Detection of Elder mistreatment Through Emergency Care Technicians - Revised for Primary Care (DETECT-RPC)

Elder mistreatment (EM) is commonly defined as an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes harm or creates a risk of harm to an older adult. EM may be intentional or unintentional and includes financial exploitation, neglect, emotional/psychological abuse, physical abuse, and sexual abuse. This is concerning as there is an estimated 11% annual prevalence among cognitively intact older adults, and a 30-75% annual prevalence among older adults with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD. Further, EM is linked with increased risk of poor quality of life, loss of property and security, physical injury, hospitalizations, emergency room visits, psychological distress, morbidity, and early mortality. Nevertheless, EM is difficult to detect and often goes unrecognized. Effective and efficient EM screening tools are urgently needed to improve early detection efforts. This proposal will address this need by adapting an evidence-based EM screening tool for home-based primary care and rigorously evaluating its potential harms and benefits. In direct response to RFA-AG-22-024, we propose stage IA research (R61 phase) to adapt the DETECT screening tool for home-based primary care — with special emphasis on older adults who were recently diagnosed with Alzheimer’s disease and Alzheimer's disease-related dementias AD/ADRD — The DETECT Revision for Primary Care (DETECT-RPC). We also propose a stage III multi-site randomized (at the provider level) controlled efficacy trial (R33 phase) of DETECT-RPC. The specific aims of the R61 phase of the proposed project are: (1) Evaluate the potential impact of state-specific laws and site-specific policies on the reporting guidance that will be provided by the DETECT-PRC tool (mixed-methods); (2) Investigate provider-level barriers to recognizing and reporting EM in home-based primary care environments (qualitative - structured interviews, focus groups); and, (3) Adapt the DETECT screening tool for home-based primary care (qualitative - structured interviews, focus groups). The specific aims of the R33 phase of the proposed project are: (1) Rigorously evaluate the effect of DETECT-RPC on targeted mechanisms of action (i.e., current barriers to identification and reporting) elucidated in the R61 phase of the study (mixed-methods); (2) Rigorously evaluate the impact of DETECT-RPC on clinician identification and reporting of older adults with increased risk of EM to the appropriate authorities (RFA key question KQ3); and, (3) Rigorously evaluate the benefits (i.e., reduce exposure to abuse and neglect, reduced physical or mental morbidity, and reduced mortality) and harms of screening with DETECT-RPC (RFA key questions KQ1 and KQ4) (mixed-methods).