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

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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.