Characterizing Elder Mistreatment Among Older Adults with Dementia

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.