Uncovering the Causes, Contexts, and Consequences of Elder Mistreatment in People with Dementia

揭示老年痴呆症患者遭受虐待的原因、背景和后果

• 批准号: 10516285
• 负责人: Zachary D Gassoumis
• 金额: $ 6.53万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10516285
• 关键词: Address; Adopted; Affect; Algorithms; Alzheimer' s disease related dementia; Assessment tool; Baseline Surveys; Behavior; California; Caregivers; Caring; Characteristics; Child Abuse and Neglect; Clinical Data; Clinical assessments; Code; Confounding Factors (Epidemiology); Consent; Contusions; County; Creatinine; Data; Data Set; Dementia; Dependence; Detection; Diagnosis; Diagnostic; Distress; Elder Abuse; Elderly; Electronic Health Record; Exhibits; Health; Health Status; Health system; Healthcare Systems; Heart Rate; Home; Hospitals; Incidence; Individual; Intervention; Interview; Interviewer; Laboratory Markers; Lead; Lesion; Link; Los Angeles; Lymphocyte; Measurement; Measures; Methods; Modeling; Morbidity - disease rate; Outcome; Participant; Patient Self-Report; Patients; Personal Satisfaction; Persons; Physical Examination; Population; Predisposition; Prevalence; Problem behavior; Prospective Studies; Psychometrics; Public Health; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Sampling; Self Assessment; Seminal; Sexual abuse; Societies; Source; Surveys; Testing; Trust; Universities; aging population; base; clinical research site; cohort; cost; demographics; emotional abuse; experience; financial exploitation; health service use; heart rate variability; high risk; innovation; knowledge base; mortality; neglect; novel strategies; patient subsets; perpetrators; physical abuse; prevent; primary caregiver; protective factors; psychosocial; resilience; risk minimization; sleep pattern; social; support network; wearable device

ABSTRACT Our primary objective is to investigate underlying mechanisms of elder mistreatment (EM) in people with Alzheimer’s Disease and related dementias (ADRD). Applying the Abuse Intervention Model, we will identify EM risk and protective factors among older adults with ADRD (potential victim), their trusted other (potential perpetrator), and their context to inform the creation of evidence-informed risk assessment tools, interventions, detection/diagnosis algorithms, and care plans for older adults with ADRD and their caregivers. Aim 1. Measure EM and track risk factors in people with ADRD and their caregivers. This cohort (target N=200 dyads), drawn from ADRD-specific clinical/research sites, will be tracked longitudinally for 18 months, with assessment every six months. EM incidence will be measured at each assessment by older adult and primary caregiver self-report and interviewer observation. In-home assessments will also collect data on characteristics of the vulnerable older adult, trusted other, and context. Survey and observation data will be linked to detailed clinical data from clinical/research sites. When possible, study data will also be linked to County electronic health records (EHRs) to identify risk and protective factors and adjust for confounding variables. Aim 2. Explore how the caregiver experience contributes to EM in people with ADRD. We will utilize a mixed method, sequential explanatory approach to prospectively study caregivers of people with ADRD to detect characteristics and antecedents of EM. Drawn from a sub-sample of Aim 1 cohort caregivers (target n=50), subjects will: (1) adopt wearable technology to track their activity, heart rate/heart rate variability, and sleeping patterns; (2) provide information about their social and instrumental support network via a CareMap; and (3) engage in an open-ended interview. These data will be linked to data collected under Aim 1 to determine the impact on persons who may be found to exhibit abusive/neglectful behavior, setting the stage for testing interventions to promote resiliency, enhance protective factors, and minimize risk factors. Aim 3. Identify electronic health record (EHR)-based indicators of EM in people with ADRD. EHRs from the County will be used to compare patients with ADRD who are identified as victims of EM with ADRD patients who are not reported as victims of EM, using one-to-many propensity score matching based on demographics, health status, and health service utilization. Analyses will explore the feasibility of using data from patient EHRs to distinguish between the abused and non-abused ADRD patient groups, including examination of exam-derived diagnostic codes (e.g., specific bruises and lesions)6 and laboratory markers (e.g., changes in creatinine, lymphocyte level),7 as pathognomonic markers or indicators of EM. These aims offer a novel approach to identify mechanisms and causes of EM in people with ADRD, to aid in developing risk assessment tools and interventions to minimize risk, enhance protection, and promote resiliency.

抽象的 我们的主要目的是调查人们对老年人虐待（EM）的潜在机制 与阿尔茨海默氏病和相关痴呆症（ADRD）。采用滥用干预模型，我们将 在患有ADRD（潜在受害者）的老年人中确定EM风险和受保护因素 （潜在的肇事者）及其上下文，以告知创建证据的风险评估工具， 针对ADRD及其护理人员的老年人的干预措施，检测/诊断算法和护理计划。 目标1。衡量ADRD及其护理人员的人中的EM并跟踪危险因素。这个队列（目标 n = 200个二元组），从ADRD特异性的临床/研究地点抽取，将纵向跟踪18个月， 每六个月评估一次。 EM事件将在每次评估时由老年人衡量， 初级护理人员的自我报告和访谈者观察。家庭评估还将收集有关的数据 脆弱的老年人，可信赖的其他和环境的特征。调查和观察数据将是 与来自临床/研究地点的详细临床数据有关。如果可能的话，研究数据也将链接到县 电子健康记录（EHR）确定风险和保护因素并调整混杂变量。 AIM 2。探索护理人员的经验如何在ADRD患者中为EM做出贡献。我们将利用一个 混合方法，顺序挖掘方法，用于前瞻性研究ADRD患者的看护人 EM的特征和先例。从AIM 1队列护理人员的子样本（目标n = 50）， 受试者将：（1）采用可穿戴技术来跟踪其活动，心率/心率变异性和睡眠 模式； （2）通过Caremap提供有关其社会和工具支持网络的信息； （3） 进行开放式采访。这些数据将链接到AIM 1下收集的数据，以确定 对可能被发现存在虐待/忽视行为的人的影响，为测试奠定了基础 促进弹性，增强保护因素并最小化风险因素的干预措施。 目标3。确定ADRD患者中EM的电子健康记录（EHR）指标。 ehrs 该县将用于比较被确定为违反EM的ADRD患者与ADRD 未报告EM的惊喜的患者，使用一对多倾向得分匹配的患者 人口统计，健康状况和健康服务利用率。分析将探索使用来自 患者EHR区分虐待和未虐待的ADRD患者组，包括检查 检查的诊断代码（例如，特定的瘀伤和病变）和实验室标记（例如，变化 肌酐，淋巴细胞水平），7作为病理标记或EM的指标。 这些目标提供了一种新颖的方法来识别ADRD患者中EM的机制和原因，以帮助 开发风险评估工具和干预措施，以最大程度地降低风险，增强保护和促进弹性。