通过家庭初级保健应急护理技术人员筛查工具修订版检测老年人虐待情况（DETECT-RPC）：一项整群随机对照试验研究方案

Detection of Elder Abuse Through Emergency Care Technicians Screening Tool Revision for Home-Based Primary Care (DETECT-RPC): a cluster randomised controlled trial study protocol.

作者信息

Cannell Brad, Sevey Nicholas, Livingston Melvin D, Burnett Jason, Lees Haggerty Kristin, Pickering Carolyn

机构信息

Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA.

Internal Medicine & Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA

出版信息

BMJ Open. 2025 Jan 15;15(1):e089028. doi: 10.1136/bmjopen-2024-089028.

DOI:10.1136/bmjopen-2024-089028

PMID:39819945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11751820/

Abstract

INTRODUCTION

The annual prevalence of elder mistreatment (EM) in cognitively intact older adults is estimated to be 11%, yet the annual prevalence in older adults with Alzheimer's disease and related dementias (AD/ADRD) is estimated to be as high as 75%. Associated with a decrease in quality of life and increase in risk of mortality, EM represents a significant public health burden. Home-based primary care (HBPC) providers are uniquely positioned to address the critical need for robust EM screening and reporting, especially among individuals with AD/ADRD. This protocol seeks to adapt the Detection of Elder mistreatment Through Emergency Care Technicians (DETECT) screening tool, previously used by emergency medical technicians, for use by HBPC providers.

METHODS AND ANALYSIS

The protocol consists of two main phases which include four substudies. Substudy 1 uses a qualitative approach to understand the current barriers to clinician identification and reporting of EM in HBPC, including what adaptations need to be made to DETECT for use in HBPC. Substudy 2 is a cluster randomised controlled trial evaluating the impact of Detection of Elder Abuse Through Emergency Care Technicians Screening Tool Revision for Home-Based Primary Care (DETECT-RPC) on clinician identification of older adult patients with increased risk of EM and referring their concerns to the appropriate authorities and service providers. Substudies 3 and 4 apply a mixed-methods approach to postscreening interviews with clinicians and caregiver/care recipient dyads, respectively. These substudies aim to evaluate DETECT-RPC's impact on barriers to EM identification and reporting as well as the harms and benefits of using the screening tool from the perspective of patients and their caregivers.

ETHICS AND DISSEMINATION

All components of this study are conducted with the approval of the Institutional Review Board of the University of Texas Health Science Center at Houston (HSC-SPH-22-0732, HSC-SPH-23-0105, HSC-SPH-23-0965, HSC-SPH-24-0123). The results of this study will be disseminated through a peer-reviewed journal as well as through presentations at professional conferences, invited talks and other standard channels.

TRIAL REGISTRATION NUMBER

NCT05958654 (ClinicalTrials.gov).

摘要

引言

据估计，认知功能正常的老年人中每年遭受虐待的发生率为11%，而患有阿尔茨海默病及相关痴呆症（AD/ADRD）的老年人中这一发生率估计高达75%。老年人遭受虐待与生活质量下降及死亡风险增加相关，是一项重大的公共卫生负担。家庭初级保健（HBPC）提供者在满足对强有力的虐待老年人筛查和报告的迫切需求方面具有独特地位，尤其是在患有AD/ADRD的个体中。本方案旨在改编急诊医疗技术人员先前使用的通过急诊医疗技术人员检测老年人虐待（DETECT）筛查工具，以供HBPC提供者使用。

方法与分析

该方案包括两个主要阶段，包含四项子研究。子研究1采用定性方法，以了解当前HBPC中临床医生识别和报告老年人虐待的障碍，包括为在HBPC中使用而对DETECT需要进行哪些改编。子研究2是一项整群随机对照试验，评估家庭初级保健的通过急诊医疗技术人员筛查工具修订版检测老年人虐待（DETECT-RPC）对临床医生识别有更高老年人虐待风险的成年患者并将其担忧转介给适当当局和服务提供者的影响。子研究3和4分别采用混合方法对临床医生以及照顾者/受照顾者二元组进行筛查后访谈。这些子研究旨在从患者及其照顾者的角度评估DETECT-RPC对老年人虐待识别和报告障碍的影响以及使用筛查工具的危害和益处。