Developing, Implementing, and Evaluating a Caregiver and Elder Abuse Screening, Risk Assessment and Treatment to Improve Outcomes for Older and Vulnerable Adults with MCI/ADRD

制定、实施和评估看护者和老年人虐待筛查、风险评估和治疗，以改善患有 MCI/ADRD 的老年人和弱势成人的治疗结果

• 批准号: 10704685
• 负责人: Monique Renae Pappadis
• 金额: $ 56.6万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704685
• 关键词: Address; Adoption; Adult; Alzheimer' s disease related dementia; Area; Caregivers; Cessation of life; Chronic; Companions; Consolidated Framework for Implementation Research; Data; Detection; Diagnosis; Education; Educational Intervention; Elder Abuse; Elder abuse prevention; Elderly; Ethnic Origin; Exposure to; Fee-for-Service Plans; Goals; Harm Reduction; Health; Hospitalization; Impaired cognition; Individual; Intervention; Interview; Literature; Medical; Medicare; Medicare claim; Mental Health; Methods; Minor; Modeling; Older Population; Outcome; Patient Care; Patients; Persons; Phase; Population; Practice Guidelines; Primary Care; Primary Prevention; Process; Provider; Public Health; Quality of life; Race; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Risk; Risk Assessment; Risk Factors; Safety; Sampling; Screening procedure; Testing; Texas; Training; Traumatic Brain Injury; Vulnerable Populations; beneficiary; brief intervention; care systems; caregiver stress; cognitive disability; evidence base; experience; feasibility testing; follow-up; high risk population; improved; improved outcome; innovation; intimate partner violence; mild cognitive impairment; mortality; physical conditioning; pilot test; pragmatic trial; premature; prevent; primary care clinic; primary care setting; protective factors; screening; screening, brief intervention, referral, and treatment; socioeconomics; standard of care; success; tool

ABSTRACT Elder abuse (EA) is chronically undetected and underreported in primary care settings, especially in older and vulnerable adults with mild cognitive impairment (MCI), such as those with traumatic brain injury and those with Alzheimer’s Disease and Related Dementias (ADRD). Elder abuse increases risks for hospitalization and mortality among older and vulnerable adults. To aid screening and provision of a brief educational intervention with adults experiencing cognitive decline, the Screening, Brief Intervention, Referral to Treatment (SBIRT) model may be an effective model to guide primary prevention of elder abuse. Following a SBIRT model, the proposed CAPA-OV (Caregiver and Patient Abuse assessment For Older and Vulnerable populations) will build on research from the EA and intimate partner violence (IPV) fields. The long-term goal of this project is to establish and test 1) a valid primary care-based EA screening tool with an embedded caregiver risk assessment and 2) a two-part effective brief intervention focused on both patients and caregivers to mitigate EA among older and vulnerable adults with MCI/ADRD. Using primary care clinics in a racially, ethnically, and socioeconomically diverse area of southeast Texas, specific aims during the R61 phase are to: Aim 1: Explore dynamic risks and protective factors of EA with older and vulnerable adults with MCI/ADRD based on qualitative interviews with adults with MCI/ADRD and caregivers and develop and validate an EA risk assessment model using 20% Medicare claims data. Aim 2: Develop a SBIRT-type intervention, the CAPA-OV, with an adapted caregiver risk assessment, for use with patients with MCI/ADRD and caregivers in primary care settings. Aim 3: Pilot test the feasibility, fidelity, barriers, and effects of implementing CAPA-OV in three primary care clinics. Based on results from the R61, minor adaption of CAPA-OV will be completed prior to implementation across primary care settings. Specific aims during the R33 phase include: Aim 4: use a pragmatic trial to test the hypothesis that patient-caregiver dyads randomized to receive CAPA-OV will show reductions in exposure to EA, improvements in physical and mental health, and enhancements in quality of life, relative to patient-caregiver dyads receiving standard of care at 6-, 12-, and 18-month follow-up. Aim 5: Evaluate the process and outcomes of implementing CAPA-OV using mixed-methods approaches guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) theoretical frameworks. In developing the first efficacious asymptomatic screening and intervention in English and Spanish that improves EA detection and reduces harms for older adults with MCI/ADRD, we will reduce the public health burden of EA. Our study innovatively addresses both vulnerable and older adults and their caregivers, addressing major risk factors for EA and subsequent health problems, and support the implementation of CAPA-OV to other primary care settings.

抽象的 在初级保健机构中，虐待老年人 (EA) 长期未被发现且报告不足，尤其是在老年人和老年群体中。 患有轻度认知障碍 (MCI) 的弱势成年人，例如脑外伤患者和患有 阿尔茨海默病和相关痴呆症 (ADRD) 虐待老年人会增加住院和治疗的风险。 帮助筛查和提供简短的教育干预。 对于经历认知能力下降的成年人，筛查、简短干预、转介治疗 (SBIRT) 模型可能是指导虐待老年人一级预防的有效模型。 拟议的 CAPA-OV（老年人和弱势群体的护理人员和患者虐待评估）将 该项目的长期目标是建立在 EA 和亲密伴侣暴力 (IPV) 领域的研究基础上。 建立并测试 1) 一个有效的基于初级保健的 EA 筛查工具，其中包含护理人员风险 评估和 2) 针对患者和护理人员的两部分有效简短干预，以减轻 患有 MCI/ADRD 的老年人和弱势成人中的 EA 在种族、民族和地区使用初级保健诊所。 德克萨斯州东南部社会经济多样化的地区，R61 阶段的具体目标是： 目标 1：探索患有 MCI/ADRD 的老年人和弱势成人的 EA 的动态风险和保护因素 基于对患有 MCI/ADRD 的成年人和护理人员的定性访谈，并制定和验证 EA 风险 使用 20% 医疗保险索赔数据的评估模型 目标 2：开发 SBIRT 型干预措施，CAPA-OV， 经过调整的护理人员风险评估，适用于 MCI/ADRD 患者和初级护理人员 目标 3：在三个领域试点测试实施 CAPA-OV 的可行性、保真度、障碍和效果。 根据 R61 的结果，CAPA-OV 的小规模调整将在之前完成。 R33 阶段的具体目标包括： 目标 4：使用 检验随机接受 CAPA-OV 的患者-护理人员二人组的假设的务实试验将显示 减少接触 EA、改善身心健康并提高生活质量， 相对于在 6、12 和 18 个月随访时接受标准护理的患者-护理人员二人组： 使用以下指导下的混合方法评估实施 CAPA-OV 的过程和结果 实施研究综合框架（CFIR）和范围、有效性、采用、 实施和维护（RE-AIM）理论框架。 用英语和西班牙语进行无症状筛查和干预，可改善 EA 检测并减少 对于患有 MCI/ADRD 的老年人的危害，我们将创新地减轻 EA 的公共卫生负担。 解决弱势群体和老年人及其照顾者的问题，解决 EA 和 后续的健康问题，并支持在其他初级保健机构实施 CAPA-OV。