Research
Objectives
The Adult Protection & Elder Mistreatment Lab conducts interdisciplinary research aimed at preventing elder mistreatment and self-neglect while strengthening the systems designed to protect vulnerable older adults. Our work integrates public health, aging, health services research, policy analysis, and program evaluation, with a focus on elder mistreatment (psychological, physical, & sexual abuse, caregiver neglect, and financial exploitation) that occurs in community settings.
We collaborate regularly with researchers, practitioners, and policymakers in Texas, throughout the U.S., and internationally. Strong ties to diverse stakeholder groups lead to practice-informed evidence that improves prevention, identification, intervention, and long-term outcomes. These ties also enhance our work to assess and reduce health disparities (e.g., based on race/ethnicity, sexual/gender minority status, disease diagnosis).
The lab is housed in the School of Public Health’s Department of Management, Policy, & Community Health, and maintains strong affiliations with the UTHealth Houston Institute on Aging and the Roybal Center for Elder Mistreatment Intervention Research. We partner with investigators from both academia and practice, in various disciplines and settings (e.g., medicine, nursing, public health, social work, law, criminal justice). We welcome additional partnerships that facilitate knowledge building and knowledge sharing between the research and practice communities.
Projects
Supporting APS Worker Decision Making with Data-Informed Tools
Adult protective services (APS) programs routinely face difficult decisions about which cases would benefit most from enhanced review or multidisciplinary intervention. Our work in this area began with MDT-ID, a collaboration with San Francisco APS. Using machine learning, MDT-ID developed and tested a stakeholder-informed algorithm for identifying complex cases for referral to a multidisciplinary team (MDT). Building on that work, we are developing a broader framework for creating, implementing, and refining decision support tools that reflect program contexts, available data, and practitioner expertise. The goal is to provide a technology-enhanced, streamlined way for APS programs and other providers to use insights from their client/patient data to strengthen triage, referral, and service delivery.
Preventing and Addressing Elder Mistreatment with Person-Centered Interventions
Preventing and responding to elder mistreatment requires interventions that address the circumstances, needs, preferences, and relationships of older adults and their families/communities. Our work develops and evaluates person-centered approaches that reduce risk, strengthen supports, and improve outcomes without unnecessarily limiting individuals’ agency or autonomy. These approaches include caregiver-focused interventions such as COACH (Comprehensive Older Adult and Caregiver Help) and KINDER (Knowledge and Interpersonal Skills to Develop Enhanced Relationships), as well as emerging work through the UTHealth Houston Roybal Center for Elder Mistreatment Intervention Research. Initial efforts are addressing a major gap in the field by developing and testing these person-centered interventions. Downstream work will examine for whom the interventions work, under what circumstances, and how promising approaches can be adapted and implemented in real-world settings.
Leveraging Health Records to Understand Mistreatment
Health records contain rich information about diagnoses, healthcare use, functional status, medications, injuries, and other factors. However, the absence of systematic indicators for the presence of mistreatment keeps us from using these records to illuminate the circumstances and consequences of mistreatment of older adults and adults with disabilities. In partnership with several groups, including researchers at Weill Cornell Medicine and Vanderbilt University and practitioners from multiple APS programs, we are working to identify victims of mistreatment in healthcare data and study their health trajectories before and after mistreatment is recognized. By linking practice-based knowledge with large-scale clinical and administrative data, this work aims to improve our understanding of who experiences mistreatment, how their health and healthcare needs evolve leading up to and following the mistreatment, and where opportunities for earlier identification or intervention may exist.
Expanding Knowledge of Elder Mistreatment in Understudied Populations
Our understanding of elder mistreatment is largely built on data from individual research projects. While often gathered using rigorous standards, these studies cannot answer many important questions about mistreatment in population subgroups. Their datasets often include too few individuals from these groups to fully understand experiences with mistreatment or its subtypes (e.g., physical abuse, caregiver neglect, financial exploitation). We are addressing this challenge using large, mostly untapped survey and surveillance datasets, including nationally representative sources, to study vulnerability, victimization, and circumstances related to mistreatment. These data allow us to examine patterns across those demographic and social groups that are theorized to have different patterns and predictors of mistreatment. The goal is to broaden the evidence base, identify disparities and overlooked risk patterns, and generate new questions for targeted research, prevention, and intervention.
Assessing Decision-Making Abilities in Everyday Life
Decisional capacity is essential to autonomy, yet existing assessments often focus on medical or legal decisions rather than the everyday choices people must make to live safely and independently in the community. Dr. Aanand Naik and colleagues developed and tested a tool to assess how older adults and others with possible capacity impairment understand, appreciate, and reason through realistic situations they may encounter in daily life. Building on longstanding work, we are now partnering with the UTHealth Houston Institute on Aging to modernize this approach and convert it into a technology-assisted tool that can make administration both more standardized and easier for practitioners to incorporate into their practice. This work aims to produce a practical, person-centered tool that can support clinicians, social service professionals, and researchers in identifying strengths, areas of concern, and situations in which individuals may need additional decision-making support.
