Detection of Elder mistreatment Through Emergency Care Technicians - Revised for Primary Care (DETECT-RPC)

虐待老年人通常被定义为照顾者或其他人在涉及对信任的期望的关系中故意或不采取行动，从而对老年人造成伤害或造成伤害风险。EM可能是有意或无意的，包括经济剥削，忽视，情感/心理虐待，身体虐待和性虐待。这是令人担忧的，因为在认知完整的老年人中估计有11%的年患病率，在患有阿尔茨海默病和阿尔茨海默病相关痴呆AD/ADRD的老年人中估计有30-75%的年患病率。此外，EM与生活质量差、财产和安全损失、身体伤害、住院、急诊室就诊、心理困扰、发病率和早期死亡的风险增加有关。然而，EM很难检测到，并且经常无法识别。迫切需要有效和高效的EM筛查工具来改善早期检测工作。该提案将通过调整基于证据的EM筛查工具来满足这一需求，以家庭为基础的初级保健，并严格评估其潜在的危害和益处。作为对RFA-AG-22-024的直接回应，我们建议进行IA阶段研究（R61阶段），以调整DETECT筛查工具，使其适用于家庭初级保健-特别强调最近被诊断患有阿尔茨海默病和阿尔茨海默病相关痴呆AD/ADRD的老年人-DETECT初级保健修订版（DETECT-RPC）。我们还提出了DETECT-RPC的第三阶段多中心随机（提供者级别）对照疗效试验（R33阶段）。拟议项目R61阶段的具体目标是：（1）评估各州特定法律和场地特定政策对DETECT-PRC工具将提供的报告指导的潜在影响（混合方法）;（2）调查在家庭初级保健环境中识别和报告EM的提供者层面的障碍（定性-结构化访谈，焦点小组）;（3）将DETECT筛查工具用于家庭初级保健（定性-结构化访谈，焦点小组）。拟议项目R33阶段的具体目标是：（1）严格评估DETECT-RPC对目标作用机制的影响（即，目前识别和报告的障碍）;（2）严格评价DETECT-RPC对临床医生识别和向相关当局报告EM风险增加的老年人的影响（RFA关键问题KQ 3）;（3）严格评价获益（即，减少遭受虐待和忽视的风险，降低身体或精神发病率，降低死亡率）以及DETECT-RPC筛查的危害（RFA关键问题KQ 1和KQ 4）（混合方法）。

Elder mistreatment (EM) is commonly defined as an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes harm or creates a risk of harm to an older adult. EM may be intentional or unintentional and includes financial exploitation, neglect, emotional/psychological abuse, physical abuse, and sexual abuse. This is concerning as there is an estimated 11% annual prevalence among cognitively intact older adults, and a 30-75% annual prevalence among older adults with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD. Further, EM is linked with increased risk of poor quality of life, loss of property and security, physical injury, hospitalizations, emergency room visits, psychological distress, morbidity, and early mortality. Nevertheless, EM is difficult to detect and often goes unrecognized. Effective and efficient EM screening tools are urgently needed to improve early detection efforts. This proposal will address this need by adapting an evidence-based EM screening tool for home-based primary care and rigorously evaluating its potential harms and benefits. In direct response to RFA-AG-22-024, we propose stage IA research (R61 phase) to adapt the DETECT screening tool for home-based primary care — with special emphasis on older adults who were recently diagnosed with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD — The DETECT Revision for Primary Care (DETECT-RPC). We also propose a stage III multi-site randomized (at the provider level) controlled efficacy trial (R33 phase) of DETECT-RPC. The specific aims of the R61 phase of the proposed project are: (1) Evaluate the potential impact of state-specific laws and site-specific policies on the reporting guidance that will be provided by the DETECT-PRC tool (mixed-methods); (2) Investigate provider-level barriers to recognizing and reporting EM in home-based primary care environments (qualitative - structured interviews, focus groups); and, (3) Adapt the DETECT screening tool for home-based primary care (qualitative - structured interviews, focus groups). The specific aims of the R33 phase of the proposed project are: (1) Rigorously evaluate the effect of DETECT-RPC on targeted mechanisms of action (i.e., current barriers to identification and reporting) elucidated in the R61 phase of the study (mixed-methods); (2) Rigorously evaluate the impact of DETECT-RPC on clinician identification and reporting of older adults with increased risk of EM to the appropriate authorities (RFA key question KQ3); and, (3) Rigorously evaluate the benefits (i.e., reduce exposure to abuse and neglect, reduced physical or mental morbidity, and reduced mortality) and harms of screening with DETECT-RPC (RFA key questions KQ1 and KQ4) (mixed-methods).