Improving Recognition of Elder Abuse through Analysis of Highly Adjudicated Cases

通过分析高度判决的案件提高对虐待老年人的认识

• 批准号: 8757750
• 负责人: Anthony Rosen
• 金额: $ 12.71万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8757750
• 关键词: Accident and Emergency department; Accidental Falls; Accidental Injury; Acute; Adult; Aging; Appointment; Award; Biological Markers; Biometry; Caring; Case Series; Case Study; Case-Control Studies; Characteristics; Clinical; Collaborations; Control Groups; Data; Diagnosis; Elder Abuse; Elder abuse prevention; Elderly; Emergency Medicine; Enrollment; Epidemiology; Faculty; Family; Fellowship; Forensic Medicine; Frequencies; Funding; Future; Geriatrics; Goals; Gold; Grant; Health; Health Care Costs; Health Personnel; Injury; Institution; Judgment; Lawyers; Medical Records; Medical Students; Mentors; Methodology; Methods; Morbidity - disease rate; New York; Outcome; Patients; Pattern; Physicians; Physiological; Presbyterian Church; Prevention Research; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Research Support; Risk Assessment; Series; Services; Students; Time; Training; Trauma; United States National Institutes of Health; Wages; abuse victim; adjudicate; authority; career; court; design; emergency service responder; evidence base; experience; improved; innovation; interest; maltreatment; mortality; perpetrators; physical abuse; public health relevance; screening; tool; violence prevention

DESCRIPTION (provided by applicant): The specific aims for this project are: (1) to comprehensively examine and describe common injury patterns, physical findings, and forensic biomarkers in a series of highly adjudicated cases of physical elder abuse using a mixed methods approach, (2) to conduct a case-control study comparing these injury patterns to those sustained by older adults after an accidental fall, and (3) to design a clinical decision rule to assist health care providers in identifying abuse victims. We will achieve these aims through a unique collaboration with the Elder Abuse Unit (EAU) of the Brooklyn District Attorney's Office. The Brooklyn EAU successfully prosecutes more than 100 cases of physical elder abuse annually and maintains comprehensive files including photographs of injuries, medical records, description of first responder interactions with victim and perpetrator, and court documents. We will closely examine 200 files to comprehensively describe injury patterns as well as characteristics of victims and abusers. This innovative design, using cases of indisputable physical elder abuse, represents an important methodologic advance, as previous research has suffered from insufficient access to a large number of well-characterized elder abuse cases. Given the challenges associated with differentiating elder abuse from accidental injury, we will compare results from these cases to a control group of geriatric patients presenting to the emergency department with accidental falls to identify injury patterns and biomarkers associated with abuse. Ultimately, we plan to derive a clinical decision rule that will assist health care providers in more effectively screening for elder abuse. The applicant, Dr. Anthony Rosen, is an Emergency Medicine physician who has demonstrated significant research and clinical interest in acute geriatric care. He has a successful track record of collaboration in elder maltreatment research with Dr. Mark Lachs, an established NIH-funded researcher, who serves as Geriatrics mentor and co-investigator. Dr. Stephen Hargarten, his Emergency Medicine mentor and a co-investigator, is a pioneer in academic Emergency Medicine and violence prevention research. Having completed an MPH in epidemiology, Dr. Rosen is already trained in research methods and biostatistics. He is a former recipient of the Medical Student Training in Aging Research (MSTAR) grant and has mentored multiple MSTAR student research projects. In addition to his faculty appointment, Dr. Rosen will pursue a Geriatric Emergency Medicine fellowship during the grant period to increase his expertise in caring for older adults. The study proposed can be feasibly completed in two years with the support provided through this R03, particularly because, through funding from his institution, Dr. Rosen will already have salary support for 75% time protected from clinical responsibilities, and all NIA funds awarded will be allocated exclusively to support this research. The long-term goal of this proposal is to develop, implement, and evaluate comprehensive strategies to improve identification and prevention of elder abuse by health care providers and to launch the academic career of a promising junior investigator.

描述（申请人提供）：本项目的具体目标是：（1）使用混合方法全面检查和描述一系列高度裁定的身体虐待老年人案件中的常见损伤模式、身体发现和法医生物标志物，（2）进行病例对照研究，将这些损伤模式与老年人意外跌倒后的损伤模式进行比较，及（3）设计一套临床决策规则，以协助医护人员识别受虐者。我们将通过与布鲁克林地区检察官办公室的虐待老人股（EAU）的独特合作来实现这些目标。布鲁克林EAU每年成功起诉100多起身体虐待老年人的案件，并保存了全面的档案，包括受伤照片，医疗记录，第一反应者与受害者和肇事者互动的描述以及法庭文件。我们将仔细审查200份档案，以全面描述伤害模式以及受害者和施虐者的特征。这种创新的设计，使用无可争议的身体虐待老年人的情况下，代表了一个重要的方法学的进步，因为以前的研究已经遭受了大量的特征鲜明的虐待老年人的情况下，获得不足。鉴于区分虐待老人与意外伤害的相关挑战，我们将比较这些病例的结果与因意外福尔斯摔倒到急诊室的老年患者对照组，以确定与虐待相关的伤害模式和生物标志物。最终，我们计划得出一个临床决策规则，这将有助于医疗保健提供者更有效地筛选虐待老人。申请人Anthony罗森博士是一名急诊医学医生，他在急性老年护理方面表现出了重大的研究和临床兴趣。他与美国国立卫生研究院资助的研究人员Mark Lachs博士在老年虐待研究方面有着成功的合作记录，Mark Lachs博士担任老年医学导师和联合研究员。Stephen Hargarten博士是他的急诊医学导师和共同研究者，是学术急诊医学和暴力预防研究的先驱。罗森博士完成了流行病学硕士学位，已经接受了研究方法和生物统计学方面的培训。他曾获得医学生老龄化研究培训（MSTAR）资助，并指导了多个MSTAR学生研究项目。除了他的教师任命，罗森博士将在赠款期间追求老年急诊医学奖学金，以增加他在照顾老年人的专业知识。在本R03提供的支持下，拟议的研究可以在两年内完成，特别是因为通过其机构的资助，罗森博士已经获得了75%的工资支持，免于承担临床责任，并且所有授予的NIA资金将专门用于支持本研究。该提案的长期目标是制定、实施和评估综合战略，以改善医疗保健提供者对虐待老年人的识别和预防，并启动有前途的初级研究员的学术生涯。