Detection of Elder abuse Through Emergency Care Technicians (DETECT)

项目摘要 虐待老年人(EM)通常被定义为照顾者或其他人在照顾者或其他人的故意行为或不采取行动 包括对老年人造成伤害或产生伤害风险的信任期望的关系。EM包括 经济虐待/剥削、忽视、情感/心理虐待、身体虐待和性虐待。暴露在危险中往往是 慢性的，通常涉及多种形式的虐待。这令人担忧，因为据估计，每年有11%的人 在认知正常的成年人中患病率更高，痴呆症患者的患病率更高。此外，新兴市场与增加的 身体受伤、住院、急诊室就诊、心理困扰、发病率和早期死亡的风险。 然而，EM很难被检测到，而且经常不被识别。有效和高效的EM筛查工具是 迫切需要改进早期发现工作。我们将收集所需的数据来确定敏感性和 检测工具的特异性，这是一种专门设计用于帮助医务人员识别潜在EM的筛查工具 社区。我们建议的方法包括对年龄较大的老年人进行随机抽样的面对面跟踪评估 使用DETECT对成年人进行筛查(N=2500名参与者)。我们将进行简短的能力评估和后续行动 初检筛查后1个月进行评估。这项评估将包括有效的情绪测量， 身体虐待、性虐待、忽视、经济剥削和多人受害。它还将包括经过验证的措施 23拟议项目的具体目标是： 目标1：验证一种创新的EM筛查工具(DETECT)。我们会将检测筛查结果与 专家领导小组确定计算每个筛查项目的诊断性能的“黄金标准”，以及所有 集体筛选项目。这一验证检测的综合方法将提供所需的经验 为其更广泛的实施奠定了基础。 目标2：通过系统化的项目缩减来优化检测工具。我们将使用验证性因素分析来 确定每个检测项目的相对预测值。结果将为系统的项目减少工作提供信息， 精简工具，以实现最佳效率的管理。 目标3：确定EM的风险和保护因素。后续面谈将提供丰富的背景数据， 强调可修改的个人和背景因素(例如，以前的EM和/或多人受害、社会支持、未满足 健康和日常生活需要、经济问题和精神因素)。拟议研究的样本量大 (n=2,500)将提供一个前所未有的机会来检验新兴市场的预测因素。

Project Summary 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 includes financial abuse/exploitation, neglect, emotional/psychological abuse, physical abuse, and sexual abuse. Exposure is often chronic, and commonly involves multiple forms of abuse. This is concerning as there is an estimated 11% annual prevalence among cognitively intact adults, and higher amongst those with dementia. Further, EM is linked with increased risk of physical injury, hospitalization, 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. We will gather the data required to determine the sensitivity and specificity of the DETECT tool, a screening tool designed specifically to help medics identify potential EM occurring in the community. Our proposed methodology includes in-person follow-up assessments with a random sample of older adults screened using DETECT (N = 2,500 total participants). We will conduct a brief capacity assessment and follow-up assessment 1 month after the original DETECT screening. This assessment will include validated measures of emotional, physical, and sexual abuse, neglect, financial exploitation, and poly-victimization. It will also include validated measures of other potentially modifiable risk and protective factors.23 The specific aims of the proposed project are: AIM 1: Validation of an innovative EM screening tool (DETECT). We will match DETECT screening results with an expert LEAD panel determination “gold standard” to calculate diagnostic performance for each screening item, and all screening items collectively. This comprehensive approach to validating DETECT will provide the needed empirical foundation for its broader implementation. AIM 2: Optimizing the DETECT Tool Via Systematic Item Reduction. We will use confirmatory factor analysis to determine the relative predictive value of each DETECT item. Results will inform systematic item reduction efforts, streamlining the tool for optimally efficient administration. AIM 3: Identify risk and protective factors for EM. Follow-up in-person interviews will provide rich contextual data that highlight modifiable personal and contextual factors (e.g., previous EM and/or polyvictimization, social support, unmet health and daily living needs, financial problems, and mental factors). The large sample size of the proposed study (N=2,500) will permit an unprecedented opportunity to examine predictors of EM.