Detection of Elder mistreatment Through Emergency Care Technicians - Revised for Primary Care (DETECT-RPC)

通过紧急护理技术人员检测老年人虐待行为 - 初级护理修订版 (DETECT-RPC)

基本信息

批准号：
10512948
负责人：
Michael Bradley Cannell
金额：
$ 64.75万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10512948
关键词：
Accident and Emergency department Address Adult Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Medical Association Caregivers Cognitive Communities Complex Computer software Detection Development Diagnosis Early Diagnosis Elder Abuse Elderly Eligibility Determination Emergency Care Emergency department screening Emergency department visit Emotional Environment Ethics Exposure to Failure Family member Focus Groups Healthcare Home Hospitalization Injury Interview Laws Link Medical Methods Morbidity - disease rate Patients Persons Phase Physical environment Physicians Policies Positioning Attribute Prevalence Primary Care Physician Primary Health Care Procedures Property Provider Psyche structure Quality of life Randomized Reporting Research Risk Risk Factors Screening procedure Security Services Sexual abuse Site Social Environment Structure Testing Texas Time Trust abuse neglect authority base design efficacy trial emotional abuse evidence base expectation experience financial exploitation improved innovation mortality neglect peer physical abuse practice setting primary care setting provider-level barriers psychological distress response screening tool

项目摘要

Elder mistreatment (EM) is commonly defined as an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes harm or creates a risk of harm to an older adult. EM may be intentional or unintentional and includes financial exploitation, neglect, emotional/psychological abuse, physical abuse, and sexual abuse. This is concerning as there is an estimated 11% annual prevalence among cognitively intact older adults, and a 30-75% annual prevalence among older adults with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD. Further, EM is linked with increased risk of poor quality of life, loss of property and security, physical injury, hospitalizations, emergency room visits, psychological distress, morbidity, and early mortality. Nevertheless, EM is difficult to detect and often goes unrecognized. Effective and efficient EM screening tools are urgently needed to improve early detection efforts. This proposal will address this need by adapting an evidence-based EM screening tool for home-based primary care and rigorously evaluating its potential harms and benefits. In direct response to RFA-AG-22-024, we propose stage IA research (R61 phase) to adapt the DETECT screening tool for home-based primary care — with special emphasis on older adults who were recently diagnosed with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD — The DETECT Revision for Primary Care (DETECT-RPC). We also propose a stage III multi-site randomized (at the provider level) controlled efficacy trial (R33 phase) of DETECT-RPC. The specific aims of the R61 phase of the proposed project are: (1) Evaluate the potential impact of state-specific laws and site-specific policies on the reporting guidance that will be provided by the DETECT-PRC tool (mixed-methods); (2) Investigate provider-level barriers to recognizing and reporting EM in home-based primary care environments (qualitative - structured interviews, focus groups); and, (3) Adapt the DETECT screening tool for home-based primary care (qualitative - structured interviews, focus groups). The specific aims of the R33 phase of the proposed project are: (1) Rigorously evaluate the effect of DETECT-RPC on targeted mechanisms of action (i.e., current barriers to identification and reporting) elucidated in the R61 phase of the study (mixed-methods); (2) Rigorously evaluate the impact of DETECT-RPC on clinician identification and reporting of older adults with increased risk of EM to the appropriate authorities (RFA key question KQ3); and, (3) Rigorously evaluate the benefits (i.e., reduce exposure to abuse and neglect, reduced physical or mental morbidity, and reduced mortality) and harms of screening with DETECT-RPC (RFA key questions KQ1 and KQ4) (mixed-methods).

老年人的虐待（EM）通常被定义为一种有意的行为，或者是由一位恋爱关系中的看护人或其他人不采取行动，涉及对信任的期望，造成伤害或造成对老年人造成伤害的风险。 EM可能是故意的或无意的，包括经济剥削，忽视，情感/心理虐待，身体虐待和性虐待。这是因为认知完整的老年人估计每年的患病率估计为11％，并且在阿尔茨海默氏病和阿尔茨海默氏病与痴呆症相关的痴呆症AD/ADRD的老年人中，年龄为30-75％。此外，EM与生活质量差，财产和安全性丧失，身体伤害，住院，急诊室拜访，心理困扰，发病率和早期死亡的风险增加有关。然而，EM很难检测到，并且经常无法识别。迫切需要有效而有效的EM筛查工具来改善早期检测工作。该提案将通过调整基于循证的EM筛查工具的家庭基础医疗保健，并严格评估其潜在危害和收益来满足这一需求。在对RFA-AG-22-024的直接响应中，我们提出了IA阶段研究（R61阶段）以适应基于家庭的初级保健的检测筛查工具 - 特别强调了最近被诊断出患有阿尔茨海默氏病的老年人和阿尔茨海默氏病与阿尔茨海默氏病相关的痴呆症AD/ADRD的诊断 - 检测到的基于初级保健（检测到基地保健）（检测到基地）（检测到RPC）。我们还提出了一个III期多站点随机（在提供者级别）的控制有效性试验（R33期）的检测RPC。拟议项目的R61阶段的具体目的是：（1）评估国家特定法律和特定地点政策对报告指南的潜在影响，该报告将由检测PRC工具（混合方法）提供；（2）调查提供者级别的障碍，以在家庭基础医疗环境中识别和报告EM（定性 - 结构化访谈，焦点小组）；（3）调整基于家庭的初级保健（定性 - 结构化访谈，焦点小组）的检测筛查工具。拟议项目的R33阶段的具体目的是：（1）严格评估检测RPC对在研究的R61阶段阐明的靶向作用机理（即当前的识别和报告障碍）的影响（混合方法）；（2）严格评估检测RPC对EM风险增加的老年人对适当当局的临床鉴定和报告的影响（RFA关键问题KQ3）；（3）严格评估了使用检测RPC（RFA关键问题KQ1和KQ4）（混合方法）对虐待和忽视的损害，降低滥用和忽视，降低身体或精神发病的降低以及降低死亡率）。