Risk Screening & Primary Prevention of Elder Abuse in People Living with Dementia

Elder mistreatment (EM) has profound effects on 1 in 10 older Americans, and rates are amongst the highest for people living with dementia (PLWD). Family caregivers most frequently inflict this harm and are typically remorseful for their behavior. This proposal will address this problem through a novel approach that identifies care partners/caregivers (CPG) at primary care medical clinics, whether they are there for their own care or that of the PLWD. During the project’s R61 phase, we will develop and test the feasibility of an evidence-based brief Risk Assessment Screen (RAS) for use in primary care clinics to screen CPGs of PLWD. A 3-component intervention will be developed and feasibility-tested. The first component will direct the CPG during the clinic visit to a website specifically designed to engage them in solution-focused strategies. The second component will provide 1-3 home or technology-assisted visits with a care navigator who provides person-centered guidance to facilitate effective caregiving strategies and alerts CPGs to risks of EM. A third component will educate the clinical care team to address caregiving needs directly with the CPG during the clinic visit and schedule a follow-up visit within 2 months to monitor for change. We will develop an Outcome Tool that includes a compilation of validated measures of modifiable risk factors known to be associated with EM by CPGs which will be used to measure change in risk of EM over time. During the project’s R33 phase, the research team will conduct a cluster randomized controlled trial to test the effectiveness of the RAS and the 3-component intervention. Primary care clinics across Los Angeles County will be randomized to one of the three study arms: control, RAS only, or RAS plus intervention. Analyses will assess the impact of screening and the intervention on participants’ level of risk of EM, as well as other outcomes at the level of the CPG and the PLWD. Additionally, potential harms from the RAS and/or the intervention will be assessed. Finally, we will generate exploratory qualitative data to improve our understanding of the mechanisms of risk and change that may result from our application of the RAS and the intervention.