Developing, Implementing, and Evaluating a Caregiver and Elder Abuse Screening, Risk Assessment and Treatment to Improve Outcomes for Older and Vulnerable Adults with MCI/ADRD

摘要 在初级保健环境中，虐待老年人（EA）长期未被发现和报告不足，特别是在老年人和 患有轻度认知障碍（MCI）的脆弱成年人，如创伤性脑损伤患者和 阿尔茨海默病及相关痴呆症（ADRD）。虐待老年人增加了住院治疗的风险， 老年人和弱势成年人的死亡率。帮助筛查和提供简短的教育干预 对于经历认知衰退的成年人，筛查，短暂干预，转诊治疗（SBIRT） 模型可能是指导虐待老人一级预防的有效模型。根据SBIRT模型， CAPA-OV（针对老年人和弱势群体的护理人员和患者虐待评估）将 建立在EA和亲密伴侣暴力（IPV）领域的研究基础上。该项目的长期目标是 建立和测试1）一个有效的基于初级保健的EA筛查工具，其中包含护理人员风险 评估和2）两部分有效的简短干预，重点是患者和护理人员，以减轻 EA在MCI/ADRD的老年人和弱势成年人中。使用初级保健诊所在一个种族，民族， 在德克萨斯州东南部的社会经济多样化地区，R61阶段的具体目标是： 目的1：探讨EA对老年和脆弱的MCI/ADRD患者的动态风险和保护因素 基于对MCI/ADRD成人和护理人员的定性访谈，并制定和验证EA风险 使用20%的医疗保险索赔数据的评估模型。目标2：开发一种SBIRT类型的干预措施，即CAPA-OV， 采用适应性护理人员风险评估，用于MCI/ADRD患者和初级护理人员 护理设置。目标3：试点测试在三个国家实施CAPA-OV的可行性、保真度、障碍和效果 初级保健诊所。根据R61的结果，将在 在初级保健机构实施。R33阶段的具体目标包括： 一项检验随机接受CAPA-OV的患者-护理者二人组将显示 减少暴露于EA，改善身心健康，提高生活质量， 相对于在6个月、12个月和18个月随访时接受标准护理的患者-护理者二人组。目标5： 评估采用混合方法实施CAPA-OV的过程和结果， 实施研究综合框架（CFIR）和覆盖面、有效性、采用、 实施和维护（RE-AIM）理论框架。在开发第一个有效的 英语和西班牙语的无症状筛查和干预，提高了EA的检测， 为了减少MCI/ADRD老年人的危害，我们将减少EA的公共卫生负担。我们的研究创新 针对脆弱和老年人及其照顾者，解决EA的主要风险因素， 随后的健康问题，并支持CAPA-OV在其他初级保健环境中的实施。

ABSTRACT Elder abuse (EA) is chronically undetected and underreported in primary care settings, especially in older and vulnerable adults with mild cognitive impairment (MCI), such as those with traumatic brain injury and those with Alzheimer’s Disease and Related Dementias (ADRD). Elder abuse increases risks for hospitalization and mortality among older and vulnerable adults. To aid screening and provision of a brief educational intervention with adults experiencing cognitive decline, the Screening, Brief Intervention, Referral to Treatment (SBIRT) model may be an effective model to guide primary prevention of elder abuse. Following a SBIRT model, the proposed CAPA-OV (Caregiver and Patient Abuse assessment For Older and Vulnerable populations) will build on research from the EA and intimate partner violence (IPV) fields. The long-term goal of this project is to establish and test 1) a valid primary care-based EA screening tool with an embedded caregiver risk assessment and 2) a two-part effective brief intervention focused on both patients and caregivers to mitigate EA among older and vulnerable adults with MCI/ADRD. Using primary care clinics in a racially, ethnically, and socioeconomically diverse area of southeast Texas, specific aims during the R61 phase are to: Aim 1: Explore dynamic risks and protective factors of EA with older and vulnerable adults with MCI/ADRD based on qualitative interviews with adults with MCI/ADRD and caregivers and develop and validate an EA risk assessment model using 20% Medicare claims data. Aim 2: Develop a SBIRT-type intervention, the CAPA-OV, with an adapted caregiver risk assessment, for use with patients with MCI/ADRD and caregivers in primary care settings. Aim 3: Pilot test the feasibility, fidelity, barriers, and effects of implementing CAPA-OV in three primary care clinics. Based on results from the R61, minor adaption of CAPA-OV will be completed prior to implementation across primary care settings. Specific aims during the R33 phase include: Aim 4: use a pragmatic trial to test the hypothesis that patient-caregiver dyads randomized to receive CAPA-OV will show reductions in exposure to EA, improvements in physical and mental health, and enhancements in quality of life, relative to patient-caregiver dyads receiving standard of care at 6-, 12-, and 18-month follow-up. Aim 5: Evaluate the process and outcomes of implementing CAPA-OV using mixed-methods approaches guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) theoretical frameworks. In developing the first efficacious asymptomatic screening and intervention in English and Spanish that improves EA detection and reduces harms for older adults with MCI/ADRD, we will reduce the public health burden of EA. Our study innovatively addresses both vulnerable and older adults and their caregivers, addressing major risk factors for EA and subsequent health problems, and support the implementation of CAPA-OV to other primary care settings.