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 虐待老年人(EA)在初级保健环境中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)的易受伤害成年人，如创伤性脑损伤和 阿尔茨海默病和相关痴呆(ADRD)。虐待老年人增加住院和 老年人和易受伤害成年人的死亡率。帮助筛查和提供简短的教育干预 成人认知功能减退的筛查、短期干预、转诊治疗(SBIRT) 该模式有可能成为指导老年虐待初级预防的有效模式。遵循SBIRT模型， 拟议的CAPA-OV(针对老年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。这个项目的长期目标是 建立并测试1)基于初级保健的有效EA筛查工具，并嵌入护理者风险 评估和2)针对患者和照顾者的两部分有效的简短干预，以缓解 老年和易受伤害的MCI/ADRD成年人的电针。使用初级保健诊所，在种族、民族和 得克萨斯州东南部社会经济多元化地区，R61阶段的具体目标是： 目的1：探讨老年和弱势MCI/ADRD患者电针治疗的动态风险和保护因素 基于对患有MCI/ADRD的成年人和照顾者的定性访谈，并制定和验证EA风险 使用20%医疗保险索赔数据的评估模型。目的2：开发一种SBIRT类型的介入治疗，CAPA-OV， 具有适应的照顾者风险评估，用于MCI/ADRD患者和初级照顾者 护理设置。目标3：试行测试实施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，CAPA-OV的轻微改编将在 在初级保健环境中实施。R33阶段的具体目标包括：目标4：使用 验证患者-照顾者双方随机接受CAPA-OV的假设的实用试验将显示 减少接触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个月的随访中接受标准护理的患者-照顾者双方。目标5： 评估使用混合方法实施CAPA-OV的过程和结果 实施研究综合框架(CFIR)及其覆盖范围、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的检测并减少了 对于患有MCI/ADRD的老年人的危害，我们将减少EA的公共卫生负担。我们的研究具有创新性 针对易受伤害的老年人和他们的照顾者，解决EA和 此外，儿童基金会还将继续关注后续的健康问题，并支持将CAPA-OV计划推广到其他初级保健机构。

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.