Uncovering the Causes, Contexts, and Consequences of Elder Mistreatment in People with Dementia

揭示老年痴呆症患者遭受虐待的原因、背景和后果

• 批准号: 10396025
• 负责人: Zachary D Gassoumis
• 金额: $ 35.74万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10396025
• 关键词: Address; Adopted; Affect; Algorithms; Alzheimer' s disease related dementia; Assessment tool; Baseline Surveys; Behavior; California; Caregivers; Caring; Characteristics; Child Abuse and Neglect; Clinical Data; Clinical assessments; Code; Confounding Factors (Epidemiology); Consent; Contusions; County; Creatinine; Data; Data Set; Dementia; Dependence; Detection; Diagnosis; Diagnostic; Distress; Elder Abuse; Elderly; Electronic Health Record; Exhibits; Health; Health Status; Health system; Healthcare Systems; Heart Rate; Home; Hospitals; Incidence; Individual; Intervention; Interview; Interviewer; Laboratory Markers; Lead; Lesion; Link; Los Angeles; Lymphocyte; Measurement; Measures; Methods; Modeling; Morbidity - disease rate; Outcome; Participant; Patient Self-Report; Patients; Personal Satisfaction; Persons; Physical Examination; Population; Predisposition; Prevalence; Problem behavior; Prospective Studies; Psychometrics; Public Health; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Sampling; Self Assessment; Seminal; Sexual abuse; Societies; Source; Surveys; Testing; Trust; Universities; aging population; base; clinical research site; cohort; cost; demographics; emotional abuse; experience; financial exploitation; health service use; heart rate variability; high risk; innovation; knowledge base; mortality; neglect; novel strategies; patient subsets; perpetrators; physical abuse; prevent; primary caregiver; protective factors; psychosocial; resilience; risk minimization; sleep pattern; social; support network; wearable device

ABSTRACT Our primary objective is to investigate underlying mechanisms of elder mistreatment (EM) in people with Alzheimer’s Disease and related dementias (ADRD). Applying the Abuse Intervention Model, we will identify EM risk and protective factors among older adults with ADRD (potential victim), their trusted other (potential perpetrator), and their context to inform the creation of evidence-informed risk assessment tools, interventions, detection/diagnosis algorithms, and care plans for older adults with ADRD and their caregivers. Aim 1. Measure EM and track risk factors in people with ADRD and their caregivers. This cohort (target N=200 dyads), drawn from ADRD-specific clinical/research sites, will be tracked longitudinally for 18 months, with assessment every six months. EM incidence will be measured at each assessment by older adult and primary caregiver self-report and interviewer observation. In-home assessments will also collect data on characteristics of the vulnerable older adult, trusted other, and context. Survey and observation data will be linked to detailed clinical data from clinical/research sites. When possible, study data will also be linked to County electronic health records (EHRs) to identify risk and protective factors and adjust for confounding variables. Aim 2. Explore how the caregiver experience contributes to EM in people with ADRD. We will utilize a mixed method, sequential explanatory approach to prospectively study caregivers of people with ADRD to detect characteristics and antecedents of EM. Drawn from a sub-sample of Aim 1 cohort caregivers (target n=50), subjects will: (1) adopt wearable technology to track their activity, heart rate/heart rate variability, and sleeping patterns; (2) provide information about their social and instrumental support network via a CareMap; and (3) engage in an open-ended interview. These data will be linked to data collected under Aim 1 to determine the impact on persons who may be found to exhibit abusive/neglectful behavior, setting the stage for testing interventions to promote resiliency, enhance protective factors, and minimize risk factors. Aim 3. Identify electronic health record (EHR)-based indicators of EM in people with ADRD. EHRs from the County will be used to compare patients with ADRD who are identified as victims of EM with ADRD patients who are not reported as victims of EM, using one-to-many propensity score matching based on demographics, health status, and health service utilization. Analyses will explore the feasibility of using data from patient EHRs to distinguish between the abused and non-abused ADRD patient groups, including examination of exam-derived diagnostic codes (e.g., specific bruises and lesions)6 and laboratory markers (e.g., changes in creatinine, lymphocyte level),7 as pathognomonic markers or indicators of EM. These aims offer a novel approach to identify mechanisms and causes of EM in people with ADRD, to aid in developing risk assessment tools and interventions to minimize risk, enhance protection, and promote resiliency.

摘要 我们的主要目的是调查老年人虐待（EM）的潜在机制， 阿尔茨海默病和相关痴呆症（ADRD）。应用滥用干预模型，我们将 确定患有ADRD的老年人（潜在受害者），他们信任的其他人中的EM风险和保护因素 （潜在的犯罪人），以及他们的背景，为创建循证风险评估工具提供信息， 干预措施，检测/诊断算法和护理计划的老年人与ADRD及其照顾者。 目标1。测量EM并跟踪ADRD患者及其护理人员的风险因素。本队列（目标 N=200对），从ADRD特异性临床/研究中心抽取，将纵向跟踪18个月， 每六个月评估一次。EM发生率将在每次评估时由老年人和 主要照顾者的自我报告和访谈观察。家庭评估还将收集以下数据： 脆弱的老年人的特征，信任的其他人，以及背景。调查和观察数据将 与临床/研究中心的详细临床数据相关联。如果可能，研究数据也将链接到县 电子健康记录（EHR），以识别风险和保护因素，并调整混杂变量。 目标二。探索护理人员的经验如何有助于ADRD患者的EM。我们将利用 混合方法，序贯解释方法，前瞻性研究ADRD患者的照顾者， EM的特征和前因。从Aim 1队列护理者的子样本中抽取（目标n=50）， 受试者将：（1）采用可穿戴技术来跟踪他们的活动、心率/心率变异性和睡眠 模式;（2）通过CareMap提供有关其社会和工具支持网络的信息;以及（3） 参加一个开放式的面试。这些数据将与目标1下收集的数据相关联，以确定 对可能表现出虐待/疏忽行为的人的影响，为测试奠定基础 干预措施，以促进复原力，加强保护因素，并尽量减少风险因素。 目标3.识别ADRD患者中基于电子健康记录（EHR）的EM指标。EHRs 将用于比较被确定为EM患者的ADRD患者 未报告为EM受害者的患者，使用基于以下的一对多倾向评分匹配 人口统计学、健康状况和卫生服务利用。分析将探讨使用以下数据的可行性： 患者EHR，以区分滥用和非滥用ADRD患者组，包括检查 检查导出的诊断代码（例如，特定的瘀伤和损伤）6和实验室标记物（例如，变化 肌酐、淋巴细胞水平），7作为EM的特异性标志物或指标。 这些目标提供了一种新的方法来确定ADRD患者EM的机制和原因，以帮助 开发风险评估工具和干预措施，以最大限度地减少风险，加强保护和提高复原力。