城市研究所-建立晚年适应力以防止虐待老年人（英）-2022.4-21页_481kb

Summary of the EMPOWER Program Pilot Study

Core Content

The EMPOWER Program is a 12-week in-home intervention designed to build late-life resilience in community-residing older adults to prevent elder abuse. The program includes weekly one-hour sessions with a facilitator, focusing on cognitive reframing, client-centered prevention education, and needs-responsive life skills training. It is structured into eight modules, each concluding with an action plan aimed at strengthening internal assets and identifying positive social support.

The study was conducted by the Urban Institute in partnership with the Phoenix-based Area Agency on Aging, Region One, and funded by the National Institute of Justice. The goal was to collaboratively develop and rigorously evaluate the program through a randomized controlled pilot study.

Main Objectives

The pilot study had five main objectives:

1. Conduct a multimethod randomized controlled trial of the EMPOWER program's implementation.
2. Assess implementation fidelity and the process of delivery.
3. Evaluate short-term outcomes related to elder mistreatment.
4. Revise and finalize the EMPOWER intervention and evaluation toolkit for potential national replication.
5. Contribute to the foundation of knowledge on interventions aimed at preventing elder abuse and neglect.

Key Findings

Implementation Evaluation

• Implementation Fidelity: The program was primarily delivered by three experienced staff members, with 79% of participants completing the 12-week intervention.
• Program Delivery: Facilitators conducted an average of 10 in-home or telephone sessions over an 11-week period, with the duration adjusted based on individual client needs.
• Client Satisfaction: Most completers strongly agreed that the facilitators treated them with respect, fostered a safe and trusting environment, and understood their problems and concerns.
• Program Content: Clients reported that EMPOWER increased their awareness of personal strengths, improved problem-solving abilities, and helped them identify community resources.
• Noncompleters: 21% of participants did not complete the program due to personal reasons, disinterest, unwillingness to connect via phone, and health challenges.
• Staff Perception: Staff believed the greatest benefits came from discussions on home safety, physical health, and financial well-being, while social connectedness and emotional well-being were also valued by some.

Outcome Evaluation

• Resilience Outcomes: The EMPOWER program showed significant improvements in four key areas:
  • Home Safety
  • Physical Health
  • Financial Well-Being
  • Social Support
• Multivariate Regression Models: Participants in the EMPOWER group scored significantly higher than the control group on all four resilience outcomes, even after controlling for pretest scores, demographic characteristics, physical health status, and exposure to the pandemic.
• Likert Scale Outcomes: The program was associated with improved knowledge and preparedness in areas such as emergency contact, fall prevention, medication understanding, and financial protection.

Limitations

• Impact of the Pandemic: Recruitment was halted from April to December 2020, reducing the sample size from the original target of 500 to 301 participants.
• Sample Characteristics: The sample was predominantly female and white, reflecting the demographics of the waitlisted population.
• Short Posttest Period: The posttest occurred only four and a half months after the pretest, which may limit the ability to observe long-term impacts.
• Generalizability: Findings are limited to Maricopa County, Arizona, and may not be applicable to other regions or populations.

Implications

• The EMPOWER program demonstrates potential efficacy in improving resilience outcomes among older adults.
• It provides a client-centered model that can be adapted and replicated for at-risk older adults in other areas.
• The study highlights the importance of social support and awareness in preventing elder abuse and promoting safe aging.
• The effect of the pandemic on older adults’ vulnerability and program engagement was significant, suggesting the need for flexible delivery methods and continued support during public health crises.

Conclusion

The EMPOWER Program is a promising elder abuse prevention initiative that focuses on building resilience through personalized, in-home support. The pilot study suggests that the program is well-implemented and associated with positive short-term outcomes, making it a valuable tool for community-based elder care. Further research is needed to expand the sample and examine long-term impacts.