Improving Recognition of Elder Abuse through Analysis of Highly Adjudicated Cases

描述(由申请人提供)：本项目的具体目标是：(1)使用混合方法，全面检查和描述一系列高度判定的身体虐待老年人案件中的常见伤害模式、身体发现和法医生物标记物，(2)进行一项病例对照研究，将这些伤害模式与老年人意外跌倒后遭受的伤害模式进行比较，以及(3)设计临床决策规则，以帮助医疗保健提供者识别虐待受害者。我们将通过与布鲁克林地区检察官办公室虐待老人股(EAU)的独特合作来实现这些目标。布鲁克林高等法院每年成功起诉100多起身体虐待老年人的案件，并保存全面的档案，包括受伤照片、医疗记录、急救人员与受害者和肇事者互动的描述以及法庭文件。我们将仔细审查200份档案，以全面描述伤害模式以及受害者和施虐者的特征。这一创新的设计使用了无可争辩的身体虐待老年人的案例，代表着一项重要的方法进步，因为以前的研究没有充分利用大量具有良好特征的虐待老年人的案例。鉴于与区分虐待老人和意外伤害相关的挑战，我们将把这些病例的结果与一组因意外跌倒而来到急诊科的老年患者进行比较，以确定与虐待有关的伤害模式和生物标志物。最终，我们计划制定一项临床决策规则，帮助医疗保健提供者更有效地筛查虐待老年人的行为。申请者安东尼·罗森博士是一名急诊内科医生，他对急性老年护理表现出了浓厚的研究和临床兴趣。他在老年虐待研究方面与NIH资助的知名研究员马克·拉克斯博士有成功的合作记录，马克·拉克斯博士是老年病学导师和联合研究员。斯蒂芬·哈加滕博士是他的急诊医学导师和合作研究员，是学术急诊医学和暴力预防研究的先驱。在完成流行病学公共卫生硕士学位后，罗森博士已经接受了研究方法和生物统计学方面的培训。他以前是医学生老龄研究培训(MStar)补助金的获得者，并指导过多个MStar学生研究项目。除了他的教职外，罗森博士还将在赠款期间寻求老年急诊医学奖学金，以增加他在照顾老年人方面的专业知识。在R03提供的支持下，建议的研究可以在两年内完成，特别是因为，通过他所在机构的资助，Rosen博士已经获得了75%的时间的工资支持，从而避免了临床责任，并且NIA获得的所有资金将专门用于支持这项研究。这项建议的长期目标是制定、实施和评估全面的战略，以改进医疗保健提供者对虐待老年人的识别和预防，并启动一名有前途的初级调查员的学术生涯。

DESCRIPTION (provided by applicant): The specific aims for this project are: (1) to comprehensively examine and describe common injury patterns, physical findings, and forensic biomarkers in a series of highly adjudicated cases of physical elder abuse using a mixed methods approach, (2) to conduct a case-control study comparing these injury patterns to those sustained by older adults after an accidental fall, and (3) to design a clinical decision rule to assist health care providers in identifying abuse victims. We will achieve these aims through a unique collaboration with the Elder Abuse Unit (EAU) of the Brooklyn District Attorney's Office. The Brooklyn EAU successfully prosecutes more than 100 cases of physical elder abuse annually and maintains comprehensive files including photographs of injuries, medical records, description of first responder interactions with victim and perpetrator, and court documents. We will closely examine 200 files to comprehensively describe injury patterns as well as characteristics of victims and abusers. This innovative design, using cases of indisputable physical elder abuse, represents an important methodologic advance, as previous research has suffered from insufficient access to a large number of well-characterized elder abuse cases. Given the challenges associated with differentiating elder abuse from accidental injury, we will compare results from these cases to a control group of geriatric patients presenting to the emergency department with accidental falls to identify injury patterns and biomarkers associated with abuse. Ultimately, we plan to derive a clinical decision rule that will assist health care providers in more effectively screening for elder abuse. The applicant, Dr. Anthony Rosen, is an Emergency Medicine physician who has demonstrated significant research and clinical interest in acute geriatric care. He has a successful track record of collaboration in elder maltreatment research with Dr. Mark Lachs, an established NIH-funded researcher, who serves as Geriatrics mentor and co-investigator. Dr. Stephen Hargarten, his Emergency Medicine mentor and a co-investigator, is a pioneer in academic Emergency Medicine and violence prevention research. Having completed an MPH in epidemiology, Dr. Rosen is already trained in research methods and biostatistics. He is a former recipient of the Medical Student Training in Aging Research (MSTAR) grant and has mentored multiple MSTAR student research projects. In addition to his faculty appointment, Dr. Rosen will pursue a Geriatric Emergency Medicine fellowship during the grant period to increase his expertise in caring for older adults. The study proposed can be feasibly completed in two years with the support provided through this R03, particularly because, through funding from his institution, Dr. Rosen will already have salary support for 75% time protected from clinical responsibilities, and all NIA funds awarded will be allocated exclusively to support this research. The long-term goal of this proposal is to develop, implement, and evaluate comprehensive strategies to improve identification and prevention of elder abuse by health care providers and to launch the academic career of a promising junior investigator.