Characterizing Elder Mistreatment Among Older Adults with Dementia

项目摘要/摘要 这个有指导的研究项目集中在两个紧急的和相关的老年人威胁之间的交集 成年人的健康和安全：阿尔茨海默病和相关痴呆(ADRD)和虐待老年人(EM)。 有认知障碍的老年人虐待老年人(EM)患病率的估计范围为27.5%- 55%。在痴呆症患者(PWD)中EM的高患病率并不令人惊讶，因为许多 EM的危险因素与依赖和照顾有关。然而，后勤和方法 挑战以及与研究残障人士虐待相关的高昂成本导致了 缺乏对这一主题的研究。现有的研究依赖于小规模的横断面研究，并没有 提供了为EM筛查和干预提供基于证据的工具所需的数据 残障人士的人数不断增加。该项目将通过利用现有的大型 加州大学洛杉矶分校阿尔茨海默氏症和痴呆症护理计划(ADC计划)的纵向数据集，以描述 在残疾人群中发现EM现象，并确定可修改的EM危险因素，以便在后续工作中应用 干预的产生、提炼和适应。目标1是专家痴呆症护理的定性研究 专家(DC)在EM方面的经验，以便为目标2中使用的数据抽象工具的修订提供信息。 来自全美16个临床机构的DC组将被进行检查：对EM的看法 频率、严重程度和触发因素；在不同程度的EM患者中识别EM的障碍和促进因素 痴呆症的严重性；以及解决EM的伦理和实践问题。目标2将描述EM类型和 来自ADC程序的定义明确的PWD样本中的频率。为了进行分析，EM数据 将从患者的医疗记录中提取并结合现有的社会人口学和临床 措施。AIM 3将使用相同的ADC计划数据集来表征EM风险和保护因素 用分层Logistic回归模型比较PWD患者/照顾者二人组 有经验的EM给那些没有经验的人。Kristin Lees Haggerty博士，项目主任兼研究员 教育发展中心(EDC)是领导这项工作的理想人选。Lees Haggerty博士有一种 在人口健康和应用心理学方面的学术背景，在老龄化中表现出生产力 研究，以及学术、临床和社区环境中强大的合作者和导师网络。Dr。 Lees Haggerty已经制定了一项全面的培训和指导计划，这将为她成为 致力于改善老年人健康和安全的独立调查人员。培训计划包括 课程工作和体验式学习机会涉及四个关键领域：ADRD研究；临床试验 设计和实施科学；卫生保健政策制定；手稿和拨款写作。这个 跨学科指导团队包括在已确定的培训领域和 指导坚定致力于支持李博士的初级调查人员的丰富经验 哈格蒂发展成为一名独立调查员。

Project Summary/Abstract This mentored research project focuses on the intersection between two urgent and related threats to older adults’ health and safety: Alzheimer’s disease and related dementias (ADRD) and elder mistreatment (EM). Elder mistreatment (EM) prevalence estimates for older adults with cognitive impairment range from 27.5%- 55%. High prevalence of EM among persons with dementia (PWD) is unsurprising considering that many of the risk factors for EM are related to dependency and caregiving. However, logistical and methodological challenges as well as the high costs associated with studying mistreatment among PWD have contributed to a dearth of research on the topic. Existing research has relied on small, cross-sectional studies and have not provided the data required to produce evidence-based tools for EM screening and intervention tailored to the growing population of PWD. This project will fill critical knowledge gaps by leveraging an already existing large longitudinal dataset from UCLA’s Alzheimer’s and Dementia Care Program (ADC Program) to describe the phenomenon of EM and identify modifiable risk factors for EM among PWD that can be applied in subsequent intervention generation, refinement, and adaptation. Aim 1 is a qualitative study of expert dementia care specialists (DCS) experiences with EM to inform revisions to a data abstraction tool used in Aim 2. Focus groups with DCS from 16 clinical settings across the US will be conducted to examine: perspectives on EM frequency, severity, and triggers; barriers and facilitators to identifying EM in patients with varying levels of dementia severity; and ethical and practical implications of addressing EM. Aim 2 will describe EM type and frequencies among a well-defined sample of PWD from the ADC program. To conduct the analyses, EM data will be extracted from patient medical records and combined with existing sociodemographic and clinical measures. Aim 3 will utilize the same ADC program dataset to characterize EM risk and protective factors among patient/caregiver dyads using hierarchical logistic regression modeling comparing PWD who experienced EM to those who did not. Kristin Lees Haggerty, PhD, a Project Director and researcher at Education Development Center (EDC), is in an ideal position to lead this work. Dr. Lees Haggerty has an academic background in population health and applied psychology, demonstrated productivity in aging research, and a strong network of collaborators and mentors in academic, clinical, and community settings. Dr. Lees Haggerty has developed a comprehensive training and mentorship plan that will prepare her to become an independent investigator devoted to improving older adults’ health and safety. The training plan includes course work and experiential learning opportunities addressing four key areas: ADRD research; clinical trial design and implementation science; health care policy making; and manuscript and grant writing. The interdisciplinary mentorship team includes national leaders with expertise in the identified training areas and extensive experience mentoring junior investigators who are strongly committed to supporting Dr. Lees Haggerty’s development into an independent investigator.