Identifying Injury Patterns and Forensic Biomarkers Diagnostic of Physical Elder Abuse

识别老年人身体虐待的伤害模式和法医生物标志物诊断

• 批准号: 9230105
• 负责人: Anthony Rosen
• 金额: $ 17.13万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9230105
• 关键词: Accident and Emergency department; Accidental Falls; Accidental Injury; Accidents; Acute; Address; Adult; Aging; Area; Award; Biological Markers; Biometry; Caring; Center for Translational Science Activities; Characteristics; Child Abuse; Classification; Clinical; Clinical Research; Clinical Sciences; Cognitive; Collaborations; Contusions; Core Facility; Criminal Justice; Data; Detection; Development; Diagnosis; Documentation; Educational workshop; Elder Abuse; Elder abuse prevention; Elderly; Emergency Department evaluation; Emergency Department-based Intervention; Emergency Medicine; Emergency medical service; Enrollment; Environment; Epidemiologic Methods; Epidemiology; Face; Fall injury; Family; Fellowship; Forearm Injuries; Forensic Medicine; Forensic Sciences; Foundations; Fracture; Funding; Geriatrics; Goals; Government Agencies; Grant; Health; Health Care Costs; Health Personnel; Health system; Housing; Image; Injury; Intervention; Interview; Justice; Knowledge; Laboratories; Leadership; Left; Legal; Link; Lower Extremity; Medical; Mental Health; Mentors; Mentorship; Neck; New York City; Nurses; Outcome; Participant; Patients; Pattern; Photography; Physical Examination; Physicians; Physiological; Policy Making; Positioning Attribute; Presbyterian Church; Prevention Research; Preventive Intervention; Protocols documentation; Radiology Specialty; Recruitment Activity; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Resources; Science Policy; Scientist; Series; Services; System; Testing; Time; Training; Vulnerable Populations; Work; Writing; abuse victim; adjudicate; authority; base; career; career development; cohort; design; diagnostic biomarker; elder neglect; evidence base; experience; falls; improved; injured; injury prevention; innovation; interest; leadership development; legal cases; medical schools; novel; physical abuse; psychosocial; research and development; skills; social; success

PROJECT SUMMARY/ABSTRACT The over-arching aims of this Beeson K76 application are to identify injury patterns and forensic biomarkers diagnostic of physical elder abuse and launch the academic career of a very promising junior investigator. Candidate: The applicant, Dr. Anthony Rosen, is an Emergency Medicine physician at Weill Cornell Medical College (WCMC) who has demonstrated significant research ability and clinical interest in elder abuse and acute geriatric care. He is the recipient of an NIA GEMSSTAR award, where he partnered with prosecutors' offices to examine legal case files to describe intriguing patterns of injury in the largest retrospective series of highly adjudicated elder abuse cases ever examined. To conduct this work, Dr. Rosen and colleagues developed a comprehensive classification system for acute geriatric injuries and a protocol for standardized photography of acute injuries. Dr. Rosen's work has begun to be recognized nationally, as he was an invited participant in the 2015 White House Elder Justice Forum and presented at NIH's recent elder abuse workshop. He has also pursued a clinical fellowship in Geriatric Emergency Medicine. Dr. Rosen is already trained in research methods and biostatistics, having completed an MPH in epidemiology. Dr. Rosen's long-term career goals are to improve protection of vulnerable older adults through identification, intervention, and prevention of elder abuse and neglect and become an independent researcher and academic leader in elder abuse and geriatric injury prevention research. He has identified four specific areas where he will benefit from additional critical training during the Beeson Award period: forensic sciences, policy-making, independent grant writing, and leadership skills. For each, in collaboration with his mentors, he has taken advantage of institutional, local, and national didactic resources and opportunities to create an ambitious plan to provide this training and experience. The Beeson K76 award will allow Dr. Rosen to develop these skills, complete the important project he proposes, and continue his promising academic career and leadership development. Mentors/Environment: Dr. Rosen has engaged an extraordinarily strong, committed mentorship team with deep knowledge of elder abuse research and extensive experience in mentoring junior researchers to independence. Dr. Rosen has worked closely for 9 years with his primary mentor, Dr. Mark Lachs, the Chief of Geriatrics for WCMC and the entire NewYork-Presbyterian Health System (NYPHS), who has led multiple R01-funded elder abuse research projects. He has also worked extensively with co-mentor Dr. Karl Pillemer, a leading social scientist in elder abuse research for nearly 30 years. Co-mentor Dr. Terry Fulmer, president of the John A. Hartford Foundation, is a leading nurse researcher with experience prospectively recruiting elder abuse victims from the Emergency Department and has provided pilot data which informs this proposal. Dr. Rosen has also assembled a diverse team of expert collaborators from criminal justice, policy-making, government agencies, injury prevention, and epidemiology methods. The WCMC Division of Emergency Medicine is committed to Dr. Rosen's success and will provide protected time and resources. In addition, WCMC provides a rich and supportive research and career development environment, which includes the Clinical and Translational Science Center, the Clinical Research Methodology Core Facility, and training courses / seminars in biomedical grant writing, transitioning to research independence, and leadership. Research: The over-arching aim and long-term goal of Dr. Rosen's research is to: identify injury patterns and forensic biomarkers diagnostic of physical elder abuse. The Specific Aims of this proposal are: (1) to identify injury patterns, physical findings, and other characteristics associated with elder physical abuse by comparing prospectively enrolled victims in comparison with geriatric patients presenting to the ED with accidental falls, (2) to identify laboratory and radiographic results associated with physical elder abuse in comparison with accidental fall injury patients, and (3) to derive a clinical prediction rule (CPR) to assist busy health care providers in more effectively identifying physical elder abuse, an under-recognized phenomenon. By enrolling prospectively and evaluating comprehensively physical abuse victims in the ED, the proposed project addresses the major methodologic limitations in Dr. Rosen's prior work, the quality and completeness of information in legal files, which were not gathered for research, and the lack of ancillary neuro-cognitive, radiographic, and laboratory testing on victims. Developing a CPR will dramatically increase the utility of the findings for busy clinicians. Subjects will be identified and recruited through partnerships with the New York City Elder Abuse Center (NYCEAC), the New York City Department for the Aging, Adult Protective Services, prosecutors' offices, and Emergency Medical Services, as well as through ED evaluation. In addition to study enrollment, victims will be assessed and treated by a first-of-its-kind, ED-based multi-disciplinary Vulnerable Elder Protection Team designed by Dr. Rosen and colleagues. He and this team are uniquely able and ideally positioned to conduct this research because of the size and reach of the NYPHS, their leadership in the NYEAC, and their long-term collaboration with agencies serving elder abuse victims locally. This innovative project is likely to greatly improve the ability of health care providers to identify victims of physical elder abuse, who are among the most vulnerable older adults. The long-term goal of this Beeson proposal is to improve protection of these victims and to launch Dr. Rosen's promising research, academic, and leadership career.

项目摘要/摘要 Beeson K76应用程序的总体目标是识别损伤模式和法医生物标志物 对身体虐待老年人的诊断，并开始一个非常有前途的初级调查员的学术生涯。 应聘者：申请者安东尼·罗森博士是威尔·康奈尔医疗中心的急诊医生 大学(WCMC)对虐待老人和虐待老人表现出显著的研究能力和临床兴趣 急性老年护理。他是NIA GEMSSTAR奖的获得者，在那里他与检察官合作 办公室审查法律案件档案，以描述最大的回顾系列中耐人寻味的伤害模式 经过高度裁决的虐待老人案件。为了进行这项工作，罗森博士和他的同事 制定了急性老年性损伤的全面分类系统和标准化方案 急性损伤的摄影。罗森博士的工作已经开始在全国范围内得到认可，因为他被邀请 参加了2015年白宫老年人正义论坛，并在NIH最近的虐待老年人研讨会上发表了演讲。 他还在老年急诊医学方面获得了临床研究员资格。罗森博士已经接受了 研究方法和生物统计学，完成流行病学硕士学位。罗森博士的长期职业生涯 目标是通过识别、干预和预防 成为虐待和忽视老年人问题的独立研究人员和学术领袖 老年伤害预防研究。他已经确定了四个具体的领域，他将从额外的 比森奖期间的关键培训：法医科学、政策制定、独立拨款撰写、 和领导才能。对于每个人，在与导师的合作下，他都利用了机构的、当地的、 和国家教育资源和机会，以创建一个雄心勃勃的计划，提供这种培训和 经验。Beeson K76奖将允许Rosen博士发展这些技能，完成重要的项目 他提出建议，并继续他充满希望的学术生涯和领导力发展。 导师/环境：罗森博士聘请了一支非常强大、专注的导师团队， 对虐待老年人的研究有深入的了解，并有指导初级研究人员 独立。罗森博士与他的主要导师马克·拉克斯博士密切合作了9年，马克·拉克斯博士是 WCMC和整个纽约长老会卫生系统(NYPHS)的老年医学，他领导了多个 R01资助的虐待老人研究项目。他还与共同导师卡尔·皮莱默博士进行了广泛的合作 在虐待老人研究领域领先社会科学家近30年。共同导师特里·富尔默博士，总裁 约翰·A·哈特福德基金会是一位领先的护士研究员，具有招聘老年人的经验 来自急诊部的虐待受害者，并提供了试点数据，为这一建议提供了信息。Dr。 罗森还组建了一支由刑事司法、政策制定、 政府机构、伤害预防和流行病学方法。WCMC急诊部 医学致力于罗森博士的成功，并将提供受保护的时间和资源。此外, WCMC提供了丰富和支持性的研究和职业发展环境，其中包括 临床和翻译科学中心，临床研究方法核心设施和培训 生物医学基金撰写、向研究独立性过渡和领导力方面的课程/研讨会。 研究：罗森博士研究的总体目标和长期目标是：确定损伤模式和 物理性虐待老年人的法医生物标志物诊断。这项建议的具体目的是：(1)确定 通过比较与老年人身体虐待相关的伤害模式、身体发现和其他特征 与因意外跌倒而到急诊室就诊的老年患者进行比较， (2)确定与身体虐待老年人有关的实验室和放射检查结果，并与 意外坠落伤患者，以及(3)推导临床预测规则(CPR)以帮助繁忙的医疗保健 在更有效地识别身体虐待老年人这一未得到充分认识的现象方面，这是一种被忽视的现象。通过注册 前瞻及全面评估教育署的身体虐待受害人，建议的计划 解决了罗森博士先前工作中的主要方法论限制，质量和完整性 没有收集用于研究的法律文件中的信息，以及缺乏辅助神经认知， 对受害者进行放射检查和实验室检测。开发心肺复苏术将极大地提高 忙碌的临床医生的发现。受试者将通过与纽约大学的合作伙伴关系来确定和招募 城市老年人虐待中心(NYCEAC)，纽约市老龄，成人保护服务部， 检察官办公室、紧急医疗服务以及通过教育部门的评估。除了学习之外 受害者将接受首创的、以ED为基础的多学科弱势群体的评估和治疗 由罗森博士和他的同事设计的老年人保护团队。他和这支球队是独一无二的能干和理想的 由于NYPHS的规模和覆盖范围，他们在 NYEAC，以及他们与为当地虐待老年人提供服务的机构的长期合作。这是一项创新 该项目可能会极大地提高医疗保健提供者识别身体虐待老年人的受害者的能力， 他们是最脆弱的老年人之一。这项比森提案的长期目标是改进 保护这些受害者，并开启罗森博士充满希望的研究、学术和领导生涯。