Primary Care Screening and Intervention for Elder Neglect in Patients with Dementia: An Evidence-Based Approach

项目总结 本研究的总体目标是：(1)开发一种新的初级保健筛查工具来识别老年人 阿尔茨海默病和相关痴呆患者的忽视(AD/ADRD)和护理要点 对照顾者的技术驱动干预[R61]，以及(2)进行NIH模型III阶段3-ARM随机试验 临床试验，以确定筛查本身和筛查结合干预的影响 与通常的护理相比[R33]。我们正专注于开发针对疏忽的筛查，而不是全部 虐待的类型鉴于忽视在AD/ADRD患者中非常常见，忽视与 在所有虐待类型中，死亡率和发病率最高，并有具体的干预目标。组合 到目前为止，筛查工具设计中所采取的所有类型的虐待都有严重的缺点。它 这使得筛选既耗时又具有挑战性。此外，不同的虐待类型也有很大不同 在不同的老年人群体中发生的现象，在不同的情况下，对 健康，可能需要不同的干预策略。此外，我们的研究团队已经开发出和 研究了针对AD/ADRD照顾者的成功的循证技术干预。我们相信，一个 将这一干预措施调整为忽视照顾者，重点是教育和技能培养以及获取机会 对于资源，可能在减少和防止忽视方面有很大的影响。R61阶段的具体目标 (目标1a)开发一种新的、易于使用的、简短的筛查工具，以查明初级保健中的老年人忽视和 描述该工具的测试特征(KQ3)，(目标1b)通过以下方式开发针对老年人忽视的创新干预 修改非常成功的基于证据的技术驱动的护理干预措施，以及(目标2)试点测试 初级保健中的筛查工具和干预(NIH模型1b阶段)，以评估可行性和可接受性。 在R33阶段，我们将进行一项三组随机对照试验(NIH模型III阶段)来比较：(1) 筛查+干预，(2)仅筛查，(3)常规护理，不筛查。《公约》的具体目标 R33阶段：(目标3)评估老年人疏忽筛查对减少疏忽暴露的影响 (KQ1)和其他患者和照顾者-通过与常规护理进行比较和(目标4)评估重要结果 筛查工具与以技术为基础的照顾者干预相结合对减少暴露于 忽视(KQ5)和其他患者和照顾者--与常规护理和筛查相比重要的结果 没有干预的情况下。在初级保健中使用新的筛查工具进行忽视筛查将产生积极影响 关于结果，包括6个月时忽视发生率的减少以及其他患者和照顾者-重要的 结果(例如，忽视的严重性、疏忽的思维；照顾者的负担)，以及筛查与 以技术为基础的护理干预将比单纯的筛查产生更大的积极影响。我们的长- 学期目标是开发一种AD/ADRD患者忽视的筛查工具，该工具可以整合到初级 CARE，并配以可扩展的干预措施，有足够的证据证明USPSTF认可是合理的。

PROJECT SUMMARY The over-arching aims of this research are to: (1) develop a novel primary care screening tool to identify elder neglect in patients with Alzheimer’s Disease and Related Dementias (AD/ADRD) and a point-of-care technology-driven intervention for caregivers [R61], and (2) conduct a NIH Model Stage III 3-arm randomized clinical trial to determine the impact of both screening itself and screening combined with the intervention compared to usual care [R33]. We are focusing exclusively on developing screening for neglect rather than all types of mistreatment given that neglect is very common in AD/ADRD patients, neglect is associated with the highest mortality and morbidity of all mistreatment types, and specific targets exist for interventions. Combining all types of mistreatment, the approach taken to date in screening tool design, has important disadvantages. It makes screening time-consuming and challenging. Additionally, different mistreatment types are very different phenomena, occur in different groups of older adults under different circumstances, have different impacts on health, and likely require different intervention strategies. Further, our research team has developed and studied a successful, evidence-based technology intervention for AD/ADRD caregivers. We believe that an adaptation of this intervention for caregiver neglect, which focuses on education and skill building and access to resources, may be highly impactful in reducing and preventing neglect. The Specific Aims of the R61 phase are: (Aim 1a) develop a novel, easy-to-use, brief screening tool to identify elder neglect in primary care and describe the tool’s test characteristics (KQ3), (Aim 1b) develop an innovative intervention for elder neglect by modifying a highly successful evidence-based technology-driven caregiving intervention, and (Aim 2) pilot-test the screening tool and intervention in primary care (NIH Model Stage 1b) to assess feasibility and acceptability. In the R33 phase, we will conduct a 3-arm randomized controlled trial (NIH Model Stage III) to compare: (1) screening + intervention, (2) screening only, and (3) usual care without screening. The Specific Aims of the R33 phase are: (Aim 3) evaluate the impact of screening for elder neglect on reduction in neglect exposure (KQ1) and other patient and caregiver-important outcomes by comparing to usual care and (Aim 4) evaluate the impact of screening tool paired with a technology-based caregiver intervention on reduction in exposure to neglect (KQ5) and other patient and caregiver-important outcomes by comparison to usual care and screening without intervention. Neglect screening in primary care with a novel screening tool will have a positive impact on outcomes including decrease in presence of neglect at 6 months and other patient and caregiver-important outcomes (e.g., neglect severity, neglectful ideation; caregiver burden) and that screening paired with a technology-based caregiving intervention will have a greater positive impact than screening alone. Our long- term goal is to develop a screening tool for neglect in AD/ADRD patients that may be integrated into primary care and paired with a scalable intervention with sufficient evidence to justify USPSTF endorsement.