Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas.
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
JAMA Netw Open. 2020 May 1;3(5):e204099. doi: 10.1001/jamanetworkopen.2020.4099.
Elder mistreatment is underdetected and underreported. The more than 800 000 medics providing services in every county in the United States represent an important and underused surveillance system.
To investigate the association between the Detection of Elder Mistreatment Through Emergency Care Technician (DETECT) screening tool use and the number of medic reports made to Adult Protective Services (APS) over a period of approximately 3 years.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used a difference in difference in differences design and included adults aged 65 years and older who were reported to Texas APS in the study region (246 cities in Denton, Johnson, and Tarrant Counties) between December 31, 2014, and February 28, 2018.
The DETECT screening tool.
Reports to APS.
The mean (SD) age of the 11 178 older adults included in this study was 76 (8) years (range, 65-105 years); there was no reported data on patient sex. A total of 18 080 reports of elder mistreatment were recorded. Medics within the study region reported more cases of elder mistreatment during the implementation of the screening tool (relative risk [RR], 4.14; 95% CI, 3.25-5.27). After adjusting for changes in the number of elder mistreatment reports in the comparison groups (ie, underlying changes in reporting trends), the number of reports to APS increased (RR, 3.03; 95% CI, 2.06-4.46). The occurrence of elder mistreatment was validated in 83% (95% CI, 75%-91%) of the reports investigated by APS during the periods when medics did not have access to the screening tool compared with 82% (95% CI, 77%-87%) during the periods when medics had access to the screening tool, indicating that there were no differences in the proportion of reports that resulted in a validated APS investigation.
The findings suggest that incorporating the DETECT screening tool into the routine practices of medics is associated with substantial increases in the frequency with which clinicians report potential cases of elder mistreatment to APS.
虐待老年人的现象未被充分发现和报告。在美国每个县提供服务的超过 80 万名医护人员代表了一个重要且未被充分利用的监测系统。
调查在大约 3 年的时间里，通过紧急护理技术员（DETECT）筛查工具的使用与向成人保护服务（APS）报告的医护人员数量之间的关联。
设计、设置和参与者：这是一项质量改进研究，采用了差异中的差异设计，包括 2014 年 12 月 31 日至 2018 年 2 月 28 日在研究区域（登顿、约翰逊和塔兰特县的 246 个城市）向德克萨斯州 APS 报告的 65 岁及以上成年人。
DETECT 筛查工具。
向 APS 的报告。
这项研究共纳入 11788 名年龄在 65 岁至 105 岁之间（平均[标准差]76[8]岁）的老年患者，无患者性别报告数据。共记录了 18080 例虐待老年人的报告。在实施筛查工具期间，研究区域内的医护人员报告了更多的老年人虐待案件（相对风险[RR]，4.14；95%CI，3.25-5.27）。在调整了比较组中老年人虐待报告数量的变化（即报告趋势的潜在变化）后，向 APS 的报告数量增加（RR，3.03；95%CI，2.06-4.46）。在医护人员无法使用筛查工具的时期，APS 调查了 83%（95%CI，75%-91%）的报告中确认发生了老年人虐待事件，而在医护人员可以使用筛查工具的时期，这一比例为 82%（95%CI，77%-87%），这表明在导致 APS 调查的报告比例方面没有差异。
研究结果表明，将 DETECT 筛查工具纳入医护人员的常规实践中，与临床医生向 APS 报告潜在老年人虐待案件的频率显著增加有关。
