Feasibility of the VOICES Elder Mistreatment Digital-Screening Tool for Older Adults with Cognitive Impairment

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7. PROJECT SUMMARY/ ABSTRACT Older adults with cognitive impairment are at greater risk of elder mistreatment compared to those without.1- 3 Elder mistreatment is a major public health problem with estimated prevalence in the United State ranges from 27.9% to 62.3% for emotional abuse and 3.5%–23.1% for physical abuse among older adults with cognitive impairment (CI).1,3-6 EM causes serious adverse outcomes for its victims including injury, increased service utilization, mental distress and increased mortality. The Emergency Department is an opportune setting to identify this vulnerable population. A major barrier in overcoming elder mistreatment is the inability to accurately identify victims. It is estimated that only 1 in 24 cases become known to authorities. This is problematic as older adults with cognitive impairment are not likely to report that they are being mistreated. Working with leading experts in user experience research, geriatrics, Alzheimer’s disease, and emergency medicine, we will conduct a usability and feasibility evaluation of using the VOICES elder mistreatment digital- Screening tool for older adults with cognitive Impairment. VOICES is a tablet-based tool to screen and identify suspicion of elder mistreatment and has been developed and tested under the parent grant and is currently being evaluated with older adults without cognitive impairment. VOICES tool utilizes virtual coaching, interactive multimedia libraries (e.g. graphics, video clips, animations, etc.), techniques from electronic screening for intimate partner violence, and brief motivational interviewing designed to enhance identifying mistreatment among older adults. Among the 130 subjects who used VOICES so far, 8 older wanted to self-report EM after using VOICES and 3 of these cases were substantiated by the ED social workers. In this supplement we will evaluate the feasibility of VOICES tool by older adults with cognitive impairment to enhance and refine the EM screening VOICES tool to be useable and acceptable by persons with cognitive impairment. Our aims are: 1) to evaluate the usability and acceptability of the VOICES screening tool for older patients with cognitive impairment, 2) to enhance and refine VOICES tool to be usable and acceptable for older adults with cognitive impairment, 3) to conduct a feasibility study (N= 80) examining the use of VOICES in a busy emergency department by older adults with cognitive impairment. This supplement, if funded, will expand the scope of our project to include the AD/ADRD population to our VOICES project that does not currently include older adults with CI to allow us to examine the feasibility of our complex intervention for older adults with CI. We expect this project will lead to a future comparative effectiveness study comparing (VOICES + in-person screening) to the standard-of-care (in-person screening).