A Nationwide Study on How COVID-19 Changed APS Policies and Practices

Abstract The purpose of this inquiry by the Virginia Tech Center for Gerontology and WRMA, Inc., was to explore changes being implemented by APS programs across the country in response to the COVID-19 pandemic. With input from the Administration for Community Living, the research team used a three-step process (e.g., telephone interviews with state-level APS administrators, a national online survey, and in-depth interviews with local and APS) to capture information on changes caused by efforts to mitigate the spread of COVID-19. This presentation concerns changes in APS policy and practice that the pandemic caused, including modifications in-person visits and adjustments to timeline requirements. Discussion of alterations in policy and practices during the first five months of the pandemic can eludicate APS and other services and planning for older adults in future emergency situations.

intrinsic capacity (IC) domains (namely sensorial, cognition, nutrition, psychological, and locomotion). For instance, the ICOPE Step1 tool suggests a cut-point of 14 seconds for fiverepetition chair rise time as a marker of impaired locomotion. Given the lack of validation of this tool in the literature, we aimed to validate the ICOPE screening tool concerning incident health outcomes, focusing on the locomotion assessment. First, we analyzed the five-domain screening tool's ability to identify older adults (OA) at higher risk of incident outcomes (frailty, disability, dementia) using longitudinal data from the Multidomain Alzheimer Preventive Trial (MAPT). For the locomotion assessment (chair rise test), we derived and cross-validated age-specific cut points from two population-based cohorts using ROC (receiver operating characteristic) analysis. We further verified those cut points among OA real-life users of the health system and clinical trial participants. In conclusion, the ICOPE Step 1 screening tool was able to identify OA at higher risk of incident frailty, disability, and dementia. New chair-rise-time cut points for age groups 70-79 years old and 80 years and older were valid in populations from different settings. The ICOPE Step 1 tool provides a practical and integrative way of screening older adults for impairments in IC and detecting those at higher risk of functional decline.

RECOGNIZING AND INTERVENING ON ELDER ABUSE, NEGLECT, AND EXPLOITATION IN THE AGE OF COVID-19
Chair: Pi-Ju Liu Discussant: Pamela Teaster The rapid outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global pandemic. Public health measures to prevent the spread of COVID-19, such as social distancing and self-quarantine, have drastically altered people's lives and led to social isolation, financial instability, and disrupted access to healthcare and social services. Older adults have not only borne the brunt of the highest COVID-19 mortality rates, but recent studies also describe growing reports of elder mistreatment. It is necessary to attend to these age-related disparities during the remainder of the COVID-19 pandemic and future health crises. This symposium includes four presentations on researchers' findings in elder mistreatment during the COVID-19 pandemic. Dr. E-Shien Chang will compare prevalence of elder mistreatment before and since the pandemic, and highlight associated risk and protective factors during the pandemic. Dr. Lena Makaroun will examine changes in elder mistreatment risk factors among caregivers during the pandemic. Dr. Pamela Teaster will present Adult Protective Services' (APS) policy and practice changes in response to the pandemic to demonstrate the pandemic's impact on service providers. Lastly, Dr. Pi-Ju (Marian) Liu will appraise elder mistreatment victims' awareness of COVID-19 and their unmet needs during the pandemic. Following the four presentations, Dr. Pamela Teaster will moderate a discussion on how elder mistreatment is a growing concern, especially during the pandemic, and what service providers are doing to protect older adults. It has been assumed that the pandemic has brought with it a surge in elder abuse due to heightened health and interpersonal stressors. However, empirical evidence is lacking. This study aimed to estimate the prevalence of, and risk and resilience factors of elder abuse during the pandemic. In a webbased survey of a socio-demographically diverse sample of 897 older persons, one in five older persons (n = 191; 21%) reported elder abuse, an increase of 84% from prevalence estimates before the pandemic. In the multivariate logistic regression models, sense of community was a persistent protective factor for elder abuse (OR= 0.89, 95% CI 0.85-0.93). At the relational level, physical distancing was associated with reduced risk of elder abuse (OR= 0.94, 95% CI 0.90-0.98). At the individual level, financial strain was associated with increased risk of abuse (OR= 1.08, 95% CI: 1.02-1.14). Implications for prevention strategies will be discussed.

ELDER ABUSE DURING THE COVID-19 PANDEMIC: PREVALENCE, RISK, AND PROTECTIVE FACTORS
Administration for Community Living, the research team used a three-step process (e.g., telephone interviews with state-level APS administrators, a national online survey, and in-depth interviews with local and APS) to capture information on changes caused by efforts to mitigate the spread of COVID-19. This presentation concerns changes in APS policy and practice that the pandemic caused, including modifications in-person visits and adjustments to timeline requirements. Discussion of alterations in policy and practices during the first five months of the pandemic can eludicate APS and other services and planning for older adults in future emergency situations. This study examined elder mistreatment victims' experiences at the beginning of the COVID-19 pandemic. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews to inquire about clients' awareness of COVID-19 and unmet needs. Nine-hundred-and-thirtyfour (71%) of 1,313 APS' past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis.

AGING IN THE AFTERMATH OF ADVERSITY: LATER-LIFE IMPACT OF INSTITUTIONAL CHILD ABUSE AND DISCLOSURE
Shauna Rohner, 1 Andreas Maercker, 2 Alan Carr, 3 and Myriam Thoma, 4 1. University of Zurich,Zürich,Zurich,Switzerland,2. University of Zurich,University of Zürich,Zurich,Switzerland,3. University College Dublin,Dublin,Dublin,Ireland,4. University of Zurich,Zurich,Zurich,Switzerland Until the 1990's in Ireland, many children in institutional care experienced abuse and neglect, with lasting negative effects, including trauma symptoms and psychopathology. While trauma disclosure can be important for recovery, findings are inconsistent and often lack consideration of wider social and interpersonal contexts. As survivors of this historical adversity enter later-life stages, research is needed on the long-term impact and to clarify the role of disclosure. Therefore, this study aimed to examine the later-life impact of institutional child abuse on health and well-being, and the role of trauma disclosure and sociointerpersonal contexts in an older adult sample. Qualitative semi-structured interviews (60-120 minutes) were conducted with 17 Irish older adults, aged 50-77 years (mean age=60.7 years), who experienced childhood institutional abuse. Audio-recorded interviews were transcribed and analysed using Framework Analysis. Themes for 'childhood and related later-life adversity' included detrimental perceptions and interactions, re-exposure and reminders, failure of system and society, and cycle of abuse. Disclosure themes included successful, unsuccessful, and non-disclosure, as well as evidence of socio-interpersonal interactions (e.g., non-disclosure influenced by shame or fear, compounded by socio-cultural values, (lack of) social acknowledgment, or the power of the church in society). Results suggest that childhood institutional abuse can have long-term negative impacts into later life, including social, psychological, physical health, and socio-economic aspects. Disclosure results emphasize the need to consider the complex social, cultural, and interpersonal contexts within which an individual is embedded. This may enhance understanding and facilitate targeted health and social care services for this older adult population.

CHILDHOOD EXPOSURE TO FAMILY VIOLENCE AND LATER-LIFE SIBLING RELATIONSHIPS Jooyoung Kong, and Jaime Goldberg, University of Wisconsin-Madison, Madison, Wisconsin, United States
There has been a growth in research examining the long-term effects of childhood adversity on later life outcomes; however, only a few studies have examined the impact that childhood adversity has on sibling relationships in late adulthood. To address this gap in the literature, the current study examines the latent class structure of childhood exposure to family violence and investigates whether a latent class membership is associated with aspects of later-life sibling relationships, including geographical proximity, frequency of contact, perceived closeness, similarity in outlook, and exchange of support. Using data from 3,921 adult participants in the Wisconsin Longitudinal Study and the Bolck, Croon, and Hagenaars (BCH) approach of latent class analysis (LCA), we identified five latent classes (prevalence rate noted): "Never experienced violence (75%)," "experienced sibling violence (7%)," "experienced parental abuse & witnessed domestic violence (4%)," "experienced father's abuse & witnessed domestic violence (10%)," "experienced mother's abuse & witnessed domestic violence (5%)". Childhood exposure to family violence was a significant predictor of later-life sibling relationships. Specifically, adults who experienced sibling violence and their mother's and/or father's abuse in childhood showed significantly lower perceived closeness and similarity in outlook with their siblings in adulthood than those who did not experience violence. Our findings suggest that childhood exposure to family violence may have a long-term negative impact on the emotional aspect of sibling relationships. Future research may explore