Rosen Tony, Shaw Amy, Elman Alyssa, Baek Daniel, Gottesman Elaine, Park Sophie, Costantini Helena, Cury Hincapie Mariana, Moxley Jerad, Ceruso Marco, Chang E-Shien, Hancock David, Jaret Adrienne D, Lees Haggerty Kristin, Burnes David, Lachs Mark S, Pillemer Karl, Czaja Sara
Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York City, New York, USA
Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York City, New York, USA.
BMJ Open. 2025 Jul 21;15(7):e085172. doi: 10.1136/bmjopen-2024-085172.
Elder neglect by both informal and formal caregivers is common, particularly among persons with dementia, and has serious health consequences but is under-recognised and under-reported. Persons with dementia are often unable to report neglect due to memory and language impairments, increasing their vulnerability. Screening for elder mistreatment and initiation of intervention in primary care clinics may be helpful, but few evidence-based tools or strategies exist. We plan to: (1) develop a novel primary care screening tool to identify elder neglect in persons with dementia, (2) develop an innovative technology-driven intervention for caregivers and (3) pilot both for feasibility and acceptability in primary care.
We will use a multistep process to develop a screening tool, including a modified Delphi approach with experts, and multivariable analysis comparing confirmed cases of neglect in patients with dementia from the existing data registry to non-neglected controls. We will develop an evidence-based, technology-driven caregiving intervention for neglect with an expert panel and iterative beta testing. Following the development of the protocol for implementation of the tool and intervention with associated training, we will pilot test both the tool and intervention in older adult patients and caregivers. We will conduct provider focus groups and interviews with patients and caregivers to assess usability and will modify the tool and intervention. These studies are in preparation for a future randomised trial.
Initial phases of this project have been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #22-06024967, with initial approval on 1 July 2022. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.
无论是非正式照料者还是正式照料者对老年人的忽视都很常见，尤其是在患有痴呆症的人群中，这会产生严重的健康后果，但却未得到充分认识和报告。患有痴呆症的人往往由于记忆和语言障碍而无法报告受到的忽视，这增加了他们的脆弱性。在初级保健诊所筛查老年人虐待情况并启动干预措施可能会有所帮助，但基于证据的工具或策略很少。我们计划：（1）开发一种新型的初级保健筛查工具，以识别痴呆症患者中的老年人忽视情况；（2）为照料者开发一种创新的技术驱动型干预措施；（3）在初级保健中对这两者进行可行性和可接受性试点。
我们将采用多步骤流程来开发一种筛查工具，包括与专家采用改良的德尔菲法，以及进行多变量分析，将现有数据登记册中痴呆症患者的确诊忽视病例与未受忽视的对照组进行比较。我们将与专家小组一起开发一种基于证据的、技术驱动型的忽视照料干预措施，并进行迭代式β测试。在制定工具和干预措施的实施方案及相关培训之后，我们将在老年患者和照料者中对工具和干预措施进行试点测试。我们将开展提供者焦点小组讨论，并对患者和照料者进行访谈，以评估其可用性，并对工具和干预措施进行修改。这些研究是为未来的随机试验做准备。
本项目的初始阶段已由威尔康奈尔医学院机构审查委员会审查并批准，协议编号为#22 - 06024967，于2022年7月1日获得初步批准。我们旨在将研究结果发表在同行评审期刊上，在国内和国际会议上以及在感兴趣的患者群体和公众中进行传播。
