Purdue Nursing researcher striving for better protection of the elderly nationwide, during and post-pandemic

Elderly woman's hands folded in lap

Written by: Tim Brouk, tbrouk@purdue.edu

Years before the coronavirus upended the nation, about 1 in 10 older Americans were victims of physical, emotional, sexual and financial abuses and/or neglect. According to an April 2020 survey, elder abuse in the United States rose sharply early in the COVID-19 pandemic. The survey reported that 1 in 5 older adults were now victims, and financial abuses such as scams and fraud had gone up 150%.

Marian Liu, assistant professor of nursing at Purdue University, has dedicated her research to change these alarming statistics. Among her contributions is an assessment tool that has been implemented in software to better generate data on how social workers, nurses, and other state or county Adult Protective Services (APS) employees are caring for their clients. Called the Identification, Services, and Outcomes Matrix, the assessment tool is based on the Elder Abuse Decision Support System.

Marian Liu

Marian Liu, assistant professor of nursing, has dedicated her life to fighting elder abuse.Purdue Marking and Communications

The goal of the assessment instrument is quality assurance while gathering more data to recognize trends more quickly and improve performance. The assessment is applied during and after a case, ideally woven into natural conversation with the victim or client. 

“During my work with APS, one of the things that was talked about was ‘How do you capture outcomes?’” said Liu, who is also co-chair for National Adult Protective Services Association’s (NAPSA) research-to-practice interest group. “We are trying to find out why some of the older adults and adults with disabilities fare better after APS intervention and some of them don’t.”

NAPSA has its national office in Washington, D.C., but APS work is handled at the state or county level. So far, Liu’s assessment work has been adopted by three counties in California — San Francisco, Tehama and Napa — as well as the entire state of Montana. Utah APS recently reached out to Liu with interest in adopting her assessment work. 

Liu’s assessments are embedded in APS case management and break down the cases to fine details. For example, if an alleged abuse was reported to APS, that abuse could be broken down into subcategories of reportable abuses so more details — indicators of each type of abuse — are gleaned. Self-neglect cases are also factored into the assessment

Liu and Zach Hass, assistant professor in the schools of Nursing and Industrial Engineering and a researcher in the Regenstrief Center for Healthcare Engineering, have begun analyzing data from APS case assessments to show what’s effective and what’s not during APS investigation and case management. The assessments cover general case management as well as emergency supply provisions, food services, medical, dental and relocation. Liu’s assessment work helps APS workers decide when these services are needed. It’s essentially data-driven decision making.

“The potential for (Liu’s assessment tool) to be really powerful, really impactful is there,” Hass said. “There is a desire in APS to show that what they do is effective or at least better understand what parts are not effective.”

Liu with her grandparents in Taiwan.

Liu with her grandparents in Taiwan.Photo provided

Becoming an advocate

Liu said many researchers in the field of gerontology and geriatrics were close to their grandparents, and she is no exception. Liu lived with her paternal grandparents, her parents and her sister throughout her childhood. Liu could always count on her grandparents’ wisdom. But it wasn’t until Liu volunteered at a day care center for adults that she saw how the elderly need advocacy.

“They looked so different than my grandparents,” Liu recalled. “That’s when I realized there are different trajectories (in aging). I got drawn to helping the most vulnerable.”

Starting in graduate school, Liu dedicated her research to elder justice issues. Liu’s work with APS began while an assistant professor at the University of California, San Francisco. She has published numerous papers while collaborating with APS on caseworker training.

“She has been a shining star for us because we need to be looking at our programs and how they work and whether they are effective,” said Lori Delagrammatikas, executive director of NAPSA. “Her assessment tool is like a yardstick, a ruler to measure whether the work we’re doing has an impact on clients’ lives. … The work she is doing is really pretty groundbreaking. It will help us going forward to really evaluate programs.” 

A growing problem

In response to the pandemic, APS will receive federal formula funding for the first time. Though the main goal is to address the pandemic, the funds show that elder abuse is a problem now and will continue to be. Elderly populations will increase, and finding ways to better serve them will be needed through research like Liu’s.

Liu gives a community talk on elder financial abuse to a group of older adults in a church.

Liu gives a community talk on elder financial abuse to a group of older adults in a church.Photo provided

For example, Liu has learned that APS workers would like to be trained to deal with infectious diseases like COVID-19 and to use personal protective equipment properly. A recent webinar on these topics, coordinated by Liu and presented by colleague Nancy Edwards, professor of nursing, reached capacity in an hour.

“We had 1,000 people and had a lot more people emailing to be registered,” Liu said. “It was obvious training is a big topic that should be addressed.”

The webinar has accumulated 2,350 views after its recording was uploaded.

Delagrammatikas predicts more states and counties will adopt Liu’s assessment work into their APS casework as more federal funding for research is expected. 

“I think COVID-19 has really pushed elder abuse and elder issues in general to the forefront,” she said. “I think this is an area that will continue to grow. Marian is a reason for that, as she is the only researcher I know that has dedicated so much work to APS. She has really become our champion.”