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

虐待老年人(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故意行为或不采取行动，从而对老年人造成伤害或造成伤害的风险。EM可能是有意的，也可能是无意的，包括经济剥削、忽视、情感/心理虐待、身体虐待和性虐待。这一点令人担忧，因为在认知正常的老年人中，估计每年有11%的患病率，在患有阿尔茨海默病和阿尔茨海默病相关痴呆的老年人中，年患病率为30%-75%。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、发病率和早期死亡率的风险增加有关。然而，EM很难被检测到，而且经常不被识别。迫切需要有效和高效的EM筛查工具来改进早期发现工作。这项提案将通过采用基于证据的EM筛查工具来满足这一需求，并严格评估其潜在的危害和好处。作为对RFA-AG-22-024的直接响应，我们建议IA阶段研究(R61阶段)将检测筛查工具应用于基于家庭的初级保健-特别强调最近诊断为阿尔茨海默病和阿尔茨海默病相关痴呆AD/ADRD的老年人-初级保健的检测修订(DETECT-RPC)。我们还提出了一项DETECT-RPC的III阶段多点随机(在提供者水平)对照疗效试验(R33阶段)。拟议项目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工具提供的报告指导的潜在影响(混合方法)；(2)调查在以家庭为基础的初级保健环境中识别和报告EM的提供者层面的障碍(定性结构访谈、焦点小组)；以及(3)为以家庭为基础的初级保健(定性结构访谈、焦点小组)采用DETECT筛查工具。拟议项目R33阶段的具体目标是：(1)严格评估DETECT-RPC对研究R61阶段阐明的目标作用机制(即目前识别和报告的障碍)的影响(混合方法)；(2)严格评估DETECT-RPC对临床医生识别和向有关当局报告EM风险增加的老年人的影响(RFA关键问题KQ3)；以及，(3)严格评估使用Detect-RPC(RFA关键问题KQ1和KQ4)进行筛查的好处(即减少遭受虐待和忽视的机会，减少身体或精神疾病的发病率，降低死亡率)和危害(混合方法)。

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).