Jogerst G J, Ely J W
Department of Family Medicine, University of Iowa, Iowa City, USA.
Fam Med. 1997 Oct;29(9):634-9.
A home visit program was designed to teach family practice residents how to evaluate patients for elder abuse and capacity (the ability to make one's own decisions).
Residents assessed potential abuse victims reported to Arizona's Adult Protective Service (APS) in their homes. Written evaluations prepared immediately following each home visit were abstracted for diagnoses (including abuse), recommendations, and patient demographics. Follow-up surveys by APS case workers determined whether the home visit recommendations were accomplished. Graduates of the residency were surveyed about their perceptions of the educational value of the program and their practice characteristics.
The residents evaluated 201 patients. The mean age was 77, and 73% of patients were female. Seventy-five percent were incapacitated, 65% of these because of dementia. Ninety-one percent were abused, and the types of abuse included neglect (69%), exploitation (20%), physical abuse (8%), and unknown (3%). Recommendations were accomplished in the majority of cases: medical advice (68%), services (65%), medical evaluations (58%), guardian (53%), and conservator (52%). Graduates who participated in this program (1985-1992) rated their ability to diagnose elder abuse and to assess the patient's home environment significantly higher than earlier graduates who did not participate in the program (1977-1984). Earlier graduates made more home visits and provided more statements for guardianship than later graduates.
The home visit program gave residents exposure to a population of elderly who were abused, demented, and living at home. This program provided clinical substance to build an effective teaching experience and furnished APS with a needed service.
设计了一项家访计划，以教导家庭医学住院医师如何评估患者是否遭受虐待以及是否具备决策能力（自主做出决定的能力）。
住院医师在患者家中对向亚利桑那州成人保护服务机构（APS）报告的潜在虐待受害者进行评估。每次家访后立即撰写的书面评估报告被提取用于诊断（包括虐待情况）、建议以及患者人口统计学信息。APS 个案工作者进行的后续调查确定了家访建议是否得到落实。对该住院医师培训项目的毕业生就他们对该项目教育价值的看法及其执业特点进行了调查。
住院医师评估了 201 名患者。平均年龄为 77 岁，73%的患者为女性。75%的患者无行为能力，其中 65%是因痴呆症。91%的患者遭受了虐待，虐待类型包括忽视（69%）、剥削（20%）、身体虐待（8%）以及情况不明（3%）。大多数情况下建议得到了落实：医疗建议（68%）、服务（65%）、医学评估（58%）、监护人（53%）以及财产监管人（52%）。参与该项目（1985 - 1992 年）的毕业生对自己诊断老年人虐待情况以及评估患者家庭环境的能力的评分显著高于未参与该项目的早期毕业生（1977 - 1984 年）。早期毕业生进行的家访更多，为监护权提供的陈述也比后期毕业生更多。
家访计划让住院医师接触到了遭受虐待、患有痴呆症且居家生活的老年人群体。该计划为构建有效的教学体验提供了临床实质内容，并为 APS 提供了一项所需服务。
