Evaluation of AoA’s Elder Abuse Prevention 

Intervention Demonstrations

ASPE | July 2015

Enacted as part of the Patient Protection and Affordable Care Act in March of 2010, the Elder Justice Act 

represents the most comprehensive federal elder abuse prevention law to date, calling national attention to 

the millions of vulnerable older Americans who are victims of abuse, neglect, and exploitation. The Elder 

Abuse Prevention Interventions demonstration, authorized by the Elder Justice Act and funded by the 

Administration on Aging (AoA), U.S. Department of Health and Human Services (HHS) in FY 2013, provided 

funding to five state grantees to test interventions designed to prevent elder abuse, neglect, and exploitation. 

The HHS Office of the Assistant Secretary for Planning and Evaluation has contracted with NORC at the 

University of Chicago to design and conduct an evaluation of the interventions being tested through this 

demonstration. The purpose of the evaluation is to study the development and implementation of the state 

grantees’ elder abuse interventions and report findings on the characteristics of victims and perpetrators of 

elder abuse or those at-risk, the use of prevention services, and outcomes. 

The states participating in the demonstration and evaluation are: Alaska Division of Senior and Disabilities Services; New York State Office for the 

Aging; University of Southern California; University of Texas Health Science Center at Houston; and Texas Department of Family and Protective 

Services and WellMed Charitable Foundation. This Research Brief is one of five summarizing the tested interventions and findings to date.

Take AIM against Elder Abuse: 

The Abuse Intervention-Prevention Model

University of Southern California, Keck School of Medicine

OVERVIEW 

The University of Southern California, Keck School of Medicine,1 in 

partnership with the California Department of Aging, California Department 

of Social Services, Legal Aid Society of Orange County, and the Orange 

County Elder Abuse Forensic Center is piloting a multidimensional 

intervention called the Abuse Intervention Model (AIM) that is targeted at 

preventing elder abuse among adults with dementia. 

This project is designed to pilot test a multi-component model for primary 

and secondary prevention of abuse of people with dementia. It involves 

early assessment of vulnerability to elder abuse and early tailored/targeted 

interventions for the person with dementia and/or their caregiver.

KEY FINDINGS TO DATE 2

Theoretical/Clinical Basis of Prevention Intervention 

Adults with dementia are at higher risk for abuse than other groups of older 

adults. The responsibilities and challenges of providing care present 

multiple pathways for caregivers to become abusive. 

Research in child abuse, domestic violence, and intimate partner violence 

has demonstrated 1) the importance of embedding prevention programs 

within the social context, targeting family members as well as victims; and 

2) tailoring prevention strategies to the unique characteristics and needs of 

the individual situation. 

Prevention Intervention 

Focusing on care-recipient caregiver dyads in which one member has 

dementia, the project 1) administers a risk assessment; 2) links dyads to 

existing services in the community and facilitates access; and 3) 

administers a follow-up assessment. 

Outcomes 

The intended short term outcomes of the project are: 1) identification of 

high risk of abuse at early stages; 2) enhanced caregiver coping skills and 

confidence; 3) reduced behavioral manifestations (e.g., agitation); 4) 

increased knowledge of disease process; and 5) increased access to 

social resources. 

The intermediate outcome is a decrease in the number of cases at or 

exceeding multi-domain risk threshold. The longer-term outcome is to 

reduce the risk of elder abuse and neglect among adults with dementia in a 

way that is reproducible and scalable. 

INFRASTRUCTURE 

AIM operates out of the Department of Family Medicine at the University of 

Southern California. AIM partners with a number of sites to identify and 

recruit participants, including an outpatient geriatrics practice, an Adult 

Protective Services agency, and an Alzheimer's disease research center at 

the University of California, Irvine, a local Alzheimer’s Association, multiple 

adult day care programs, and numerous other community-based agencies 

in Orange County, CA. 

The project facilitates links to existing services, such as geropsychiatry, 

Savvy Caregiver course, in-home caregiver agencies, Caregiver Resource 

Center, Friendly Visitor program, caregiver support groups, legal aid, and 

family counseling.

ELDER ABUSE 

Over 225,000 Californians are victims each year, but experts believe the 

problem to be much larger.3 The full scope is limited due to the problem's 

hidden and complex nature. 

People with dementia and those over 85 are at even greater risk of elder 

abuse than the general adult population.4

 

INTERVENTION 

Target Population

The target population is older adults with dementia at risk for abuse and 

their primary caregivers. As of July 2015, 75 dyads have been enrolled in 

the program. 

AIM Prevention Intervention 

The prevention intervention includes baseline and follow-up risk 

assessments, targeted referrals for services, and home visits over the 

course of three months. Using a social-ecological perspective5 to describe 

abuse risk and protective factors,6 AIM focuses on the dyadic care 

relationship and socio-cultural and /environmental contextual factors. The 

structure of the intervention allows for multiple disciplines to intervene 

simultaneously at multiple risk points. 

Research Brief

Evaluation of AoA’s Elder Abuse Prevention Intervention Demonstrations | July 2015 | Page 1 
University of Southern California, Keck School of Medicine: Take AIM against Elder Abuse: The Abuse Intervention Mode

Visit 1 - Recruitment, Risk Assessment (90 minutes): Working with 

recruitment sites, the project coordinator identifies and recruits participants. 

The coordinator and interviewer meet with the care recipient and caregiver 

(the dyad) and interview each member separately during a home visit. The 

team assesses decision-making capacity, obtains informed consent, and 

administers the risk assessment. 

For an adult with dementia, the domains assessed are aggression, 

resistance to care, and activities of daily living (ADL) dependency. Risk 

domains assessed for the caregiver are anxiety, depression, and perceived 

burden. Contextual factors, such as limited social support, financial strain, 

and relationship quality, are also assessed. 

Following the initial home visit, the assessments are analyzed by the 

research team. They develop a risk assessment profile and identify 

appropriate referral sources in the community for assistance. 

Visit 2 - Review of Profile, Service Referrals (60 minutes): At the 

second home visit, the coordinator reviews the risk assessment profile for 

the care recipient and caregiver, and walks them through recommended 

referrals and the process of obtaining services. Each elder abuse risk 

factor on the AIM Assessment Battery is mapped to an appropriate 

treatment, training, or concrete service (as shown in the Elder Abuse Risk 

Factors and Toolkit of Existing Interventions at right). 

For example, if the elder has difficultly with ADLs, referral to an in-home 

caregiver agency may be recommended. If the adult with dementia is 

resistant to care, the caregiver may be referred to the local Savvy 

Caregiver Plus program (sponsored by the Alzheimer’s Association), an 

evidence-based training designed to increase knowledge of disease 

progression, build confidence, and develop practical skills and strategies to 

improve and support care. If the elder is aggressive or the caregiver is 

experiencing anxiety or depression, or feels over-burdened, referrals for 

appropriate therapeutic care or services are provided. Services are also 

available to address limited social support (e.g., weekly home and 

telephone visitations) or legal aid (e.g., benefits, financial and advanced 

care planning). 

Participation in referred services occurs over the course of the three month 

intervention, with the time commitment ranging from 1 to 12 hours per 

month. To protect confidentiality, the service provision agencies do not 

provide AIM with information on whether the dyad has contacted the 

agency or used services. 

Visit 3 Service Use, 3 month Follow-up Risk Assessment (90 

minutes): AIM meets with the dyad during a third and final home visit to reassess decision making capacity, administer the follow-up risk 

assessment, and assess service use. While the structure of the 

intervention requires three 'formal' visits with the dyad, contact may 

continue throughout the process as the coordinator links the dyad to 

service agencies and facilitates data collection. 

IMPLEMENTATION 

A university-community partnership, AIM project staff liaison with 

community members, referral sources, and service providers in Orange 

County. While the project team moved to USC, the location of the 

intervention program has stayed in Orange County to capitalize on the 

resources and relationships established there, which has facilitated AIM 

implementation.

Key to early implementation of AIM is its partnership with the Orange 

County Elder Abuse Forensic Center (EAFC), which seeks to better 

understand and treat elder abuse through fostering collaboration across 

service agencies. The EAFC includes nine organizations: 

■ University of California Irvine School of Medicine 

■ Adult Protective Services 

■ Office of the District Attorney 

■ Sheriff's Department 

■ Public Administrator/Public Guardian 

■ Community Service Programs 

■ Long-Term Care Ombudsman 

■ Older Adult Services

■ Human Options 

Team members are familiar with the quality of community resources and 

the procedures through which older adults can gain access. This "on the 

ground" knowledge is essential to implementation. 

LESSONS LEARNED 

With established 

knowledge of 

community resources 

and their accessibility, 

the AIM model can be 

replicated and adapted 

to other communities. 

Most amenable to 

replication is the 

targeted, multidisciplinary approach to 

identifying appropriate 

resources for the dyad. 

An important 

consideration for 

implementing the 

intervention in another 

community is to have 

resources to fund the assessment process and the time it takes to link the 

care recipient and caregiver dyads to the appropriate services. A 

university-community partnership, translating research into practice, serves 

as a promising model. 

FOR MORE INFORMATION CONTACT

The University of Southern California Keck School of Medicine:

■ Principal Investigator: Laura Mosqueda, MD 

Laura.Mosqueda@med.usc.edu

■ Co-PI: Melanie Gironda, PhD mgironda@med.usc.edu 626.457.4265

■ Co-PI: Bonnie Olsen, PhD Bonnie.Olsen@med.usc.edu

Suggested Citation: Henning, S., Hafford, C., & Nguyen, K. June 2015. Take Aim 

Against Elder Abuse: The Abuse Intervention Model. Elder Abuse Prevention 

Intervention Program. Washington, DC: Assistant Secretary for Planning and 

Evaluation, U.S. Department of Health and Human Services: NORC at the University of 

Chicago.

1 The project relocated from the Department of Family Medicine at the University of California, Irvine School of Medicine in 2014. 2 The findings to date are derived from a two-day site visit to UT Health in December 2014 to learn about planning, infrastructure and implementation of the prevention intervention and progress to date. Key 

informant interviews were conducted with the USC research team (PI and Co-PIs), the project coordinator, field interviewer, and two community service providers. NORC observed an EAFC meeting. 

Program documents and protocols were reviewed. NORC thanks the AIM team for hosting the visit. All outcome data collected will be analyzed in mid-2015 when the intervention phase ends. 3 http://ssa.ocgov.com/abuse/

4 Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2009). Abuse of people with dementia by family carers: representative cross sectional survey. BMJ, 338, b155. 

Wiglesworth, A., Mosqueda, L., Mulnard, R., Liao, S., Gibbs, L., & Fitzgerald, W. (2010). Screening for abuse and neglect of people with dementia. J Am Geriatr Soc, 58(3), 493-500. 5 Bronfenbrenner, U. (1994). Ecological models of human development. In T. Husen & T. N. Postlethwaite (Eds.), International Encyclopedia of Education (2nd Ed., Vol. 3, pp. 1643– 1647). Oxford, England: 

Pergamon Press.

6 Doll, L. S., Saul, J. R., & Elder, R. W. (Eds.). (2007). Injury and Violence Prevention Interventions: An Overview. New York: Springer.

Elder Abuse Risk Factors and 

Toolkit of Existing Interventions

Adults with Dementia

1. Aggression (Geropsychiatry)

2. Resistance to care (Savvy Caregiver Plus 

Course)

3. ADL Dependency (In-home Caregiver Agency)

Caregiver

4. Anxiety (Problem-Solving Therapy)

5. Depression (Individual Counseling)

6. Perceived Burden (Friendly Visitor Program) 

Context

7. Limited Social Support (Caregiver Support 

Group)

8. Financial Strain (Legal Aid)

9. Relationship Quality (Family Counseling)

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