Primary Care Clinics for Estimating Prevalence & Incidence of Elder Mistreatment

描述(申请人提供)：虐待老年人(EM)是一个潜在的致命的公共卫生问题，导致人类痛苦和可预防的发病率和死亡率。感染的压疮、尿液灼伤、骨折、抑郁和死亡都是EM可怕后果的例子。与NIA的使命一致，我们打算通过检测和治疗EM来改善老年人的健康和福祉。这项研究的目标是对在5家初级保健诊所就诊的640名老年人进行虐待老年人的筛查。新模式将在患者就诊期间纳入老年人虐待评估仪器，由训练有素的临床医生筛查人员进行管理。当EM筛查呈阳性时，将由专家小组进行验证。此外，我们将探讨在6个月后进行临床随访以检测EM发病率的再次筛查的可行性和可接受性。我们的目标将是1)通过临床医生在社区初级保健诊所使用有效、可靠的工具进行筛查，估计城市社区居住老年人中虐待老年人的流行率；2)通过筛查和临床医生随后的再次筛查，估计六个月内虐待老年人(EM)的发生率；3)在城市社区居住的老年人的大样本中，比较标准化、有效和可靠的工具，即老年人评估工具(EAI-R)和新开发的单一项目筛查问题。横断面研究设计将用于解决第一个特定目标，以估计老年人虐待(EM)的流行率，而前瞻性队列研究设计将用于解决第二个特定目标，以估计EM的六个月发病率。 虐待老年人是一个潜在的致命公共卫生问题，会导致人类痛苦和可预防的发病率和死亡率。受感染的压疮、尿液灼伤、骨折、抑郁和死亡都是虐待老年人造成的可怕后果。这项研究将探索在繁忙的初级保健诊所筛查虐待老年人的患病率和发生率的可行性。我们将制定和测试有效的虐待老年人筛查策略，并在全国范围内复制。

DESCRIPTION (provided by applicant): Elder Mistreatment (EM) is a potentially fatal public health problem that causes human suffering and preventable morbidity and mortality. Infected pressure ulcers, urine burns, fractures, depression and death are examples of the horrific outcomes of EM. Consistent with the mission of NIA, we intend to improve the health and well-being of older adults by detecting and treating EM. The goal of this study is to screen 640 older adults who visit their doctors at 5 primary care clinics for elder mistreatment. The new model will incorporate an elder mistreatment assessment instrument during the patient visit, administered by trained clinician screeners. When EM is screened positive, it will be verified by an expert team. Further, we will explore the feasibility and acceptability of re-screening at 6 months in a follow-up clinic visit to detect incidence of EM. Our aims will be to 1) estimate the prevalence of elder mistreatment in a large urban sample of community-dwelling elderly persons, via screening by clinicians with a valid, reliable instrument in community primary care clinics, 2) estimate the six-month incidence of elder mistreatment (EM), via screening and subsequent re-screening by clinicians, 3) compare a standardized, valid, reliable instrument, the Elder Assessment Instrument (EAI-R), which screens elders for psychological abuse, physical abuse and neglect by caregivers with a newly- developed single-item screening question, in this large sample of urban community-dwelling elderly persons. A cross-sectional study design will be used to address the first specific aim, to estimate the prevalence of elder mistreatment (EM) while a prospective cohort study design will be used to address the second specific aim, to estimate the six-month incidence of EM. Elder mistreatment is a potentially fatal public health problem that causes human suffering and preventable morbidity and mortality. Infected pressure ulcers, excoriations from urine burns, fractures, depression and death are examples of the horrific outcomes of elder mistreatment. This study will explore the feasibility of screening for the prevalence and incidence of elder mistreatment in busy primary care clinics. We will develop and test effective strategies for screening for elder mistreatment that can be replicated nationally.