Identifying Injury Patterns and Forensic Biomarkers Diagnostic of Physical Elder Abuse

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PROJECT SUMMARY/ABSTRACT The over-arching aims of this Beeson K76 application are to identify injury patterns and forensic biomarkers diagnostic of physical elder abuse and launch the academic career of a very promising junior investigator. Candidate: The applicant, Dr. Anthony Rosen, is an Emergency Medicine physician at Weill Cornell Medical College (WCMC) who has demonstrated significant research ability and clinical interest in elder abuse and acute geriatric care. He is the recipient of an NIA GEMSSTAR award, where he partnered with prosecutors’ offices to examine legal case files to describe intriguing patterns of injury in the largest retrospective series of highly adjudicated elder abuse cases ever examined. To conduct this work, Dr. Rosen and colleagues developed a comprehensive classification system for acute geriatric injuries and a protocol for standardized photography of acute injuries. Dr. Rosen’s work has begun to be recognized nationally, as he was an invited participant in the 2015 White House Elder Justice Forum and presented at NIH’s recent elder abuse workshop. He has also pursued a clinical fellowship in Geriatric Emergency Medicine. Dr. Rosen is already trained in research methods and biostatistics, having completed an MPH in epidemiology. Dr. Rosen’s long-term career goals are to improve protection of vulnerable older adults through identification, intervention, and prevention of elder abuse and neglect and become an independent researcher and academic leader in elder abuse and geriatric injury prevention research. He has identified four specific areas where he will benefit from additional critical training during the Beeson Award period: forensic sciences, policy-making, independent grant writing, and leadership skills. For each, in collaboration with his mentors, he has taken advantage of institutional, local, and national didactic resources and opportunities to create an ambitious plan to provide this training and experience. The Beeson K76 award will allow Dr. Rosen to develop these skills, complete the important project he proposes, and continue his promising academic career and leadership development. Mentors/Environment: Dr. Rosen has engaged an extraordinarily strong, committed mentorship team with deep knowledge of elder abuse research and extensive experience in mentoring junior researchers to independence. Dr. Rosen has worked closely for 9 years with his primary mentor, Dr. Mark Lachs, the Chief of Geriatrics for WCMC and the entire NewYork-Presbyterian Health System (NYPHS), who has led multiple R01-funded elder abuse research projects. He has also worked extensively with co-mentor Dr. Karl Pillemer, a leading social scientist in elder abuse research for nearly 30 years. Co-mentor Dr. Terry Fulmer, president of the John A. Hartford Foundation, is a leading nurse researcher with experience prospectively recruiting elder abuse victims from the Emergency Department and has provided pilot data which informs this proposal. Dr. Rosen has also assembled a diverse team of expert collaborators from criminal justice, policy-making, government agencies, injury prevention, and epidemiology methods. The WCMC Division of Emergency Medicine is committed to Dr. Rosen’s success and will provide protected time and resources. In addition, WCMC provides a rich and supportive research and career development environment, which includes the Clinical and Translational Science Center, the Clinical Research Methodology Core Facility, and training courses / seminars in biomedical grant writing, transitioning to research independence, and leadership. Research: The over-arching aim and long-term goal of Dr. Rosen’s research is to: identify injury patterns and forensic biomarkers diagnostic of physical elder abuse. The Specific Aims of this proposal are: (1) to identify injury patterns, physical findings, and other characteristics associated with elder physical abuse by comparing prospectively enrolled victims in comparison with geriatric patients presenting to the ED with accidental falls, (2) to identify laboratory and radiographic results associated with physical elder abuse in comparison with accidental fall injury patients, and (3) to derive a clinical prediction rule (CPR) to assist busy health care providers in more effectively identifying physical elder abuse, an under-recognized phenomenon. By enrolling prospectively and evaluating comprehensively physical abuse victims in the ED, the proposed project addresses the major methodologic limitations in Dr. Rosen’s prior work, the quality and completeness of information in legal files, which were not gathered for research, and the lack of ancillary neuro-cognitive, radiographic, and laboratory testing on victims. Developing a CPR will dramatically increase the utility of the findings for busy clinicians. Subjects will be identified and recruited through partnerships with the New York City Elder Abuse Center (NYCEAC), the New York City Department for the Aging, Adult Protective Services, prosecutors’ offices, and Emergency Medical Services, as well as through ED evaluation. In addition to study enrollment, victims will be assessed and treated by a first-of-its-kind, ED-based multi-disciplinary Vulnerable Elder Protection Team designed by Dr. Rosen and colleagues. He and this team are uniquely able and ideally positioned to conduct this research because of the size and reach of the NYPHS, their leadership in the NYEAC, and their long-term collaboration with agencies serving elder abuse victims locally. This innovative project is likely to greatly improve the ability of health care providers to identify victims of physical elder abuse, who are among the most vulnerable older adults. The long-term goal of this Beeson proposal is to improve protection of these victims and to launch Dr. Rosen’s promising research, academic, and leadership career.