Detection of Elder mistreatment Through Emergency Care Technicians - Revised for Primary Care (DETECT-RPC)

老年人虐待（EM）通常被定义为照顾者或另一个人在涉及信任预期的关系中造成伤害或造成伤害风险的故意行为或未采取行动。EM可能是有意或无意的，包括经济剥削、忽视、情感/心理虐待、身体虐待和性虐待。这是令人担忧的，因为在认知完整的老年人中，估计每年有11%的患病率，在老年痴呆症和阿尔茨海默病相关的痴呆症AD/ADRD中，每年有30-75%的患病率。此外，EM与生活质量差、财产和安全损失、身体伤害、住院、急诊室就诊、心理困扰、发病率和早期死亡的风险增加有关。然而，电磁很难被检测到，而且经常无法被识别。迫切需要有效和高效的电磁筛查工具来改善早期检测工作。该提案将通过采用基于证据的EM筛查工具用于家庭初级保健，并严格评估其潜在的危害和益处，来解决这一需求。为了直接响应RFA-AG-22-024，我们建议进行IA期研究（R61期），以适应家庭基础初级保健的DETECT筛查工具-特别强调最近被诊断患有阿尔茨海默病和阿尔茨海默病相关痴呆AD/ADRD的老年人-初级保健的DETECT修订（DETECT- rpc）。我们还建议进行DETECT-RPC的III期多站点随机（在提供者水平）对照疗效试验（R33期）。拟议项目的R61阶段的具体目标是：(1)评估特定州的法律和特定地点的政策对将由DETECT-PRC工具（混合方法）提供的报告指南的潜在影响；(2)调查在以家庭为基础的初级保健环境中，提供者层面识别和报告EM的障碍（定性结构化访谈，焦点小组）；(3)将DETECT筛查工具应用于家庭初级保健（定性结构化访谈，焦点小组）。拟议项目的R33阶段的具体目标是：(1)严格评估DETECT-RPC对研究R61阶段（混合方法）中阐明的目标作用机制（即当前识别和报告的障碍）的影响；(2)严格评估DETECT-RPC对临床医生识别和向有关部门报告EM风险增加的老年人的影响（RFA关键问题KQ3）；(3)严格评估DETECT-RPC筛查（RFA关键问题KQ1和KQ4）（混合方法）的益处（即减少暴露于虐待和忽视，减少身体或精神发病率，降低死亡率）和危害。

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 may be intentional or unintentional and includes financial exploitation, neglect, emotional/psychological abuse, physical abuse, and sexual abuse. This is concerning as there is an estimated 11% annual prevalence among cognitively intact older adults, and a 30-75% annual prevalence among older adults with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD. Further, EM is linked with increased risk of poor quality of life, loss of property and security, physical injury, hospitalizations, 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. This proposal will address this need by adapting an evidence-based EM screening tool for home-based primary care and rigorously evaluating its potential harms and benefits. In direct response to RFA-AG-22-024, we propose stage IA research (R61 phase) to adapt the DETECT screening tool for home-based primary care — with special emphasis on older adults who were recently diagnosed with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD — The DETECT Revision for Primary Care (DETECT-RPC). We also propose a stage III multi-site randomized (at the provider level) controlled efficacy trial (R33 phase) of DETECT-RPC. The specific aims of the R61 phase of the proposed project are: (1) Evaluate the potential impact of state-specific laws and site-specific policies on the reporting guidance that will be provided by the DETECT-PRC tool (mixed-methods); (2) Investigate provider-level barriers to recognizing and reporting EM in home-based primary care environments (qualitative - structured interviews, focus groups); and, (3) Adapt the DETECT screening tool for home-based primary care (qualitative - structured interviews, focus groups). The specific aims of the R33 phase of the proposed project are: (1) Rigorously evaluate the effect of DETECT-RPC on targeted mechanisms of action (i.e., current barriers to identification and reporting) elucidated in the R61 phase of the study (mixed-methods); (2) Rigorously evaluate the impact of DETECT-RPC on clinician identification and reporting of older adults with increased risk of EM to the appropriate authorities (RFA key question KQ3); and, (3) Rigorously evaluate the benefits (i.e., reduce exposure to abuse and neglect, reduced physical or mental morbidity, and reduced mortality) and harms of screening with DETECT-RPC (RFA key questions KQ1 and KQ4) (mixed-methods).