DOI: 10.3886/icpsr38332
title: Building Late-Life Resilience to Prevent Elder Abuse: A Randomized Controlled Pilot Study of the EMPOWER Program, Arizona, 2019-2021
title: Archival Version

description: Over the past two decades, as the proportion of older Americans has increased, so too have instances of elder abuse, including physical, emotional, and sexual abuse; financial exploitation; and caregiver neglect. The most recent national survey estimates show at least 1 in 10 community-residing older adults experience elder abuse each year, which translates to over 7 million Americans annually. Rates of abuse are magnified for older adults with the least financial and social resources, including those with low incomes, living in isolated rural communities, and facing structural barriers such as systemic racism. Emerging research on the COVID-19 pandemic prompts even greater concern for elder abuse: the virus has disproportionately affected older adults, resulting in increased social isolation, physical health impairment, and exposure to COVID-related fraud. Recognizing the urgent need to develop and rigorously evaluate programs aimed at preventing elder abuse, the US Department of Justice's National Institute of Justice funded a demonstration from 2017 to 2021 during which researchers from the Urban Institute and practitioners at the Phoenix-based Area Agency on Aging, Region One ("the Area Agency") co-developed an elder abuse prevention program in Maricopa County, Arizona, which Urban's team then evaluated through a randomized controlled pilot study. This multiphase demonstration included an initial planning phase and a subsequent pilot study, which is the focus of this report. The EMPOWER: Building Late-Life Resilience program is a 12-week in-home intervention, with one-hour weekly visits designed to empower community-residing older adults with the resiliency and resources to lead safe and healthy lives throughout the aging process. EMPOWER provides one-on-one assessments, client-centered prevention education, and needs-responsive life skills training embedded in a series of cognitive reframing conversations with an experienced facilitator. The program has eight modules, each of which culminates in an action plan focused on strengthening a client's internal assets and identifying sources of positive social support. Caseworkers facilitate motivational discussions centered on clients' self-identified goals and action planning, with the aim of optimizing clients' home safety, physical health, social connectedness, and emotional and financial well-being.
description: The purpose of this study was to collaboratively develop and rigorously test an elder abuse prevention program focused on the resilience of community-residing older adults. Resilience comprises the strengths and protective factors necessary to respond to and overcome adversity, including the adaptations needed to support safe and healthy aging. In the theoretical framework underlying EMPOWER's development, elder abuse can occur in different ways, many of which are outside older adults' control. EMPOWER focuses on the paths that are theoretically controllable. Specifically, it aims to strengthen older adults' knowledge and awareness of community resources and social supports, attitudes toward and motivation to adapt to age-related changes, and life skills and behaviors that facilitate self-empowerment throughout the aging process.
description: During the demonstration's first two years (the planning phase, conducted from 2017 to 2019), Urban and the Area Agency codeveloped the EMPOWER program, compiling a 112-page facilitator manual and a client journal and identifying supportive program materials (e.g., night-lights, pillboxes, calendars, gratitude journals, health care forms). The Urban and Area Agency teams developed the content of the program after conducting multiple reviews of relevant literature and holding meetings with an advisory panel of violence prevention and elder abuse experts, including the Maricopa County Elder Abuse Prevention Alliance. An initial test of EMPOWER and the planned data collection were conducted at the end of the planning phase, and findings informed revisions to the program and research design. Additionally, this study included mixed-methods collection of quantitative and qualitative data. Qualtrics-based surveys of treatment and control participants were the primary source of data. Owing to the demonstration's brief timeline, the decision was made to measure participant data at only two points: pretest and posttest approximately four months later (given that EMPOWER was designed as a three-month intervention). Surveys were administered in person until the COVID-19 pandemic lockdown in Arizona (March 11, 2020), after which Urban interviewers administered surveys by telephone. All participants were offered stipends for their time. The surveys consisted predominantly of closed-ended (quantitative) questions, though the posttest included open-ended questions about the EMPOWER program (for the treatment group).
description: The study include four datasets and a total of 1943 variables. The data files asked the respondents to describe if they received the EMPOWER program from the Area Agency on Aging, their living circumstances, asked the participants if they have ever being abused and who was responsible for the abuse, the information about their romantic relationship, their mental, and emotional health, and if they were able to walk around unassisted by a wheelchair, walker, or cane. The datasets also included additional demographic variables such as; Sex, Race, Ethnicity, Age, Employment, Annual Income, and Education of the participants.
description: Not Applicable.
description: Response Rates: 79% of those assigned to EMPOWER completed the program (74 participants), and facilitators conducted an average of 10 in-home or telephone sessions over an 11-week period.
description: Presence of Common Scales: Likert Scales
description: Of the 182 participants, 94 were randomly assigned to receive EMPOWER and 88 were assigned to the control group. Approximately 80 percent of the participants identified as female (80 percent of the control group, 82 percent of the treatment group), and over 70 percent identified as white (78 percent of the control group, 74 percent of the treatment group). Participants' ages ranged from 60 to 96, with an average age of 73 (74 for the control group, 72 for the treatment group). More than 90 percent reported annual incomes of $20,000 or less; this included 91 percent of the control group and 92 percent of the treatment group.
description: Datasets: DS0: Study-Level Files DS1: EMPOWER Pretest Data for Archiving DS2: EMPOWER Post-test Data for Archiving DS3: Interviewer Survey for Data Archiving DS4: Program Tracker for Data Archiving
description: Smallest Geographic Unit: None.
description: mail questionnaire; mixed mode; telephone interview