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：
10703453
负责人：
Michael Bradley Cannell
金额：
$ 59.79万
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/10703453
关键词：
Accident and Emergency department Adult Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Medical Association Authorization documentation Caregivers Cognitive Communities Complex Computer software Detection Development Diagnosis Disease Early Diagnosis Early identification 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 Primary Care Physician 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 Trust abuse neglect authority design efficacy trial emotional abuse evidence base expectation experience financial exploitation improved innovation mHealth mortality neglect peer physical abuse practice setting primary care clinician 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).

虐待老年人 (EM) 通常被定义为护理人员或其他人在涉及信任期望的关系中故意采取或不采取行动，从而对老年人造成伤害或造成伤害的风险，这可能是故意的。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。这是认知方面的问题，因为在完整的老年人中，估计年患病率为 11%，在老年人中，年患病率为 30-75%。患有阿尔茨海默病此外，EM 与生活质量差、财产和安全损失、身体伤害、住院、急诊室就诊、心理困扰、发病和早期死亡的风险增加有关。 EM 很难检测到，并且经常被忽视，因此迫切需要有效且高效的 EM 筛查工具来改善早期检测工作。该提案将通过采用基于证据的 EM 筛查工具来满足家庭初级保健的需求，并对其进行严格评估。潜在的危害和好处作为对 RFA-AG-22-024 的直接回应，我们建议进行 IA 阶段研究（R61 阶段），以适应家庭初级保健的 DETECT 筛查工具——特别关注最近被诊断患有老年痴呆症的老年人。阿尔茨海默病和阿尔茨海默病相关痴呆 AD/ADRD — 初级保健 DETECT 修订版 (DETECT-RPC) 我们还提出了一项 III 期多中心随机（在提供者层面）对照疗效试验。 DETECT-RPC R61 阶段的具体目标是： (1) 评估特定州法律和特定地点政策对 DETECT 将提供的报告指南的潜在影响。 -PRC 工具（混合方法）；(2) 调查家庭初级保健环境中识别和报告 EM 的提供者层面的障碍（定性 - 结构化访谈、焦点小组）；用于家庭初级保健的 DETECT 筛查工具（定性 - 结构化访谈、焦点小组）拟议项目 R33 阶段的具体目标是： (1) 严格评估 DETECT-RPC 对目标作用机制的影响（即）。 (2) 严格评估DETECT-RPC对临床医生识别和报告老年患者的影响向有关当局报告 EM 风险增加的成年人（RFA 关键问题 KQ3）；以及 (3) 严格评估筛查的益处（即减少遭受虐待和忽视、降低身体或精神发病率以及降低死亡率）和危害使用 DETECT-RPC（RFA 关键问题 KQ1 和 KQ4）（混合方法）。