Pi-Ju (Marian) Liu

Purdue University | Purdue · School of Nursing

Using a mix-method design, we examined participants' willingness to respond to mass marketing scams (MMS). In Experiment 1, we examined the effect of age (young versus older) and letter style ("hot" versus "cold") on the intention to respond. The intention of responding was negatively associated with risk (p < .001) and having at least a high schoo...

The theft of controlled substances has been studied in the community and healthcare settings including hospitals, pharmacies, hospice, and pain clinics. However, research on these thefts in long-term care homes has yet to be published. This exploratory study makes first steps toward bridging this gap. Using 107 Minnesota Department of Health’s inve...

Adult Protective Services (APS) is the only government agency dedicated to investigating elder mistreatment. This frontline agency also provides and coordinates needed services to its clients, but their service effectiveness has not been extensively investigated. Over half of all APS cases investigated are self-neglect. Although no universal defini...

As social networks shrink with age, older adults value the importance of interpersonal relationships with close others, such as partners, family and friends. Previous studies focused on perpetrators' and victims' characteristics; however, few studies examined the relationships with close others and the incidence of elder mistreatment. This study us...

Background and objectives: Adult Protective Services (APS) are the frontline agencies investigating elder mistreatment and providing/coordinating post-investigation services. Yet, their effectiveness in reducing different types of mistreatment in relation to services is unknown. This study aimed to address the knowledge gap by identifying services...

As federal agencies support the development of data systems for adult protective services (APS), researchers and practitioners are increasingly using administrative data to study types of adult maltreatment, including self-neglect, and the systems that respond to them. To date, however, APS has worked with little guidance about how best to use thes...

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-thirty-four (71%) of 1,313 APS’ past clients or their collaterals were interview...

Financial exploitation (FE) perpetrators are usually seen in a position of trust, such as family members or friends, whereas perpetrators of scam tend to be unknown individuals. Few empirical studies have examined victim risk factors, and this study aimed to systematically compare risk factors of FE versus scam. One-hundred-and-ninety-five adults (...

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 ins...

A recent study by our team showed that family discord about care provision among multiple family caregivers was a significant predictor of caregiver burden, anxiety, depression, and activity restrictions. This study examined the combined effects of family discord, work impacts (missed work, caregiving affects work), and workplace supports (flexible...

Mistreatment of nursing home residents is prevalent and leads to harmful consequences. The Centers for Medicare & Medicaid Services’s (CMS) mission to protect residents’ right to be free from mistreatment is implemented partially through state survey agencies’ (SSAs) issuance of deficiency citations. The goal of this study was to compare SSA standa...

Introduction/Objectives The healthcare intake process plays a significant role in informing medical personnel about patients’ demographic information, subjective health status, and health complaints. Intake forms can help providers personalize care to assist patients in getting proper referrals and treatment. Previous studies examined factors that...

This study examined elder mistreatment victims’ experiences at the beginning of the COVID-19 pandemic, focusing on their COVID-19 awareness and unmet needs. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews with clients or collaterals (client’s family, trusted other, or service provider) to inquire about clients’...

Aim: To examine the role of Adult Protective Services' (APS's) nurses in helping abused, neglected and exploited older people, this study investigated how nurses' contribution differs from social workers. Though the majority of APS' workforce is staffed by social workers, some programmes also employ nurses. Design: Secondary data analysis using...

Background and Objectives. In testing a comprehensive decision support system for Adult Protective Services (APS), this study addressed two problems common in APS research and practice: the psychometric quality of the measures and measurement burden. Research Design and Methods. Data were generated on 1,472 APS cases over six months in two Californ...

Adult Protective Services (APS) training is critical to the mission of APS in supporting the workforce, but not much is known from caseworkers’ perspectives. To learn more, 63 caseworkers in five California counties, from urban, suburban, and rural areas, participated in focus groups. Discussion was organized around three open-ended questions regar...

The historical lack of outcomes-related data in Adult Protective Services (APS) has affected funding coming to the program. Without data quantifying the effectiveness of APS services, policymakers have been unable to justify budget increases to improve wages for workers or professionalize the field. For the first time in APS history, the U.S. Admin...

Adult Protective Services (APS) is responsible for investigating reports of abuse, exploitation, and neglect among vulnerable adults. Additionally, APS also refers or provides needed services to victims. Though APS also takes the lead position in investigation and service planning, determining harm and designing person-centered remedies often requi...

Research in Adult Protective Services suffers from the problems of small sample size, low completion rates, and poor data quality. To address the “small sample size” issue, data were generated on 1,472 elder abuse cases over six months in California using the Identification, Services and Outcomes (ISO) Matrix. The problem of poor data quality was a...

Substantiation of abuse, neglect, and exploitation (ANE) data collected during the Identification, Services, and Outcomes (ISO) Matrix pilot included some outlier scores warranting further investigation. To examine outliers and other unexpected findings in greater detail, we completed case reviews and caseworker interviews to explore why outlier ca...

Abuse in later life could potentially lead to lower levels of social support, especially when perpetrated by family members who are charged with protecting the older adult in their care. Using both waves of the National Elder Mistreatment longitudinal data (wave one collected in 2008 and wave two in 2015; N=774), long-term effects of abuse (i.e., p...

Adult Protective Services (APS) investigates and substantiates vulnerable adult abuse, neglect, and exploitation (ANE) cases. The frontline social service agency also refers or provides needed services to ANE victims. Outcomes of APS has been scarce, with definitions of outcomes varying from study to study. Using a pretest-posttest design, we partn...

Objective assessment is an important tool for Adult Protective Services (APS) in supporting a diverse population. Out of the 1472 APS’ clients, aged 65 and over, assisted during the study period, 39% identified as a non-white race and 30% did not speak English. Providing services to this vulnerable population is made even more difficult by the need...

In this study, abuse, exploitation, and neglect (ANE) harm was measured by type of abuse using standardized items from the Identification, Services, and Outcomes (ISO) Matrix before Adult Protective Services (APS) interventions (pretest) and after APS interventions (posttest). Change scores from 1,472 older adults (average age 78-year-old; 57% fema...

The majority of Adult Protective Services (APS) workforce is staffed by social workers, though some agencies have recognized the need to address clients’ medical needs such as wounds, injuries, nutrition issues, hydration issues, premature death and more. Using survey data from the National Adult Protective Services Association (NAPSA), we analyzed...

This brief report summarizes Adult Protective Services training provided to workers across the nation, using survey results from the National Adult Protective Services Association (NAPSA). Although most states delivered training that covered some learning objectives of NAPSA’s 23 core competency training modules, there was a wide variation with som...

Obesity is a costly and pervasive risk factor that requires attention to reduce chronic disease rates. This study evaluated the effect of a lifestyle medicine intervention, Complete Health Improvement Program (CHIP), on reducing weight, blood pressure, lipid levels, and hemoglobin A1c. A secondary aim was to build a preliminary predictive model for...

Objectives The purpose of this study is to determine how individual and contextual factors that contribute to homicide-suicide (HS) differ between young adults, middle-aged adults, and older adults, and to describe, in detail, the circumstances that lead to HS by older adults. Methods Data were obtained from the Center for Disease Control and Prev...

Background and objectives: Family caregivers often have other family members helping to provide care. The purpose of our study was to examine relationships between care coordination quality among family members and the following caregiver outcomes: caregiver mental health (depressive symptoms, anxiety), social activity restrictions, and caregiver...

Can standardized assessment contribute to improving Adult Protective Services (APS) practice? In this exploratory study, San Francisco and Napa APS utilized a newly developed short self-neglect assessment to test how standardized measures provide information for substantiation decision making. Findings demonstrated satisfactory reliability and vali...

Adult Protective Services (APS) is responsible for investigating reports of abuse, exploitation, and neglect among vulnerable adults. California’s APS program investigates approximately 15% of all abuse, neglect, and exploitation reports in the country. Once abuse or neglect is substantiated, caseworkers design and implement a service plan for clie...

Adult Protective Services (APS) is the most widely used intervention in response to elder abuse, exploitation, neglect, and self-neglect. In California, once an alleged abuse is substantiated, caseworkers design and implement a service plan for older adults to reduce future risk of abuse. However, APS intervention outcomes have not been extensively...

In 2014 California implemented a demonstration project called Cal MediConnect, which used managed care organizations to integrate Medicare and Medicaid, including long-term services and supports for beneficiaries dually eligible for Medicare and Medicaid. Postenrollment telephone surveys assessed how enrollees adjusted to Cal MediConnect over time....

Mass marketing scams extract an enormous toll, yet the literature on scams is just emerging. In Experiment 1, 211 adults reviewed a solicitation and rated their intention of contacting an “activation number” for a prize. Scarcity and authority were manipulated. Many (48.82%) indicated some willingness to contact to “activate” the winnings. Intentio...

Background and Objective Social support is known to be an important protective factor against elder financial exploitation (FE), yet few empirical studies have examined the relationship between FE and distinct components of social support. Perceived social support, social network size, and interactions with close network members (positive and negat...

Background: In 2014 California implemented a federal dual alignment demonstration that used a capitated managed care health plans called Cal MediConnect (CMC) to integrate medical care and long term services and supports (LTSS) for beneficiaries with both Medicare and Medicaid. These beneficiaries often have complex care needs, including multiple...

In the United States, the Adult Protective Services (APS) program is responsible for investigating reports of abuse, exploitation, and neglect among mostly vulnerable older adults. Data on APS clients, perpetrators, and interventions are not widely available, as each state operates APS independently and defines their service populations differently...

Objectives. The Elder Abuse Decision Support System (EADSS) was designed to meet the critical need for improved methods for assessment and substantiation of elder mistreatment, using a web-based system with standardized assessment measures. Methods. Six Illinois agencies participated in the field test. One-year pre/post analyses assessed substantia...

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS dataset contains 948 el...

Objectives: Elder emotional/psychological abuse is the infliction of mental anguish on older adults through verbal or non-verbal acts. Using indicators based on existing literature, theoretically important abuser characteristics and victim vulnerabilities were collected using the Elder Abuse Decision Support System (EADSS) to test a theory of emot...

The Elder Abuse Decision Support System was designed to meet the critical need for improved methods for assessment and substantiation of elder mistreatment, using a web-based system with standardized assessment measures. Six Illinois agencies participated in the field test. One-year pre/post analyses assessed substantiation results, using Illinois'...

Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected...

To examine the role of numeracy, or comfort with numbers, as a potential risk factor for financial elder exploitation in a community sample. Individually administered surveys were given to 201 independent, community-dwelling adults aged 60 and older. Risk for financial elder exploitation was assessed using the Older Adult Financial Exploitation Mea...

Abstract Financial elder exploitation (FE) is an increasing problem for vulnerable elders and for the social service and criminal justice system designed to protect them. The current paper examines neuropsychological correlates in a sample of older adults who have been documented victims of financial elder exploitation. The purpose of this explorat...

This book provides the first comprehensive collection of topics that lie within the intersection of positive psychology and multicultural issues. Written by leaders in the field and using a broad definition of culture (including race, ethnicity, socioeconomic or social class status, disability status, religion/spirituality, sexual orientation, and...

Older adults face important risky decisions about their health, their financial future, and their social environment. We examine age differences in risk-taking behaviors in multiple risk domains across the adult life span. A cross-sectional study was conducted in which 528 participants from 18 to 93 years of age completed the Domain-Specific Risk-T...

Background: Statistical numeracy, necessary for making informed medical decisions, is reduced among older adults who make more decisions about their medical care and treatment than at any other stage of life. Objective numeracy scales are a source of anxiety among patients, heightened among older adults. Objective: We investigate the subjective...

This article provides a clinical framework for understanding the dynamic of "undue influence," a term that refers to a dynamic between two individuals in which the weaker individual is exploited, often financially. The article also presents case examples illustrating aspects of the problem.

Because many seniors choose Medicare Part D plans offering poorer coverage at greater cost, the authors examined the effect of price frames, brand names, and choice set size on participants' ability to choose the lowest cost plan. A 2×2×2 within-subjects design was used with 126 participants aged 18 to 91 years old. Mouselab, a web-based program, a...

Studies on decision making have come to challenge the idea that having more choice is necessarily better. The Medicare prescription drug program (Part D) has been designed to maximize choice for the consumer but has simultaneously created a highly complex decision task with dozens of options. In this study, in a sample of 121 adults, we examined th...

The Medicare Modernization Act of 2003 (better known as Medicare Part D) represents the most important change to Medicare since its inception in the mid-1960s. The large number of drug plans being offered has raised concern over the complex design of the program. The purposes of this article are to examine the effect of age and choice set size (3 v...

Research Objective Compare decision processes of older and younger adults as the amount of information increases.Background Recent studies on decision-making dispute the dogma that larger choice sets provide consumers better opportunities to maximize utility. Many decry Medicare’s Part D plan has too many options and results in sub-optimal outcomes...