Resident To Resident Elder Mistreatment (RREM) in Long Term Care

描述(由申请人提供)：这项研究的具体目的是(1)利用从居民、工作人员和事件报告中获得的信息，改进长期护理机构中居民对居民虐待老年人(RREM)案例的识别方法；(2)在10个具有代表性的长期护理机构样本中进行第一次系统的RREM患病率研究；以及(3)从临床、功能和其他特征以及发生REM事件的环境和情景背景方面描述RREM的受害者和肇事者。在本研究中，我们将RREM定义为长期护理居民之间消极和攻击性的身体、性或言语互动，在社区环境中，这种互动很可能被解释为不受欢迎，并有很高的可能性导致身体或心理痛苦。我们假设，RREM是普遍存在的，并与各种主题、环境和设施特征有关，如性别、一天中的时间和痴呆症病房的居住地。在对结合了“人际攻击”和“养老院行为障碍研究”的最佳方法开发的工具进行最终测试后(特定目标1)，将对具有代表性的设施样本进行患病率研究，并估计调整后的设施和整个研究范围的RREM流行率(特定目标2)。最后，将定性和定量地审查RREM主体、肇事者和事件的特征(具体目标3)。这一修订的改进包括：(1)改进和澄清病例发现方法；(2)更清楚地阐明与具体假设相联系的分析战略；(3)大大改进对参与设施的保障措施，其中一些设施已经招募(见设施和纽约州卫生部的支持函)。其他试点研究表明，驻地工作人员参与率高，工作人员普遍熟悉RREM，以及适用于RREM工作人员实时识别的新方法(“轮班优惠券”技术)的可行性。这项工作的优点包括其具有前瞻性的案例发现方法，一个更温和但具有代表性的样本，可降低操作复杂性，以及将定性和定量方法结合起来进行事件描述。该项目还结合了一个独特的有资格进行这项工作的多样化研究小组，其中包括马克·拉克斯(Mark Laches)(研究虐待老年人的老年病学家)、珍妮·特雷西(Jeanne Teresi)(统计学家、心理测量学家和老年病学家，在长期护理研究方面有数十年的经验)，以及卡尔·皮勒默(Karl Pillemer)(社会学家，在养老院组织和虐待老年人方面拥有著名的专业知识)。这项研究的长期目标是获得有关RREM的信息，这些信息将作为预防RREM的干预措施的基础，或者在不可避免的情况下避免不良的相关结果。公共卫生相关性：这项研究将调查长期护理中居民对居民老年人虐待(RREM)的频率和性质，例如发生在居民之间的身体和言语攻击行为。虽然长期护理中住院医生虐待工作人员的问题已经得到了广泛的关注，但住院医生对住院医生的虐待问题还没有得到研究。这项研究将利用居民和工作人员作为记者，确定问题发生的频率、事件的性质以及最有可能涉及的居民。希望这项研究将导致可将RREM的发生降至最低的干预措施。

DESCRIPTION (provided by applicant): The specific aims of this research are (1) To refine methodology for identifying cases of resident-to-resident elder mistreatment (RREM) in long-term care facilities using triangulation methodology that derives information from resident, staff, and incident reports; (2) To conduct the first systematic prevalence study of RREM in a representative sample of 10 long-term care facilities; and (3) To describe the victims and perpetrators of RREM with respect to clinical, functional, and other characteristics and the environmental and situational contexts in which RREM episodes occur. For the purpose of this study, we define RREM as negative and aggressive physical, sexual, or verbal interactions between long-term care residents, that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress. We hypothesize that RREM is prevalent and associated with a variety of subject, environmental, and facility characteristics, such as gender, time of day, and residence on a dementia unit. After final testing of an instrument that was developed by marrying the best methodologies from "interpersonal aggression" and "nursing home behavioral disturbance research" (Specific Aim 1), a prevalence study in a representative sample of facilities will be conducted and an adjusted facility and study-wide RREM prevalence estimated (Specific Aim 2). Finally, the characteristics of RREM subjects, perpetrators, and events will be examined both qualitatively and quantitatively (Specific Aim 3). Enhancements in this revision include (1) improvement and clarification of the case finding methodology, (2) clearer articulation of the analytic strategy which is linked to specific hypotheses, and (3) substantially improved safeguards for participating facilities, some of which have already been recruited (see letters of support from the facilities and the New York State Department of Health). Additional pilot studies demonstrate high resident participation rates, widespread staff familiarity with RREM, and the feasibility of a novel method adapted for staff identification of RREM in real time (the "shift coupon" technique). Strengths of this work include its prospective case finding methodology, a more modest but representative sample that reduces operational complexity, and the integration of qualitative and quantitative methods for event description. The project also weds a diverse research group uniquely qualified to conduct this work, including Mark Lachs (a geriatrician who studies elder abuse), Jeanne Teresi (a statistician, psychometrician and gerontologist with decades of experience in long-term care research), and Karl Pillemer (a sociologist with renowned expertise in nursing home organization and elder abuse). The Long Term Goals of this research are to garner information about RREM that will serve as the basis for interventions that could prevent it, or avert undesirable associated outcomes when it is unavoidable. PUBLIC HEALTH RELEVANCE: This study will examine the frequency and nature of resident to resident elder mistreatment (RREM) in long term care, such as physical and verbal aggressive behavior that occurs between residents. While the problem of staff abuse of residents in long term care has received extensive attention, the problem of resident to resident mistreatment is unstudied. Using residents and staff as reporters, this research will determine how frequently the problem occurs, what the episodes are like, and which residents are most likely to be involved. It is hoped that the research will lead to interventions that can minimize the occurrence of RREM.