAME UP IN OUR BREAK-OUT GROUP WAS THIS ISSUE OF TRANSITION PERIODS. AND TRANSITION OPPORTUNITIES FOR ENTERSECTION. THAT'S OKAY. I WAS WONDERING IF THERE'S ANYTHING FROM OTHER FIELDS THAT WE COULD LEARN ABOUT THAT TRANSITION PERIOD AND HOW WE MIGHT INTERVENE IN TRANSITION. LIFE CHANGES, I KNOW PEOPLE COMING AND GOING, RETIREMENT, WE TALKED ABOUT MARYANN YOU'RE THE ONLY ONE LEFT BUT MAYBE IF ANYONE COULD ANSWER THAT. >> I KNOW THEY DO IT IN SCHOOL. THERE'S INTERVENTIONS IN PLACE TO HELP WITH THOSE TRAN SIGNATURES. I FEEL LIKE PEOPLE LOOK AT ME LIKE I'M CRAZY BUT MAYBE IT'S BECAUSE IT'S LATE AND I'M NOT COHERENT. ONE THING WE LEARNED FROM THE IPV FIELD IN THOSE TRANSITIONS IS TO PAR THE TRANSITION THE POWER DIFFERENTIAL SO THAT FOR INSTANCE IN RETIREMENT PERHAPS THE MALE PERSON IS IN ADDITION POSITION COMPARED TO THE FEMALE PERSON. SO IN TERMS OF LOOKING AT INCREASING AWARENESS FOR THAT -- THESE POTENTIAL SHIFTS MAY HAPPEN AND WHAT IT MEANS ARE IMPORTANT THINGS IN TERMS OF TRAINING AND PREPARING PEOPLE THAT MIGHT BE WORKING IN THOSE ENVIRONMENTS. >> CAN I JUST SAY, I THINK THAT'S ANOTHER LOW HANGING FRUIT THAT WE CAN LOOK AT IN INTERVENTIONS RELATED TO ELDER ABUSE, WE NEED TO FIGURE OUT SUCCESSFUL OUTCOMES BUT WE HAVE A ENOUGH OF A CLUE I DON'T THINK SHOULD PREVENT US FROM GOING FORWARD. WE CAN DO BOTH SIMULTANEOUSLY, AND I THINK WHATEVER SOMEBODY IS YOU'RE MAKING A NEW DIAGNOSIS, THAT CAN BE A TRANSITIONAL POINT. WHEN SOMEBODY IS MOVING FROM HOME INTO ASSISTED LIVING OR FROM HOSPITAL TO NURSING HOME, ET CETERA, THOSE ARE TRANSITION POINTS THAT I THINK CREATE NEW VULNERABILITIES OR OPPORTUNITIES HOWEVER YOU WANT TO LOOK AT IT FOR ELDER ABUSE, BUT FOR PREVENTION AS WELL. THOSE ARE STUDIES THAT HAPPEN RIGHT NOW AND YOU CAN HAVE RANDOMIZED CONTROL TRIALS FOR THOSE SORTS OF THINGS. >> PARALLEL TO THE PRE-MARITAL COUNSELING CONCEPT, THE TRANSITION FROM A PARENT MOVING IN WITH A CHILD OF A PARENT GIVING UP DRIVING OR SOME OF THOSE STEP UP OR DOWN WHICHEVER YOU CALL IN TERMS OF INCREASED DEPENDENCIES. I CAN IMAGINE, I GUESS I WOULD HOPE FOR SOME CAREGIVER TRAINING, HOW DO I DO THIS? PEOPLE MIGHT WELL BE WELL MEANING IN TERMS OF I'M GOING TO TAKE CARE OF MY PARENT BUT I DON'T HAVE A CLUE WHAT THAT LOOKS LIKE. WHEN IT GETS TO THE MIDNIGHT HOUR IT'S STRESSFUL AND PEOPLE DON'T HAVE THE TOOL. SO CREATING INTERVENTIONS THAT REALLY HELP CREATE THOSE COMPETENCIES BECAUSE IT'S A NORM THAT PEOPLE MIGHT NOT KNOW HOW TO DO THAT BECAUSE THEY HAVE NEVER DONE IT, MIGHT GO ALONG WAY. I THINK ONE THING I'M HEARING FROM MYCOLLEAGUES IN IPV AND CHILD ABUSE IS THE INTERVENTION HAS TO BE PERSISTENT, ONGOING AND FROM A LOT OF DIFFERENT DIRECTIONS IN ORDER TO BE EFFECTIVE. I THINK ONE THING WE HAVE DONE IS WE HAVE TRIED ONE THING HERE AND ONE THING THERE AND IT HASN'T BEEN THIS SUSTAINED MULTI-FACTORIAL HOW IT WORKS IN YOUR FEEL. >> I WANT TO MAKE A COMMENT >> WE HAVE DONE WORK ON CAREGIVERRING CAREERS. I CARE GIVER GOES FROM A TYPICAL COO REAR STARTING WITH LOW LEVEL CAREGIVERRING HELPING SOMEBODY OUT BUT AS THE PERSON TRANSITIONS TO A MORE INTENSE ADL PERHAPS COGNITIVE DECLINE THERE COULD BE WARNING SIGNS PLACES WE NEED TO BE CAREFUL AND MAYBE INTERVENE. THE OTHER IDEA, WONDERING IF ANYONE IN THE ROOM OR SOMETHING THAT MIGHT BE AN ABUSE HISTORY AMONG THE COUPLE, THIS WILL TAKE THE LONGITUDINAL DESIGN WHERE IS YOU GOT GOT THINGS THAT START OUT, MAYBE STARTS SELF NEGLECT, GOES INTO NEGLECT, PSYCHOLOGICAL ABUSE, DOING NO WHICH -- DO WE KNOW WHICH PSYCHOLOGICAL ABUSER BECOME PHYSICAL ABUSERS, IN THIS CASE ANYTHING IN THAT AREA. >> INTERVENTION LOW HANGING FRUIT, CONTINUE DEVELOPING OUR RESEARCH CAPACITY OR OURANT TO ACTUALLY COMPARE THINGS, SYSTEMATICALLY MANY SYSTEMATIC REVIEW MANY ARE FAMILIAR THEY FOUND 8 COMPARISON DEI KNOW STUDIES AND IN THE END THEY FOUND EQUAL RESULTS OR NO SIGNIFICANT DIFFERENCES BETWEEN DIFFERENT TYPES OF STUDIES DIFFERENT APPROACHES AND YES IT'S POSSIBLE THERE WEREN'T DIFFERENCES BETWEEN THE INTERVENTIONS BUT EQUALLY OR MORE PLAUSIBLE THEY WEREN'T MEASURE -- THEY WEREN'T MEASURING THESE KEY OUTCOMES CORRECTLY, THEY WEREN'T USING MEASURES TO CAPTURE CLIENT CHANGE ACROSS TIME IN THESE INTERVENTIONS. I THINK THE PROBLEM WITH USING A STANDARD SCALE ON THAT KEY OUTCOME OF RISK ALLEVIATION, IT CAN EITHER LACK SENSITIVITY IN THAT IT DOESN'T DETECT INDIVIDUALLY RELEVANT OR UNIQUELY SALIENT RISK INDICATORS OR IT MAY LACK RESPONSIVENESS IN THAT IF THERE IS MEANINGFUL CHANGE OCCURRING TWO OR THREE ITEMS IN THE SCALE, IT'S DILUTED BY A HOST OF IRRELEVANT STATIC ITEMS THAT ARE ALSO ON THE SCALE. I JUST -- COME UP A FEW TIMES HERE JUST TO BRIEFLY EXPLAIN PEOPLE WHO DON'T KNOW WHAT IT IS, IT'S AN INDIVIDUALIZED FORM OF MEASURING CHANGE ACROSS THE COURSE OF AN INTERVENTION AND WITH GOAL ATTAINMENT WHAT HAPPENS IS THAT EACH CLIENT IS GIVEN A INDIVIDUALIZED SET OF GOALS OR ITEMS WORKING TOWARDS THE OVERALL OBJECTIVE OF RISK ALLEVIATION. THE BEAUTY OF THIS STRATEGY THOUGH IT'S INDIVIDUALIZED, IT GENERATE IT IS STANDARD T SCORE COMPARED ACROSS CASES. JUST THROW THAT OUT THERE. >> I HESITATE TO BRING THIS UP BECAUSE IT 'NOT LOW HANGING FRUIT BUT IT WOULDN'T NECESSARILY BE EXPENSIVE RESEARCH. THINKING ABOUT THE UNDER-REPRESENTED COMMUNITIES, IT'S CRUCIAL TO UNDERSTAND DYNAMICS OF ELDER MISTREATMENT AND HOW IT PLAYS OUT IN THOSE COMMUNITIES SPECIFICALLY BECAUSE THESE INTERVENTIONS ARE NECESSARILY GOING TO WORK IN THOSE COMMUNITY MS. THE SAME WAY. SO YOU HAVE TO KNOW ON THE GROUND HOW THEY WORK IN THOSE COMMUNITIES. BECAUSE DYNAMICS THAT PEOPLE ARE DISCUSSING HERE I JUST THINK WOULDN'T NECESSARILY APPLY TO SOME OF THE NATIVE COMMUNITIES THAT I'M FAMILIAR WITH. FOR INSTANCE I FOUND THAT OFTEN COMMUNITIES ARE WELL AWARE WITH OF THE ABUSE GOING ON AND HESITANT TO DO ANYTHING ABOUT IT. SO I THINK IT WOULD BE IMPORTANT TO MAKE SURE WE DON'T LOSE IN SOME OF THESE REALLY IN DEPTH QUALITATIVE STUDIES WHAT'S GOING ON SO WHEN WE GET TO THE INTERVENTION POINT THE INTERVENTIONS ARE GOING TO BE EFFECTIVE IN THAT COMMUNITY CONTEXT. OKAY. DOES -- I WOULD LIKE TO MOVE JUST TO THE LAST QUESTION BECAUSE WE ONLY HAVE FIVE MINUTES, IS THERE ANYTHING MORE WE WOULD LIKE TO SAY ABOUT MEASURING SUCCESS? THAT'S SO IMPORTANT. LAURA, I KNOW YOU HAVE SOME -- YOU WANT TO MAKE SOME COMMENTS ABOUT THAT. AND DAVID. >> I HAVE A COGNITIVE IMPAIRMENT. WHAT MY COMMENTS WERE GOING TO BE ABOUT THAT. I THINK YOU WERE CONCERNED ABOUT SOME OF THE OUTCOME MEASURES THAT WE HAVE. >> I THINK ALONG THOSE LINES I MAY HAVE SAID IT EARLIER, IS THAT WE DON'T KNOW WHAT A GOOD OUTCOME IS TO ONE MIGHT NOT BE A GOOD OUTCOME TO ANOTHER. SO THAT'S WITHIN CASES AND BETWEEN CASES. SO FOR EXAMPLE, FOR THE PHYSICIAN, I MIGHT REALLY THINK IT'S A GREAT OUTCOME WHEN MY PATIENT IS REMOVED FROM THE DANGEROUS SITUATION. MY PATIENT MIGHT NOT THINK IT GOOD OUTCOME REMOVED FROM A DANGEROUS SITUATION BECAUSE THEY WERE REMOVED FROM THEIR HOME WHERE THEY WANT TO LIVE. IN THE APS WORK WE HAVE A DIFFERENT IDEA OF WHAT A GOOD OUTCOME IS, THAT'S AN ISSUE TO SAY WHAT A GOOD OUTCOME IS. IN THE SAME SITUATION ONE PERSON CONSIDERS THIS A GOOD OUTCOME ANOTHER WOULDN'T, GOAL ATTAIN. HAS TO BE BASED ON INDIVIDUAL AND FIGURE OUT HOW TO GET TO COGNITIVE DECISIONS DECISION MAKING AND CAPACITY, UNDER WHAT CIRCUMSTANCES CAN PEOPLE WHO HAVE A COGNITIVE IMPAIRMENT ALSO BE ABLE TO MAKE THAT DECISION WHAT A GOOD OUTCOME IS. THAT'S WHERE IT'S MURKY. >> ACTUALLY DAVID MAYBE YOU SHOULD COMMENT ON THAT, GOAL ATTAINMENT SCALING WHEN YOU HAVE PEOPLE COGNITIVELY IMPAIRED? >> VERY GOOD QUESTION. SO IN PUREST FORM, GOALS SCALING EITHER THE PROCESS IN WHICH YOU WOULD CONDUCT IN A COLLABORATIVE EFFORT WITH THE CLIENT. AND THAT WOULD REQUIRE CERTAIN COGNITIVE ABILITIES. HOWEVER, THERE ARE ALSO OTHER APPLICATIONS THAT SCALING WHICH IT IS MORE CLINICIAN DRIVEN AND GENERATED BASED ON YOUR KNOWLEDGE OF THAT INDIVIDUAL'S CIRCUMSTANCES FAMILY NEEDS, AND YOUR OWN EXPERTISE AND PRACTICE KNOWLEDGE AS A PRACTITIONER. AND SO I BELIEVE IT CAN BE APPLIED WHEN YOU'RE WORKING WITH CLIENTS WHO ARE COGNITIVELY IMPAIRED. IT'S JUST A BIT OF AN APPROACH, MORE CLINICIAN GENERATED, AS OPPOSED TO A PURELY COLLABORATED PROCESS. THAT'S FINE. >> OTHER COMMENTS FROM ANYBODY IN THE AUDIENCE? GOAL ATTAINMENT SCALING IS USED IN COGNITIVELY IMPAIRED PATIENTS UNDERGOING GERIATRIC FUNCTIONAL ASSESSMENT SO NOT AS IF THERE'S NO PRECEDENT FOR THIS. >> OBVIOUSLY THERE ARE PLENTY OF MEASURES USED WITH PROXIES, SO ONE COULD STUDY THAT TO SEE IF THERE'S ANY DIFFERENCES, YOU WOULD HAVE TO GET A GROUP OF PEOPLE WHO ARE MILDLY IMPAIRED AND SEE IF THERE'S VERY MUCH DIFFERENCE BETWEEN THE PROXIES GENERATED BY A CAREGIVER LET'S SAY AND THE ACTUAL PERSON. IT'S IMPERFECT BIT'S A WHICH OF LOOKING LIKE WE HAVE DONE WITH OTHER PROXY RESEARCH. SO THE ONLY THING I WOULD LIKE TO SAY ABOUT THIS IS THAT I DO THINK WE NEED MORE STRONG MEASURES OF OUTCOMES. MORE PSYCHOMETRIC WORK DONE. THERE'S LITTLE ANYTIME LITERATURE, I THINK THAT'S BEEN RAISED BEFORE BY A NUMBER OF PEOPLE BUT WE HAVE TO LOOK AT WHAT MEASURES WE HAVE OF OUTCOMES HOW GOOD ARE THEY, WHAT WE HAVE TO DO TO IMPROVE THE MEASURE AND WHAT OTHER MEASURES DO WE NEED. >> I WANT TO KNOW HOW MUCH WITH THE THOUGHT TO INCREASE MEASURE COLLECTION AND SETTING WHERE THIS WOULD BE MEASURES THAT ENTER INTO THE ELECTRONIC HEALTH RECORD AT ALL STAGES AND SO FOR CHILDREN, INDIVIDUALS OF OLDER AGE, WHETHER YOU'RE YOUNG AS A PARENT OR GUARDIAN OR THEY WILL BE ALSO PART OF THAT ELECTRONIC HEALTH RECORD. IS THAT A FANTASY? REALISTIC? YES, IT IS A FANTASY. ENJOY YOUR CHOCOLATE. I THINK THERE'S GREAT OPPORTUNITY ELECTRONIC HEALTH RECORDS, THE PROBLEM WITH ELECTRONIC HEALTH RECORDS WITH PRACTICING PHYSICIAN, THERE'S INSURANCE COMPANIES, AS WE MOVE TOWARD MAKING THEM BETTER CLINICAL TOOLS THAT WILL BECOME MORE A REALITY. I THINK WE HAVE AN OPPORTUNITY TO DO THAT IS PATIENT CENTERED MEDICAL HOMES MORE TEAM BASED APPROACHES, YOU'LL HAVE MORE INDIVIDUAL CARE PLAN KINDS OF THINGS HOPEFULLY DEVELOPED, AS WE MOVE TOWARD PERSON CENTERED CARE MODELS. THE OTHER OPPORTUNITY IS IN ALZHEIMER'S DISEASE RESEARCH CENTERS. WHERE THEY ARE COLLECTING DATA ABOUT INDIVIDUAL WITH DEMENTIA, FOLLOWING OVER TIME AND GETTING IMPORTANT INFORMATION ABOUT CAREGIVER STRESS AND WHAT'S HAPPENED THERE, THAT'S GREAT PLACE TO PIGGY BACK ON GETTING SOME IDEA ABOUT THE NATURAL HISTORY OF WHAT HAPPENS RELATED TO ABUSE AND NEGLECT. >> THANK YOU. I THINK WE'RE RIGHT ON TIME. >> THANK YOU TO THE THIRD PANEL. [APPLAUSE] THANKS TO EVERYONE FOR STICKING WITH IT FOR NINE HOURS. IS THAT RIGHT? SO MT CONNOLLY ARE GOING TO DO SOME SUMMARY AND NEXT STEPS FOR US. AND THOSE OF YOU HEADING OUT, THANK YOU SO MUCH. >> MARK IS GOING TO DANCE. AND DO THE HEAVY LIFTING WHILE GETTING THE SLIDES. -- THE SLIDES ARE SET UP BUT -- I'LL MAKE ONE PRELIMINARY POINT THEN MARK WILL GO AND MARK WILL FINISH UP, PLAYING MANY THE BACKGROUND HERE IS COMPLICATED DYNAMIC THAT RICHARD TOUCHED ON EARLIER WHICH IS THE RELATIONSHIP BETWEEN SCIENCE AND LAW. THIS IS A GROSS, GROSS SIMPLIFICATION BUT IF YOU LOOK BACK IN 1962 HENRY KEMP'S RAIDS OWE LOGICAL RESEARCH AND JAMA ARTICLE PROPEL FUNNELING HUNDREDS OF MILLIONS OF DOLLARS INTO SCIENCE IN CHILD ABUSE. WE HAVE VIOLENCE AGAINST WOMEN ACT 1994, NATIONALLAL ALZHEIMER'S PROJECT ACT, MORE RECENTLY. ALL INVOLVING HUNDREDS OF MILLIONS OF DOLLARS SO FAR GENERATED $4 MILLION. SO IF YOU LOOK AT THE RELATIONSHIP BETWEEN THE POWER OF SCIENCE TO MOVE -- I MEAN THE POWER OF SCIENCE NOVEMBER LAW AND POWER OF LAW TO MOVE SCIENCE, IT'S CHICKEN AND EGG KIND OF THING BUT IT'S ANOTHER REASON WE DESPERATELY NEED SCIENCE BECAUSE WE NEED TO BE ABLE TO MAKE A COHERENT CREDIBLE CASE. ONE LAST THING I WILL SAY IN TERMS OF LOW HANGING FRUIT, IN RESPONSE TO YOUR QUESTION WAS THE -- ONE THING THAT WAS IN THE OTHER JUSTICE ACT THERE'S RESEARCH IN IT WHERE WE WROTE IT THAT CAME OUT, INCLUDING STUFF COLLEAGUES AT NIA AND OTHER PARTS OF IT NIH HELP US THINK ABOUT, AND ONE THING THAT DID SURVIVE, MANDATE THAT HHS PROVIDES GUIDANCE TO THE RESEARCH COMMUNITY ON THESE VERY DIFFICULT HUMAN SUBJECTS AND IRB ISSUES, THAT HAS YET TO HAPPEN SO THAT'S REALLY LOW HANGING FRUIT. >> AFTER SHE PONTIFICATES I HAVE TO SUMMARIZE THE ENTIRE DAY. I TOOK NOTES, THESE DON'T NECESSARILY REFLECT EVERYTHING THAT WAS SAID IN DISCUSSION BUT FOR EACH MAJOR SESSION AND MAYBE I CAN BUTT THROUGH TO REFRESH YOUR RECOLLECTION. IN THE FIRST SECTION ON IDENTIFYING REVIEWS SCREENING STANDARDS AND DETECTING CHALLENGES WE HEARD FROM TONY ABOUT THE NEED TO DEVELOP DECISION RULES TO AID BUSY CLINICIANS, RICHARD TOLD A VERY IMPORTANT CAUTIONARY TALE ABOUT WHEN YOU GO TO PLACES LIKE EMERGENCY DEPARTMENTS YOU SELECTIVELY RECRUIT PEOPLE FROM LOW SOCIO ECONOMIC ENVIRONMENT AND BEGIN SIMPLE RISK FACTOR PROFILE INCORRECT AND BUNCH AFTER CLINICAL AND POLICY AND RESEARCH PROBLEMS THAT WE NEED TO BE AWARE OF. AS DR. CAR OPINION TEAR POINTED OUT, -- CARPENTER, BIASES THAT OCCUR WHEN YOU CONDUCT INSTRUMENTS IN ONE ENVIRONMENT AND USE IN ANOTHER WHERE SENSITIVITY AND SPECIFICITY CAN BE VERY PROFOUNDLY EFFECTED, LAURA POINTED OUT ELOQUENTLY THAT WE OFTEN SEE PERPETRATORS OF ELDER ABUSE THROUGH THE DOMESTIC VIOLENCE LENS, NOT AS FREQUENTLY AS EVIL AS WE MAKE OUT. SOME OF THESE ARE PATIENTS WITH DEMENTIA THEMSELVES, BEHAVIORS FROM BRAIN DISEASE PANCREAS IF IT DIDN'T MAKE INSULIN, IT'S THE SAME KIND OF THING. WE HEARD PROXIES WORK IN YOUNGER DOMESTIC VIOLENCE SORT OF SITUATION PARTICULARLY THE PROXY IS THE ABUSEER. HIGH-TECH PROMISE FOR MEASURING VIOLENCE, THIS IS A PHENOMENON THING, IT'S NOT A SEROLOGY STUDY LOOK AT PREVALENCE OF INFLUENZA OR WE GET OUR REPORTS FOR PREVALENCE STUDIES FROM PEOPLE'S MOUTHS AND THAT'S A PROBLEM. SO MAYBE ELECTRONIC TOOLS CAN HELP US, WE HEARD HOW RESEARCHERS HAVE DIFFICULTY GET THAT TO WORK ON THE FIELD. COGNITIVE IMPAIRMENT THEME THROUGHOUT THE DAY COMPLICATES EVERYTHING WE DO, IRB, STUDYING FOLKS ENROLLING PEOPLE. I LIKE RICHARD'S COMMENTS ABOUT DECIDING WHAT THE MISTAKES YOU WANT TO MAKE. TOO MANY FALSE POSITIVES AND NEGATIVES, THEY CAN'T GO IN THE SAME DIRECTION DEPENDING HOW YOU ADJUST INSTRUMENTS. AND THEN ON ORIGINS OF ABUSE EARLY CYCLES OF ABUSE ACROSS THE LIFE SPAN, I HEARD A TON FROM THIS SESSION, IMPORTANT LESSONS FROM OTHER FIELDS, CONNECTS WITH EARLIER LIFE VIOLENCE, STRENGTH BASED APPROACH, USING PHYSICAL THERAPY IN GERIATRICIAN, IN YOUNGER CAN DV VICTIMS LONGITUDINAL STUDIES HAVE BEEN HELPFUL, THE SOURCES OF THAT DATA IS CRITICALLY IMPORTANT. INTERESTING TO HEAR HOW DIFFERENT FORMS OF CHILD MALTREATMENT OR TRANSMITTED DIFFERENTLY IN DIFFERENT GROUPS, HOW FASCINATING. NO MORE PREVALENCE STUDIES AS DR. FLAMIER, MAYBE OTHERS. I THINK THERE IS ROOM FOR PREVALENCE STUDIES THEY LOOK AT THINGS LIKE COGNITIVELY IMPAIRED PEOPLE EXCLUSIVELY, MORE RISK FACTOR STUDIES, BUT EVERYBODY AGREES WE NEED INTERVENTION STUDIES FOR PREVENTION TREATMENT AND RISK MITIGATION. A LOT TODAY I LEARNED FROM THE IPV PEOPLE ABOUT VICTIMIZATION USUALLY DISTRESSED THESE FOLKS ARE, WE HAVE TOO NARROW A VIEW WHAT ELDER ABUSE IS, DEVASTATING AND SHE -- WE SHOULDN'T JUST BE THINKING ABOUT THIS AS A FAMILY MEDIATED EVENT. I TALKED ABOUT THE STRENGTH BASED APPROACH AS OPPOSED TO RISK FACTOR RESEARCH. SHE DID MAKE INTERESTING COMMENTS MEASURING AVERAGE EFFECTS LUMP ELDER ABUSE INTO THESE DIFFERENT -- ALL THESE FORMS OF ABUSE TO ONE METRIC ELDER ABUSE WE WIND UP AS EPIDEMIOLOGISTS SAY MEASURING AVERAGE EFFECT AND LOTS OF INTERESTING CONTOURS OF THE LANDSCAPE, THAT SWAMP NEEDS TO BE DRAINED. SHE TALKED THE NEED FOR STABLE FUNDING MECHANISM FOR ELK KER ABUSE AND WE HEARD ABOUT CENTERS FROM TERRY, MYSELF, FROM JASON, SPECIFICALLY IN THE CONTEXT OF HAVING A STABLE MEASUREMENT PROTOCOL OVER CENTERS AND ENVIRONMENTS WHICH IS CRUCIAL. I WOULD LIKE TO SUMMARIZE FROM THE BREAK OUT SESSION WHAT THEIR MAJOR FINDINGS WERE, THE LAST SLIDE AND THE FIRST, WE HEARD ABOUT THE IMPORTANCE OF QUALITATIVE RESEARCH, HOW TO DO LONGITUDINAL STUDIES, WE DRIVE MEASURES ACROSS CULTURE AND UNDER-REPRESENTED GROUPS NEED BASELINE DATA, UNDERSTAND WHAT BASAL RATES ARE. AND THE SECOND SESSION ABOUT PREVENTING MAL TREATMENT IN FAMILIAL ENVIRONMENT, THE NEED FOR FUNDING THE OUTCOMES AND RESEARCH CONSISTENTLY, WHAT SORTS OF INTERVENTIONS WORK, COST ANALYSIS OF INTERVENTIONS AN NON-INTERVENTIONS ARE DOING NOTHING HARMFUL AND COSTLY AND VICTIMIZATION SUBTYPES AND POLYVICTIMMIZATION SO RECURRENT THEMES ARE COMING THROUGH HERE. IN THE DIMINISHED COGNITIVE CAPACITY BREAK-OUT SESSION, WE HEARD TRAJECTORIES OF DECISION CAPACITY AND WITH AND WITHOUT DEMENTIA, VERY INTERESTING THE FOLKS HAVE PHYSIOLOGIC CHANGE MS. COGNITION THAT AFFECT THEIR FINANCIAL THINKING. THAT'S A VERY POLITICALLY INCORRECT IDEA THAT PEOPLE MIGHT NEED PROTECTION EVEN IN THE ABSENCE OF DIMEANTING ILLNESS, I PERSONALLY THINK 50 YEARS FROM NOW WE WILL LOOK AT THE FACT THAT WE LET 9-YEAR-OLDS TRADE ONLINE WITHOUT SCREENING OR MULTI-NATIONAL CORP RAYING IT IS WAY WE VIEW THE FACT THAT WE LET 6-YEAR-OLDS WORK IN FACTORIES. BAFFLING TO ME, WE'RE STARTING TO MAKE OLDER PEOPLE TAKE DRIVING TESTS AND THINGS THAT WILL GET TO THAT PLACE. WE TALKED ABOUT OTHER STEPS TO DEVELOP AND TRANSLATE PROCESSES AND STEPS PROFESSIONAL INTERACTING WITH ADULTS WHEN THERE'S A CONCERN ABOUT DIMINISHED CAPACITY. JASON NATHAN TALKED ABOUT HOW TO TRAIN FRONT LINE WORKERS TO ASSESS CAPACITY, DOING IT EVERY DAY WITHOUT PORTFOLIO WE SHOULD GIVE THEM BETTER REPRODUCIBILITY TOOLS. WE HEARD ABOUT SOCIAL COGNITION, I THINK THIS IS OFTEN HOW PEOPLE WITH NORMAL COGNITION MAKE BAD DECISIONS, EVEN WHEN NEUROPSYCHOLOGICALLY NORMAL THROUGH TEN HOURS OF TESTING T. AND THIS ISSUE OF INSIGHT THAT JASON FREQUENTLY RAISES HOW PEOPLE OFTEN CANNOT APPRECIATE THEIR IMPAIRMENTS AND DIFFERENTIATEED FROM TASTE AND PREFERENCE IS A CRITICAL ONE. LAST SESSION I PARTICIPATED IN AROUND ETHICS AND LAW WE TALKED ABOUT NEED TO INCLUDE SHAREHOLDERS IN IRBs, HOW WE NEED TO COMMUNICATE THE IMPORTANCE OF ELDER ABUSE RESEARCH TO ALL CONSTITUENCIES. CREATE ONGOING COMMUNITY OF RESEARCHERS AND PRACTITIONERS WHO SUPPORT EACH OTHER AND TALK THROUGH IRB ISSUES AND ABLE TO SAY NO, IN MY INSTITUTION IT WAS NOT A BIG DEAL TO GET WAIVER OR GET THIS THING DONE. WE NEED TO EXPLORE THE POSSIBILITY OF GUIDELINES FOR ELDER ABUSE RESEARCH WITH REGARD TO IRB, SO THERE'S STANDARD EXEMPLARS OR TEMPLATES, AND THE SESSION WE HEARD ALSO FASCINATING SESSION, I HEARD FROM MY FAVORITE OF THE DAY, WE HEARD THAT THERE HAVE BEEN SOME SUCCESSFUL INTERVENTION STRATEGIES FOR OTHER VICTIMS OF DOMESTIC VIOLENCE BUT NOT ELDER BECAUSE. THE CHILD ABUSE SETTING WAS FASCINATING TO ME. THAT WE SORT OUT COME POINTS OF SUCCESSFUL INTERVENTIONS SUSTAINED NATURE OF THEM, AND THE FACT THERE HAVE BEEN RANDOMIZED TRIALS, SHE LOOKED AT THE PATHOPHYSIOLOGY OF WHY CERTAIN KINDS OF CHILD MAL TREATMENT OCCURS DISREGULATION PATHOPHYSIOLOGY, I THOUGHT WAS FASCINATING. I THOUGHT IT WAS FASCINATING THAT IT'S ONCE THE HORSE LEFT THE BARN IT BECOMES MORE DIFFICULT, THAT MUCH ABUSE ONCE ABUSE OCCURS INTERVENTION IS TOUGHER. PROBLEMS IN ELDER ABUSE INCLUDE POOR DESIGN, NO RANDOMIZED TRIALS RECRUITMENT AND RETENTION WE HEARD OVER AND OVER TODAY WE NEED DIFFERENT OUTCOMES, DAVID TALKED ABOUT GOAL ATTAINMENT SCALING AND HOW WE WHICH YOU KNOW SHOULDN'T LOOK AT DID WE GET YOU OUT OF THE HOUSE. MAYBE THE ABUSE IS LESS DISTRESS AREFUL, IT OCCURS LESS FREQUENTLY, LESS VIOLENT, EARLY ELDER ABUSE RESEARCHER I WOULD JUST EXTRICATE VICTIMS AND EVERYTHING WOULD BE NORMAL AGAIN, THAT JUST NEVER HAPPENS, IT'S A VERY RARE EVENT, AND I THINK GOAL ATTAINMENT SCALING IS A VERY PROMISING WAY OF DEVELOPING NEW CLIENTS CENTERED OUTCOMES. I HEARD IPV WE NEED SEVERAL KINDS OF INTERVENTIONS SIGH MULL TAPE YOULY, THE APPROACH IS INTEGRATE AS PART OF THE COMMUNITY SOLUTION. LAURA TALKED ABOUT FORENSIC CENTERED AND MBTs STARTING TO UNDERGO SOME SCIENTIFIC EVALUATION, LIKE WHAT SHE SAID THE FACT THEY ARE GROWING, LEAPS AND BOUNDS TELLS US SOMETHING BUT THE PROBLEM, IF YOU STUDY ONE YOU HAVE STUDIED ONE SO WE HAVE FORENSIC CENTERS AND MULTI-DISCIPLINARY TEAMS, SPREADING THROUGHOUT THE COUNTRY , CLINICAL PROJECTS THAT REALLY IN SOME WAYS ARE IN THE BEST TRADITION OF COLLABORATIONS, WE NEED TO LAYER SCIENCE ON TOP OF THAT. WE NEED TO MARRY SCIENCE AND SERVICE BY PUTTING STANDARDIZED MEASURES HAVING A COMMON CORE DATA COLLECTION PROCESSES, OVER THESE SIX OR SEVEN OR EIGHT PLACES THAT ARE DOING IT FULL TIME AND A BUNCH OF PLACES THAT ARE UP AND RUNNING. HAVING BEEN HERE 25 YEARS AGO FOR A CONFERENCE LIKE THIS, I AM STRUCK BY HOW LESS SILOED WE ARE BUT BY THE FACT WE ARE PRETTY SILOED. THERE ARE A BUNCH OF FOLKS THAT I LIKE TO SPEND TIME WITH AND LEARN MORE ABOUT YOUR WORK, I'M HONORED TO BE HERE. DO YOU HAVE ANY FINAL COMMENTS BASED ON MY REVIEW TODAY? >> YOU DID WELL PONTIFICATING. COUPLE OF THINGS. IT'S ALSO AN ISSUE THAT CAN BE WEDGED TO OTHER PLACES, I WAS STRUCK THAT AT SIX WEEKS AGO THERE WAS AN EXECUTIVE ORDER USING BEHAVIORAL SCIENCE INSIGHTS TO BETTER SERVE THE AMERICAN PEOPLE OUT OF THE WHITE HOUSE. GOING TO THE INSIDE WOWS ISSUE OF AGEISM AND MANY OTHER ASPECTS OF THIS PROBLEM, AGEISM IS ONE OF THE FEW KINDS OF DISCELL NATION THAT WE'RE STILL ALLOWED TO ENGAGE IN IN A SORT OF PUBLIC WAY WE'RE ALLOWED THE TALK ABOUT GEEZERS, ALLOWED TO DO THAT, AND IT MAKES DIMINISHES THE HUMANS OF THE PEOPLE THAT WE'RE TALKING ABOUT. AND IT MAKES THIS ISSUE A LOT HARDER TO TAKE ON. SO I THINK THAT DEPLOYING BEHAVIORAL SCIENCE IN THAT AND MANY OTHER ASPECTS OF THE PROBLEM HAS SOME POTENTIAL. WE HAVE USE THE WORD PUBLIC HEALTH VERY MUCH HERE TODAY AND IT'S SORT OF -- WE NEED TO RECOGNIZE, WHAT WE CALL THINGS MATTER, AND IT IS A MASSIVE PUBLIC HEALTH ISSUE THAT IS NOT TREATED AS SUCH AS YET. SO I THINK THAT THAT'S ANOTHER -- ACTUALLY IT'S KIND OF LOW-HANGING FRUIT. YOU CAN NAME THINGS AND IT HAS POWER. IN ADDITION TO THE GORILLAS IN THE ROOM, COGNITIVE IMPAIRMENT AGEISM, THE THIRD ONE I WOULD PUT ON THE TABLE CLEARLY, CARE GIVING SLASH DEPENDENCE NEXUS, IT MAKES COMPLICATED IN THIS FIELD. I WANT TO TALK ABOUT THE POWER OF THREE THINGS, THE POWER OF HAVING -- OF HAVING CENTERS WHATEVER THEY ARE, HAS -- THEY HAVE A NUMBER OF DIFFERENT ADVANTAGES. I WAS STRUCK THAT WE ONLY HAVE A FEW PLACES IN THE FIELD, THAT COMBINE A BUNCH OF DIFFERENT STUFF, MAKING MARK'S POINT A DIFFERENT WAY. WORK WITH ELDER ADULTS, PIPELINE TRAINING FOR NEW PROFESSIONALS, CONVENING PARTNERS WHICH IS A BIG DEAL, WHEN YOU CONVENE, I THINK IN THE NEW YORK CITY REVIEW CENTER HAS A HUNDRED PARTNERS. IT'S HARD WORK AND YOU NEED CONSISTENCY IN THE CONVENING BODY. AND IT IS CONVENIENT LAYER SCIENCE ON TOP OF IT. FLAMIER TALKED ABOUT HARMONIZING OF THE DATA THAT'S THE OTHER THING THAT WE LEARNED FROM CENTERS IS IN PLACES THAT HAVE -- ISSUES THEY HAVE NUMEROUS COORDINATED CENTERS YOU HAVE TO HARMONIZE THE DATA AND ESPECIALLY NOW THAT APS IS BEGINNING FOR THE FIRST TIME IN HISTORY TO COLLECT ADULT PROTECTIVE SERVICES DATA. THERE'S AN OPPORTUNITY TO INFORM THAT PROCESS WITH DATA AND GET OUT AHEAD OF -- AND LEARN FROM THE OHIO LEARN FROM CHILD ABUSE DATA AND DOMESTIC VIOLENCE DATA. REALLY IMPROVE ON THAT. TWO OTHER POINTS. THE POWER OF FUNDING. I THINK ALL OF US LEARNED IN DIFFERENT WAYS, WHEN YOU GET FUNDING THE ISSUE YOU WORK ON ARE IMPORTANT. THAT SENDS A MESSAGE TO THE PIPELINE. THAT'S ONE OF THE REASONS THAT THIS IS SUCH AN IMPORTANT EFFORT AND YOU DON'T SEND THAT MESSAGE BY ANY CELL AND DIMING, A LITTLE STUDY HERE AND THERE AND A LITTLE STUDY THERE. THERE NEEDS TO BE SOMETHING BIG, IT NEEDS THE MAKE A STATEMENT. THIS IS THE PRELUDE TO THE THANK YOU TO NIH BECAUSE ALL OF US IN THIS ROOM AND EVERYBODY WATCHING KNOWS THAT IT TAKES AN ENORMOUS AM OF TIME AND EFFORT TO PUT SOMETHING LIKE THIS TOGETHER ESPECIALLY WHEN CROSS DIFFERENT INSTITUTES AND DIFFERENT OFFICES, WITHIN THE BODY OF THE MOST PRESTIGIOUS RESEARCH ORGANIZATION IN THE HISTORY OF THE WORLD. AND WE REALLY, REALLY NEED YOU AND TO HAVE IT IN CONTEXT OF THIS ISSUE IS TRANSFORMATIVE AND SO THAT'S MY LAST POINT, THANK YOU AND THE POWER THAT YOU CAN BRING TO CHANGE HEART AND MINDS AND SCIENCE AND KNOWLEDGE AND IMPROVE LIVES OF MILLIONS AND MILLIONS OF PEOPLE PHENOMENAL AND SORT OF THE OTHER SIDE OF THE LONGEVITY THIS INSTITUTE OR THE NATIONAL INSTITUTES OF AGING HAVE BROUGHT. I WOULD SAY OBLIGATION THAT GOES WITH IT. WE FIGURED HOW TO LIVE THIS LONG, NOW WE HAVE TO FIGURE OUT HOW TO DEAL WITH THE DOWN SIDE OF AGING. THANK YOU. [APPLAUSE] >> THANK YOU FOR YOUR CONTRIBUTIONS AND HARD WORK PREPARING TODAY AND GETTING YOUR HEADS AROUND WHAT WAS KIND OF AN UNUSUAL SET OF PEOPLE TO BRING TOGETHER SET OF TOPICS FOR US ALL TO TALK ABOUT TOGETHER. IT IS ESSENTIAL WE DON'T LEAVE THIS ROOM AND NEVER SEE EACH OTHER AGAIN, WE ARE REALLY COMMITTED TO HOTTER TERM TO GET PUBLICATIONS TO DELVE DEEPER INTO THE CONVERSATIONS WITH WE HAVE HAD TODAY AND PRODUCE SOMETHING THAT CAN HAVE A WIDER AUDIENCE THAT JUST THE PEOPLE IN THE ROOM OR PEOPLE WHO WATCH THE VIDEOCAST SO FOR ALL OF YOU ON THE PANELS WE WILL BE GETTING IN TOUCH WITH YOU SOON TO SCHEDULE SOME FOLLOW-UP, PHONE CALLS AND FIGURING OUT WHAT WE CAN TAKE OF THIS AND HOW TO MOVE FORWARD AND WHAT OUR OTHER NEXT STEPS MIGHT BE. WE'RE GOING TO LET YOU OUT TEN MINUTES EARLY. THANK YOU SO MUCH. LIZ DO YOU HAVE ANYTHING ELSE TO SAY? >> I WOULD LIKE TO THANK KATE ON BEHALF OF ALL OF US FOR OUTSTANDING PLANNING. [APPLAUSE] >> THANK YOU. GOODBYE.