Primary Care Screening and Intervention for Elder Neglect in Patients with Dementia: An Evidence-Based Approach

痴呆症患者忽视老年人的初级保健筛查和干预：循证方法

• 批准号: 10705301
• 负责人: MARK STEVEN LACHS
• 金额: $ 69.26万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705301
• 关键词: Address; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Caregiver Burden; Caregiver support; Caregivers; Cellular Phone; Characteristics; Clinical; Cognitive; Consumption; Dementia; Disadvantaged; Education; Elder Abuse; Elderly; Equilibrium; Exposure to; Focus Groups; Goals; Health; Health Personnel; Intervention; Interview; Knowledge; Measures; Modeling; Morbidity - disease rate; Outcome; Patients; Phase; Point of Care Technology; Population; Primary Care; Process; Provider; Randomized, Controlled Trials; Research; Resources; Risk; Screening procedure; Sensitivity and Specificity; Severities; Tablets; Technology; Testing; Training; United States National Institutes of Health; United States Preventative Services Task Force; Vulnerable Populations; acceptability and feasibility; arm; brief screening; caregiver interventions; caregiving; comparison intervention; data registry; design; elder neglect; evidence base; handheld mobile device; ideation; implementation tool; improved; innovation; maltreatment; mortality; neglect; novel; pilot test; point of care; prevent; primary care provider; protocol development; randomized, clinical trials; screening; screening guidelines; skills; standard measure; tool; treatment as usual; tv watching; usability

PROJECT SUMMARY The over-arching aims of this research are to: (1) develop a novel primary care screening tool to identify elder neglect in patients with Alzheimer’s Disease and Related Dementias (AD/ADRD) and a point-of-care technology-driven intervention for caregivers [R61], and (2) conduct a NIH Model Stage III 3-arm randomized clinical trial to determine the impact of both screening itself and screening combined with the intervention compared to usual care [R33]. We are focusing exclusively on developing screening for neglect rather than all types of mistreatment given that neglect is very common in AD/ADRD patients, neglect is associated with the highest mortality and morbidity of all mistreatment types, and specific targets exist for interventions. Combining all types of mistreatment, the approach taken to date in screening tool design, has important disadvantages. It makes screening time-consuming and challenging. Additionally, different mistreatment types are very different phenomena, occur in different groups of older adults under different circumstances, have different impacts on health, and likely require different intervention strategies. Further, our research team has developed and studied a successful, evidence-based technology intervention for AD/ADRD caregivers. We believe that an adaptation of this intervention for caregiver neglect, which focuses on education and skill building and access to resources, may be highly impactful in reducing and preventing neglect. The Specific Aims of the R61 phase are: (Aim 1a) develop a novel, easy-to-use, brief screening tool to identify elder neglect in primary care and describe the tool’s test characteristics (KQ3), (Aim 1b) develop an innovative intervention for elder neglect by modifying a highly successful evidence-based technology-driven caregiving intervention, and (Aim 2) pilot-test the screening tool and intervention in primary care (NIH Model Stage 1b) to assess feasibility and acceptability. In the R33 phase, we will conduct a 3-arm randomized controlled trial (NIH Model Stage III) to compare: (1) screening + intervention, (2) screening only, and (3) usual care without screening. The Specific Aims of the R33 phase are: (Aim 3) evaluate the impact of screening for elder neglect on reduction in neglect exposure (KQ1) and other patient and caregiver-important outcomes by comparing to usual care and (Aim 4) evaluate the impact of screening tool paired with a technology-based caregiver intervention on reduction in exposure to neglect (KQ5) and other patient and caregiver-important outcomes by comparison to usual care and screening without intervention. Neglect screening in primary care with a novel screening tool will have a positive impact on outcomes including decrease in presence of neglect at 6 months and other patient and caregiver-important outcomes (e.g., neglect severity, neglectful ideation; caregiver burden) and that screening paired with a technology-based caregiving intervention will have a greater positive impact than screening alone. Our long- term goal is to develop a screening tool for neglect in AD/ADRD patients that may be integrated into primary care and paired with a scalable intervention with sufficient evidence to justify USPSTF endorsement.

项目摘要 这项研究的整理目的是：（1）开发一种新型的初级保健筛查工具来识别较老 阿尔茨海默氏病和相关痴呆症（AD/ADRD）的患者忽略了 技术驱动的护理人员干预[R61]和（2）进行NIH模型III阶段3臂随机分组 临床试验以确定筛查本身和筛查的影响以及干预 与通常的护理相比[R33]。我们专注于制定忽视筛查，而不是全部 鉴于AD/ADRD患者的忽视很常见，错误的类型与 所有虐待类型的死亡率和发病率最高，干预措施存在特定目标。结合 所有类型的错误，该方法迄今为止在筛选工具设计中采用了重要的缺点。它 使筛查时间耗时和挑战。另外，不同的虐待类型非常不同 现象发生在不同情况下不同的老年人组中，对 健康，可能需要不同的干预策略。此外，我们的研究团队已经发展了 研究了针对AD/ADRD护理人员的成功，基于证据的技术干预。我们相信 适应这种干预措施以忽视护理人员，该干预专注于教育和技能建设和访问 对于资源而言，可能在减少和防止忽视方面具有很大影响。 R61阶段的具体目的 是：（目标1a）开发一种新颖，易于使用的简短筛查工具，以识别基层医疗中的老年人的忽视和 描述该工具的测试特征（KQ3），（AIM 1B）通过 修改非常成功的基于循证的技术驱动的护理干预措施，并（AIM 2）试点测试 筛查工具和初级保健（NIH模型1B）的干预，以评估可行性和可接受性。 在R33阶段，我们将进行3臂随机对照试验（NIH模型III）以比较：（1） 筛选 +干预，（2）仅筛选，（3）通常不筛选的护理。特定目标 R33阶段是：（目标3）评估筛查对老年人忽视减少忽视暴露的影响 （KQ1）以及与常规护理和（AIM 4）评估相比，其他患者和护理人员至关重要的结果 筛选工具与基于技术的护理人员干预对减少暴露的影响 与常规护理和筛查相比，忽视（KQ5）以及其他患者和护理人员重要的结果 没有干预。使用新颖的筛查工具在初级保健中忽略筛查将产生积极的影响 关于结果，包括在6个月时忽视的情况下减少以及其他患者和护理人员很重要 结果（例如，忽视严重性，忽视的想法；照顾者伯恩），筛选与 基于技术的护理干预将产生比单独筛查更大的积极影响。我们的长期 术语目标是开发一个可能集成到主要的AD/ADRD患者中忽略的筛选工具 护理并与可扩展的干预措施配对，并有足够的证据来证明USPSTF认可的合理性。