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

痴呆症患者忽视老年人的初级保健筛查和干预：循证方法

• 批准号: 10705301
• 负责人: MARK STEVEN LACHS
• 金额: $ 69.26万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705301
• 关键词: Address; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Caregiver Burden; Caregiver support; Caregivers; Cellular Phone; Characteristics; Clinical; Cognitive; Consumption; Dementia; Disadvantaged; Education; Elder Abuse; Elderly; Equilibrium; Exposure to; Focus Groups; Goals; Health; Health Personnel; Intervention; Interview; Knowledge; Measures; Modeling; Morbidity - disease rate; Outcome; Patients; Phase; Point of Care Technology; Population; Primary Care; Process; Provider; Randomized, Controlled Trials; Research; Resources; Risk; Screening procedure; Sensitivity and Specificity; Severities; Tablets; Technology; Testing; Training; United States National Institutes of Health; United States Preventative Services Task Force; Vulnerable Populations; acceptability and feasibility; arm; brief screening; caregiver interventions; caregiving; comparison intervention; data registry; design; elder neglect; evidence base; handheld mobile device; ideation; implementation tool; improved; innovation; maltreatment; mortality; neglect; novel; pilot test; point of care; prevent; primary care provider; protocol development; randomized, clinical trials; screening; screening guidelines; skills; standard measure; tool; treatment as usual; tv watching; usability

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.

项目摘要 本研究的主要目的是：（1）开发一种新的初级保健筛查工具，以识别老年人 阿尔茨海默病和相关痴呆（AD/ADRD）患者的忽视和护理点 技术驱动的护理人员干预[R61]，和（2）进行NIH模型III期3组随机 临床试验，以确定筛查本身和筛查与干预相结合的影响 与常规护理相比[R33]。我们只专注于发展忽视筛查，而不是所有 由于忽视在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，有具体的干预目标。结合 迄今为止在筛选工具设计中采用的所有类型的虐待方法都具有重要的缺点。它 使得筛查既耗时又具有挑战性。此外，不同的虐待类型是非常不同的， 不同的老年人群体在不同的情况下发生的现象， 健康，可能需要不同的干预策略。此外，我们的研究团队还开发了 研究了AD/ADRD护理人员成功的循证技术干预。我们相信一个 针对照顾者忽视问题调整这一干预措施，重点是教育和技能建设以及获得 对资源而言，这可能对减少和防止忽视具有很大影响。R61阶段的具体目标 （目标1a）开发一种新的、易于使用的、简单的筛查工具，以识别基层护理中忽视老人的情况， 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措施 修改一个非常成功的循证技术驱动的干预措施，以及（目标2）试点测试 初级保健中的筛查工具和干预（NIH模型阶段1b），以评估可行性和可接受性。 在R33阶段，我们将进行一项3组随机对照试验（NIH模型III期），以比较：（1） 筛查+干预，（2）仅筛查，和（3）常规护理而不进行筛查。的具体目标 R33阶段是：（目的3）评估老年忽视筛查对减少忽视暴露的影响 (KQ1)和其他患者和其他重要的结果，通过与常规护理进行比较，并（目的4）评估 筛查工具与基于技术的护理人员干预相结合对减少暴露的影响 与常规护理和筛查相比，忽视（KQ 5）以及其他对患者和护理人员重要的结果 没有干预。在初级保健中使用新型筛查工具进行新生儿筛查将产生积极影响 结果包括6个月时忽视的减少以及其他患者和其他重要事件 结果（例如，忽视严重程度，忽视的想法;照顾者负担）和筛选配对， 以技术为基础的预防干预将比单纯的筛查产生更大的积极影响。我们长久以来- 长期目标是开发一种筛查AD/ADRD患者忽视的工具， 护理，并与有足够证据证明USPSTF认可的可扩展干预相结合。