Risk Screening & Primary Prevention of Elder Abuse in People Living with Dementia

摘要 虐待老年人(EM)对十分之一的美国老年人有深远的影响，老年人虐待的比率是最高的之一 痴呆症患者(PLWD)。家庭照顾者最常造成这种伤害，通常 对他们的行为感到懊悔。这项提议将通过一种新的方法来解决这个社会问题， 确定初级保健医疗诊所的护理伙伴/护理者(CPG)，无论他们是为自己而来 或者是PLWD的关心。在项目的R61阶段，我们将开发和测试证据的可行性- 基于初级保健诊所用于筛查PLWD CPG的简要风险评估筛查(RAS)。A 3- 将开发组件干预并进行可行性测试。第一部分将指导中央人民政府在 诊所访问专门设计的网站，让他们参与以解决方案为重点的战略。第二 组件将提供1-3个家庭或技术辅助访问，由护理导航员提供人员- 提供集中指导，促进有效的照护策略，并提醒CPG注意EM的风险。第三个组成部分 将教育临床护理团队在诊所访问期间直接与中央人民政府解决护理需求，并 在2个月内安排一次跟踪访问，以监测变化。我们将开发一个成果工具，其中包括 CPG已知与EM相关的可修改风险因素的有效测量汇编， 将用于衡量新兴市场风险随时间的变化。在项目的R33阶段，研究团队将 进行整群随机对照试验，以测试RAS和三组分的有效性 干预。洛杉矶县的初级保健诊所将被随机分配到三个研究部门之一： 对照、仅RAS或RAS加干预。分析将评估筛查和干预的影响 关于参与者患EM的风险水平，以及CPG和PLWD水平的其他结果。另外， 将评估RAS和/或干预的潜在危害。最后，我们将生成探索性的 定性数据，以提高我们对风险和变化机制的理解，这些变化可能由我们的 RAS的应用和干预。

ABSTRACT Elder mistreatment (EM) has profound effects on 1 in 10 older Americans, and rates are amongst the highest for people living with dementia (PLWD). Family caregivers most frequently inflict this harm and are typically remorseful for their behavior. This proposal will address this societal problem through a novel approach that identifies care partners/caregivers (CPG) at primary care medical clinics, whether they are there for their own care or that of the PLWD. During the project’s R61 phase, we will develop and test the feasibility of an evidence- based brief Risk Assessment Screen (RAS) for use in primary care clinics to screen CPGs of PLWD. A 3- component intervention will be developed and feasibility-tested. The first component will direct the CPG during the clinic visit to a website specifically designed to engage them in solution-focused strategies. The second component will provide 1-3 home or technology-assisted visits with a care navigator who provides person- centered guidance to facilitate effective caregiving strategies and alerts CPGs to risks of EM. A third component will educate the clinical care team to address caregiving needs directly with the CPG during the clinic visit and schedule a follow-up visit within 2 months to monitor for change. We will develop an Outcome Tool that includes a compilation of validated measures of modifiable risk factors known to be associated with EM by CPGs which will be used to measure change in risk of EM over time. During the project’s R33 phase, the research team will conduct a cluster randomized controlled trial to test the effectiveness of the RAS and the 3-component intervention. Primary care clinics across Los Angeles County will be randomized to one of the three study arms: control, RAS only, or RAS plus intervention. Analyses will assess the impact of screening and the intervention on participants’ level of risk of EM, as well as other outcomes at the level of the CPG and the PLWD. Additionally, potential harms from the RAS and/or the intervention will be assessed. Finally, we will generate exploratory qualitative data to improve our understanding of the mechanisms of risk and change that may result from our application of the RAS and the intervention.