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  1. Article ; Online: Drivers of racial/ethnic differences in perceived end-of-life care quality: More questions than answers.

    Bullock, Karen / Makaroun, Lena K

    Journal of the American Geriatrics Society

    2022  Volume 70, Issue 4, Page(s) 1057–1059

    MeSH term(s) Hospice Care ; Humans ; Terminal Care ; United States
    Language English
    Publishing date 2022-02-28
    Publishing country United States
    Document type Editorial ; Research Support, U.S. Gov't, Non-P.H.S. ; Comment
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.17663
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  2. Article ; Online: Elder Abuse in the Time of COVID-19-Increased Risks for Older Adults and Their Caregivers.

    Makaroun, Lena K / Bachrach, Rachel L / Rosland, Ann-Marie

    The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry

    2020  Volume 28, Issue 8, Page(s) 876–880

    MeSH term(s) Aged ; Betacoronavirus ; COVID-19 ; Caregivers/psychology ; Coronavirus Infections/epidemiology ; Coronavirus Infections/psychology ; Elder Abuse/prevention & control ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/psychology ; Risk Factors ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-05-19
    Publishing country England
    Document type Editorial
    ZDB-ID 1278145-9
    ISSN 1545-7214 ; 1064-7481
    ISSN (online) 1545-7214
    ISSN 1064-7481
    DOI 10.1016/j.jagp.2020.05.017
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  3. Article ; Online: Changes in Elder Abuse Risk Factors Reported by Caregivers of Older Adults during the COVID-19 Pandemic.

    Makaroun, Lena K / Beach, Scott / Rosen, Tony / Rosland, Ann-Marie

    Journal of the American Geriatrics Society

    2021  Volume 69, Issue 3, Page(s) 602–603

    MeSH term(s) Aged ; COVID-19 ; Caregiver Burden/psychology ; Caregivers/psychology ; Caregivers/statistics & numerical data ; Elder Abuse/psychology ; Elder Abuse/statistics & numerical data ; Female ; Humans ; Income/statistics & numerical data ; Loneliness/psychology ; Male ; Middle Aged ; Pennsylvania ; Risk Factors ; SARS-CoV-2 ; Social Isolation/psychology ; Surveys and Questionnaires
    Language English
    Publishing date 2021-01-05
    Publishing country United States
    Document type Letter ; Research Support, N.I.H., Extramural
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.17009
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  4. Article ; Online: Medical and Social Factors Associated With Referral for Elder Abuse Services in a National Health Care System.

    Makaroun, Lena K / Thorpe, Carolyn T / Mor, Maria K / Zhang, Hongwei / Lovelace, Elijah / Rosen, Tony / Dichter, Melissa E / Rosland, Ann-Marie

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2023  Volume 77, Issue 8, Page(s) 1706–1714

    Abstract: Background: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine ... ...

    Abstract Background: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national U.S. health care system.
    Methods: We conducted a national case-control study in U.S. Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010 and 2018. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models.
    Results: Of 5 567 664 Veterans meeting eligibility criteria during the study period, 15 752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (adjusted odds ratio; 95% confidence interval), age ≥ 85 (3.56 vs age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 vs spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28), and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services.
    Conclusion: In the largest cohort of patients receiving EA-related health care services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in health care-based EA surveillance and detection.
    MeSH term(s) Aged ; Case-Control Studies ; Delivery of Health Care ; Elder Abuse ; Female ; Humans ; Referral and Consultation ; Social Factors ; United States/epidemiology ; Veterans
    Language English
    Publishing date 2023-01-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glab354
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  5. Article ; Online: Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study.

    Makaroun, Lena K / Rosland, Ann-Marie / Mor, Maria K / Zhang, Hongwei / Lovelace, Elijah / Rosen, Tony / Dichter, Melissa E / Thorpe, Carolyn T

    Journal of the American Geriatrics Society

    2023  Volume 71, Issue 6, Page(s) 1724–1734

    Abstract: Background: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. ...

    Abstract Background: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system.
    Methods: We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model.
    Results: The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation.
    Conclusions: A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.
    MeSH term(s) Humans ; Aged ; United States/epidemiology ; Frailty/diagnosis ; Frailty/epidemiology ; Elder Abuse ; Case-Control Studies ; Medicare ; Delivery of Health Care ; Frail Elderly
    Language English
    Publishing date 2023-01-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.18245
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  6. Article ; Online: Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic.

    Elman, Alyssa / Gottesman, Elaine / Makaroun, Lena K / Chang, E-Shien / Baek, Daniel / Clark, Sunday / Rosen, Tony

    Journal of applied gerontology : the official journal of the Southern Gerontological Society

    2023  Volume 42, Issue 7, Page(s) 1551–1564

    Abstract: The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six ... ...

    Abstract The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six focus groups and seven interviews during March-April 2021 using a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and caseworkers in New York City, a community hard hit by the initial COVID surge. Data from transcripts were analyzed to identify themes. Participants identified challenges faced by APS (e.g., clients less willing to engage with APS, inability to perform necessary job tasks remotely, and low staffing levels) as well as strategies APS used in response (e.g., increasing collaboration with other community-based programs and service providers, enabling remote court hearings through technology and in-person facilitation, and ensuring staff had access to personal protective equipment). These findings may inform APS planning for future large-scale societal disruptions.
    MeSH term(s) Humans ; Aged ; COVID-19/epidemiology ; Elder Abuse/prevention & control ; Pandemics ; Social Welfare ; Focus Groups
    Language English
    Publishing date 2023-04-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 155897-3
    ISSN 1552-4523 ; 0733-4648
    ISSN (online) 1552-4523
    ISSN 0733-4648
    DOI 10.1177/07334648231166276
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    Zs.A 2901: Show issues Location:
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  7. Article ; Online: Family caregivers navigating the health care system: Evolving roles during the COVID-19 pandemic.

    Semere, Wagahta / Makaroun, Lena K / Beach, Scott / Schillinger, Dean / Rosland, Ann-Marie

    Families, systems & health : the journal of collaborative family healthcare

    2022  Volume 40, Issue 2, Page(s) 268–273

    Abstract: Introduction: The COVID-19 pandemic has altered access to health care; it remains unclear how patients with chronic illness and disability and their family caregivers are adapting to these changes. In this study, we examined changes in family caregiver ... ...

    Abstract Introduction: The COVID-19 pandemic has altered access to health care; it remains unclear how patients with chronic illness and disability and their family caregivers are adapting to these changes. In this study, we examined changes in family caregiver roles helping care recipients with chronic illness and disability navigate health care needs during the COVID-19 pandemic.
    Methods: From April 15 to May 27, 2020, we distributed online and telephone surveys to family caregiver members of a population-based regional research registry. Caregivers reported whether they were helping "more," "less," or the "same" with ten health care activities (e.g., filling prescriptions, attending medical appointments) now, compared to before the coronavirus pandemic. Using multivariable logistic regression models, we examined caregiver and caregiving context characteristics associated with helping more with 1 or more health care activities.
    Results: Of 561 caregiver respondents, mean age was 59 years, 76% were women, and 56% co-resided with care recipients. Many caregivers (59%) reported increased help with 1 or more health care activities since the pandemic. Caregivers reported greater help getting medical supplies (31%) and attending care recipients' phone (21%) and video (16%) medical appointments. Women (OR 1.55; 95% CI 1.02-2.36) and caregivers assisting with short-term physical conditions were more likely to help more with 1 or more health care activities (OR 2.81; 95% CI 1.20-6.59).
    Discussion: Family caregivers reported their responsibilities helping care recipients with chronic conditions and disabilities stay engaged with health care increased since the pandemic. Providers and health systems should consider targeted strategies to support caregivers helping vulnerable patients access necessary care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
    MeSH term(s) COVID-19/epidemiology ; Caregivers ; Chronic Disease ; Delivery of Health Care ; Female ; Humans ; Male ; Middle Aged ; Pandemics
    Language English
    Publishing date 2022-05-12
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1326859-4
    ISSN 1939-0602 ; 1091-7527 ; 0736-1718
    ISSN (online) 1939-0602
    ISSN 1091-7527 ; 0736-1718
    DOI 10.1037/fsh0000688
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  8. Article ; Online: Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System.

    Makaroun, Lena K / Halaszynski, Jaime J / Smith, Kathrine A / Drake, Ruth / Amelio-Hering, Vanessa / Atchison, Karley / Dichter, Melissa E / Rosland, Ann-Marie / Thorpe, Carolyn T / Rosen, Tony

    Journal of general internal medicine

    2024  

    Abstract: Background: Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical ... ...

    Abstract Background: Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening.
    Objective: Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA.
    Design: Survey of all 139 VHA medical centers from January to August 2021.
    Participants: Surveys were completed by the Social Work Chief, or delegate, at each site.
    Main measures: The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey.
    Key results: Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents' understanding of the definition of screening.
    Conclusions: High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.
    Language English
    Publishing date 2024-01-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-023-08560-2
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  10. Article ; Online: Elder Abuse in the Time of COVID-19—Increased Risks for Older Adults and Their Caregivers

    Makaroun, Lena K. / Bachrach, Rachel L. / Rosland, Ann-Marie

    The American Journal of Geriatric Psychiatry

    2020  Volume 28, Issue 8, Page(s) 876–880

    Keywords Geriatrics and Gerontology ; Psychiatry and Mental health ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 1278145-9
    ISSN 1545-7214 ; 1064-7481
    ISSN (online) 1545-7214
    ISSN 1064-7481
    DOI 10.1016/j.jagp.2020.05.017
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