Uncovering the Causes, Contexts, and Consequences of Elder Mistreatment in People with Dementia

摘要 我们的主要目标是研究人类虐待老年人(EM)的潜在机制 患有阿尔茨海默病和相关痴呆症(ADRD)。应用虐待干预模式，我们将 确定患有ADRD(潜在受害者)的老年人的EM风险和保护因素，ADRD是他们信任的 (潜在犯罪者)及其背景，以便为建立循证风险评估工具提供信息； 为患有ADRD的老年人及其照顾者提供干预、检测/诊断算法和护理计划。 目的1.测量和跟踪ADRD患者及其照顾者的EM危险因素。这个队列(目标 从ADRD特定的临床/研究地点抽取的200个二联体)将被纵向跟踪18个月， 每六个月进行一次评估。EM发病率将在每次评估时由老年人和 主要照顾者自我报告和面试者观察。上门评估还将收集以下数据 易受伤害的老年人的特征、受信任的其他人和背景。调查和观测数据将是 链接到来自临床/研究站点的详细临床数据。如果可能，研究数据也将链接到县 电子健康记录(EHR)，以确定风险和保护因素，并调整混杂变量。 目的2.探索照顾者的经历如何有助于ADRD患者的EM。我们将利用一个 前瞻性研究ADRD患者照料者的混合方法、序贯解释方法 EM的特点和前身。从目标1队列照顾者(目标n=50)的子样本中提取， 受试者将：(1)采用可穿戴技术跟踪他们的活动、心率/心率变异性和睡眠 模式；(2)通过CareMap提供关于他们的社会和工具支持网络的信息；以及(3) 参加一次开放式的面试。这些数据将链接到根据目标1收集的数据，以确定 对可能被发现表现出虐待/疏忽行为的人的影响，为测试做好准备 采取干预措施，提高复原力，增强保护因素，最大限度地减少风险因素。 目的3.确定ADRD患者基于电子健康记录(EHR)的EM指标。电子健康记录 将用于比较被确认为EM患者的ADRD患者与ADRD患者 未报告为EM受害者的患者，使用基于以下条件的一对多倾向评分匹配 人口统计、健康状况和健康服务利用情况。分析将探索使用以下数据的可行性 患者电子病历以区分被虐待和未被滥用的ADRD患者组，包括检查 检查得出的诊断代码(例如，特定的擦伤和损伤)6和实验室标记(例如， 肌酐、淋巴细胞水平)，7作为EM的病原学标志物或指标。 这些目的提供了一种新的方法来识别ADRD患者EM的机制和原因，以帮助 开发风险评估工具和干预措施，以最大限度地减少风险、加强保护和促进复原力。

ABSTRACT Our primary objective is to investigate underlying mechanisms of elder mistreatment (EM) in people with Alzheimer’s Disease and related dementias (ADRD). Applying the Abuse Intervention Model, we will identify EM risk and protective factors among older adults with ADRD (potential victim), their trusted other (potential perpetrator), and their context to inform the creation of evidence-informed risk assessment tools, interventions, detection/diagnosis algorithms, and care plans for older adults with ADRD and their caregivers. Aim 1. Measure EM and track risk factors in people with ADRD and their caregivers. This cohort (target N=200 dyads), drawn from ADRD-specific clinical/research sites, will be tracked longitudinally for 18 months, with assessment every six months. EM incidence will be measured at each assessment by older adult and primary caregiver self-report and interviewer observation. In-home assessments will also collect data on characteristics of the vulnerable older adult, trusted other, and context. Survey and observation data will be linked to detailed clinical data from clinical/research sites. When possible, study data will also be linked to County electronic health records (EHRs) to identify risk and protective factors and adjust for confounding variables. Aim 2. Explore how the caregiver experience contributes to EM in people with ADRD. We will utilize a mixed method, sequential explanatory approach to prospectively study caregivers of people with ADRD to detect characteristics and antecedents of EM. Drawn from a sub-sample of Aim 1 cohort caregivers (target n=50), subjects will: (1) adopt wearable technology to track their activity, heart rate/heart rate variability, and sleeping patterns; (2) provide information about their social and instrumental support network via a CareMap; and (3) engage in an open-ended interview. These data will be linked to data collected under Aim 1 to determine the impact on persons who may be found to exhibit abusive/neglectful behavior, setting the stage for testing interventions to promote resiliency, enhance protective factors, and minimize risk factors. Aim 3. Identify electronic health record (EHR)-based indicators of EM in people with ADRD. EHRs from the County will be used to compare patients with ADRD who are identified as victims of EM with ADRD patients who are not reported as victims of EM, using one-to-many propensity score matching based on demographics, health status, and health service utilization. Analyses will explore the feasibility of using data from patient EHRs to distinguish between the abused and non-abused ADRD patient groups, including examination of exam-derived diagnostic codes (e.g., specific bruises and lesions)6 and laboratory markers (e.g., changes in creatinine, lymphocyte level),7 as pathognomonic markers or indicators of EM. These aims offer a novel approach to identify mechanisms and causes of EM in people with ADRD, to aid in developing risk assessment tools and interventions to minimize risk, enhance protection, and promote resiliency.