Resident To Resident Elder Mistreatment (RREM) in Long Term Care

描述（申请人提供）：本研究的具体目的是：（1）使用从居民、工作人员和事件报告中获得信息的三角测量法，改进识别长期护理机构中居民对居民虐待（RREM）病例的方法;（2）在10个长期护理机构的代表性样本中进行首次RREM的系统患病率研究;描述RREM的受害者和肇事者的临床、功能和其他特征，以及RREM发作发生的环境和情境背景。为了这项研究的目的，我们将RREM定义为长期护理居民之间的负面和攻击性的身体，性或言语互动，在社区环境中可能被视为不受欢迎，并有很高的潜力造成身体或心理困扰。我们假设RREM是普遍存在的，并与各种主题，环境和设施的特点，如性别，一天中的时间，和居住在痴呆症单位。在对通过结合“人际攻击”和“养老院行为障碍研究”（具体目标1）的最佳方法开发的工具进行最终测试后，将在具有代表性的设施样本中进行患病率研究，并估计调整后的设施和研究范围内的RREM患病率（具体目标2）。最后，RREM主体，肇事者和事件的特点将进行定性和定量研究（具体目标3）。此次修订的改进包括（1）改进和澄清病例发现方法，（2）更清晰地阐明与特定假设相关的分析策略，以及（3）大幅改善参与机构的保障措施，其中一些机构已经招募（见机构和纽约州卫生部的支持函）。额外的试点研究表明，居民参与率高，广泛的工作人员熟悉RREM，和一种新的方法适用于工作人员识别RREM在真实的时间（“轮班优惠券”技术）的可行性。这项工作的优势包括其前瞻性的个案调查方法，一个更温和的，但具有代表性的样本，减少业务的复杂性，并整合定性和定量方法的事件描述。该项目还结合了一个多元化的研究小组，专门从事这项工作，包括马克·拉克斯（Mark Lachs）（研究虐待老人的老年医学家），珍妮·特雷西（Jeanne Teresi）（统计学家，心理测量学家和老年医学家，在长期护理研究方面拥有数十年的经验）和卡尔·皮勒默（Karl Pillemer）（在养老院组织和虐待老人方面具有知名专业知识的社会学家）。这项研究的长期目标是收集有关RREM的信息，这些信息将作为干预措施的基础，可以预防它，或者在不可避免的情况下避免不良的相关结果。公共卫生相关性：本研究将探讨长期照护中住院医师对住院医师虐待的频率与性质，例如住院医师之间发生的身体与言语攻击行为。虽然长期护理人员虐待居民的问题已受到广泛关注，但居民对居民的虐待问题尚未得到研究。使用居民和工作人员作为报告者，这项研究将确定问题发生的频率，事件是什么样的，以及哪些居民最有可能参与。希望这项研究将导致干预措施，可以尽量减少RREM的发生。

DESCRIPTION (provided by applicant): The specific aims of this research are (1) To refine methodology for identifying cases of resident-to-resident elder mistreatment (RREM) in long-term care facilities using triangulation methodology that derives information from resident, staff, and incident reports; (2) To conduct the first systematic prevalence study of RREM in a representative sample of 10 long-term care facilities; and (3) To describe the victims and perpetrators of RREM with respect to clinical, functional, and other characteristics and the environmental and situational contexts in which RREM episodes occur. For the purpose of this study, we define RREM as negative and aggressive physical, sexual, or verbal interactions between long-term care residents, that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress. We hypothesize that RREM is prevalent and associated with a variety of subject, environmental, and facility characteristics, such as gender, time of day, and residence on a dementia unit. After final testing of an instrument that was developed by marrying the best methodologies from "interpersonal aggression" and "nursing home behavioral disturbance research" (Specific Aim 1), a prevalence study in a representative sample of facilities will be conducted and an adjusted facility and study-wide RREM prevalence estimated (Specific Aim 2). Finally, the characteristics of RREM subjects, perpetrators, and events will be examined both qualitatively and quantitatively (Specific Aim 3). Enhancements in this revision include (1) improvement and clarification of the case finding methodology, (2) clearer articulation of the analytic strategy which is linked to specific hypotheses, and (3) substantially improved safeguards for participating facilities, some of which have already been recruited (see letters of support from the facilities and the New York State Department of Health). Additional pilot studies demonstrate high resident participation rates, widespread staff familiarity with RREM, and the feasibility of a novel method adapted for staff identification of RREM in real time (the "shift coupon" technique). Strengths of this work include its prospective case finding methodology, a more modest but representative sample that reduces operational complexity, and the integration of qualitative and quantitative methods for event description. The project also weds a diverse research group uniquely qualified to conduct this work, including Mark Lachs (a geriatrician who studies elder abuse), Jeanne Teresi (a statistician, psychometrician and gerontologist with decades of experience in long-term care research), and Karl Pillemer (a sociologist with renowned expertise in nursing home organization and elder abuse). The Long Term Goals of this research are to garner information about RREM that will serve as the basis for interventions that could prevent it, or avert undesirable associated outcomes when it is unavoidable. PUBLIC HEALTH RELEVANCE: This study will examine the frequency and nature of resident to resident elder mistreatment (RREM) in long term care, such as physical and verbal aggressive behavior that occurs between residents. While the problem of staff abuse of residents in long term care has received extensive attention, the problem of resident to resident mistreatment is unstudied. Using residents and staff as reporters, this research will determine how frequently the problem occurs, what the episodes are like, and which residents are most likely to be involved. It is hoped that the research will lead to interventions that can minimize the occurrence of RREM.