Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol

IntroductionElder mistreatment (EM) is a high prevalence threat to the health and well-being of older adults in the USA. Medics are well-positioned to help with identification of older adults at risk for EM, however, field robust screening tools appropriate for efficient, observation-based screening are lacking. Prior work by this team focused on the development and initial pilot testing of an observation-based EM screening tool named detection of elder abuse through emergency care technicians (DETECT), designed to be implemented by medics during the course of an emergency response (911) call. The objective of the present work is to validate and further refine this tool in preparation for clinical dissemination.Methods and analysisApproximately 59 400 community-dwelling older adults who place 911 calls during the 36-month study observation period will be screened by medics responding to the call using the DETECT tool. Next, a random subsample of 2520 of the 59 400 older adults screened will be selected to participate in a follow-up interview approximately 2 weeks following the completion of the screening. Follow-up interviews will consist of a medic-led semistructured interview designed to assess the older adult’s likelihood of abuse exposure, physical/mental health status, cognitive functioning, and to systematically evaluate the quality and condition of their physical and social living environment. The data from 25% (n=648) of these follow-up interviews will be presented to a longitudinal, experts and all data panel for a final determination of EM exposure status, representing the closest proxy to a ‘gold standard’ measure available.Ethics and disseminationThis study has been reviewed and approved by the Committee for the Protection of Human Subjects at the University of Texas School of Public Health. The results will be disseminated through formal presentations at local, national and international conferences and through publication in peer-reviewed scientific journals.

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Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

Journal of Community Health ◽

10.1007/s10900-019-00739-1 ◽

2019 ◽

Vol 45 (3) ◽

pp. 640-660 ◽

Cited By ~ 5

Author(s):

Johanna T. Dwyer ◽

Jaime J. Gahche ◽

Mary Weiler ◽

Mary Beth Arensberg

Keyword(s):

Older Adults ◽

Predictive Validity ◽

Screening Tool ◽

Protein Energy Malnutrition ◽

The United States ◽

Community Dwelling ◽

Screening Tools ◽

World Health ◽

Community Settings ◽

Protein Energy

Abstract Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

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MP34: Elder abuse in the emergency department: a systematic scoping review

CJEM ◽

10.1017/cem.2019.169 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S54-S55

Author(s):

E. Mercier ◽

A. Nadeau ◽

A. Brousseau ◽

M. Emond ◽

J. Lowthian ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Physical Abuse ◽

Health Care Providers ◽

Scoping Review ◽

Elder Abuse ◽

Community Dwelling ◽

Screening Tools ◽

Care Providers

Introduction: This systematic scoping review aims to synthetize the available evidence on the epidemiology, risk factors, clinical characteristics, screening tools, prevention strategies, interventions and knowledge of health care providers regarding elder abuse in the emergency department (ED). Methods: A systematic literature search was performed using three databases (Medline, Embase and Cochrane Library). Grey literature was scrutinized. Studies were considered eligible when they were observational studies or randomized control trials reporting on elder abuse in the prehospital and/or ED setting. Data extraction was performed independently by two researchers and a qualitative approach was used to synthetize the findings. Results: A total of 443 citations were retrieved from which 58 studies published between 1988 and 2018 were finally included. Prevalence of elder abuse following an ED visit varied between 0.01% and 0.03%. Reporting of elder abuse to proper law authorities by ED physicians varied between 2% to 50% of suspected cases. The most common reported type of elder abuse detected was neglect followed by physical abuse. Female gender was the most consistent factor associated with elder abuse. Cognitive impairment, behavioral problems and psychiatric disorder of the patient or the caregiver were also associated with physical abuse and neglect as well as more frequent ED consultations. Several screening tools have been proposed, but ED-based validation is lacking. Literature on prehospital- or ED-initiated prevention and interventions was scarce without any controlled trial. Health care providers were poorly trained to detect and care for older adults who are suspected of being a victim of elder abuse. Conclusion: Elder abuse in the ED is an understudied topic. It remains underrecognized and underreported with ED prevalence rates lower than those in community-dwelling older adults. Health care providers reported lacking appropriate training and knowledge with regards to elder abuse. Dedicated ED studies are required.

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Development and validation of new screening tool for predicting dementia risk in community-dwelling older Japanese adults

Journal of Translational Medicine ◽

10.1186/s12967-021-03121-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Keitaro Makino ◽

Sangyoon Lee ◽

Seongryu Bae ◽

Ippei Chiba ◽

Kenji Harada ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression Model ◽

Screening Tool ◽

Community Dwelling ◽

Tree Model ◽

Face To Face ◽

Dementia Risk ◽

Dementia Incidence ◽

Community Dwelling Older Adults

Abstract Background Established clinical assessments for detecting dementia risk often require time, cost, and face-to-face meetings. We aimed to develop a Simplified Telephone Assessment for Dementia risk (STAD) (a new screening tool utilizing telephonic interviews to predict dementia risk) and examine the predictive validity of the STAD for the incidence of dementia. Methods We developed STAD based on a combination of literature review, statistical analysis, and expert opinion. We selected 12 binary questions on subjective cognitive complaints, depressive symptoms, and lifestyle activities. In the validation study, we used STAD for 4298 community-dwelling older adults and observed the incidence of dementia during the 24-month follow-up period. The total score of STAD ranging from 0 to 12 was calculated, and the cut-off point for dementia incidence was determined using the Youden index. The survival rate of dementia incidence according to the cut-off points was determined. Furthermore, we used a decision-tree model (classification and regression tree, CART) to enhance the predictive ability of STAD for dementia risk screening. Results The cut-off point of STAD was set at 4/5. Participants scoring ≥ 5 points showed a significantly higher risk of dementia than those scoring ≤ 4 points, even after adjusting for covariates (hazard ratio [95% confidence interval], 2.67 [1.40–5.08]). A decision tree model using the CART algorithm was constructed using 12 nodes with three STAD items. It showed better performance for dementia prediction in terms of accuracy and specificity as compared to the logistic regression model, although its sensitivity was worse than the logistic regression model. Conclusions We developed a 12-item questionnaire, STAD, as a screening tool to predict dementia risk utilizing telephonic interviews and confirmed its predictive validity. Our findings might provide useful information for early screening of dementia risk and enable bridging between community and clinical settings. Additionally, STAD could be employed without face-to-face meetings in a short time; therefore, it may be a suitable screening tool for community-dwelling older adults who have negative attitudes toward clinical examination or are non-adherent to follow-up assessments in clinical trials.

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Predictive Validity of Health-Related Fitness Tests on Back Pain and Related Disability: A 6-Year Follow-Up Study Among High-Functioning Older Adults

Journal of Physical Activity and Health ◽

10.1123/jpah.9.2.249 ◽

2012 ◽

Vol 9 (2) ◽

pp. 249-258 ◽

Cited By ~ 1

Author(s):

Pauliina Husu ◽

Jaana Suni

Keyword(s):

Older Adults ◽

Back Pain ◽

Community Dwelling ◽

Screening Tools ◽

Increased Risk ◽

Fitness Tests ◽

Health Related ◽

Side Bending ◽

Health Related Fitness

Background:Back pain and related disability seem to be increasing among older adults. Health-related fitness tests have been developed to identify individuals at risk for mobility difficulties. However, poor fitness as a risk factor for back problems has seldom been studied. The purpose of the current study was to investigate whether performance in fitness tests predicts back pain and related disability during 6 years of follow-up.Methods:Study population consisted of community-dwelling men and women, born 1927 to 1941, who participated in assessment of health-related fitness and reported no long-term back pain or related disability at baseline (n = 517). The assessment included measurements of body mass index (BMI), one-leg stand, backward tandem walk, trunk side-bending, dynamic back extension, forward squat, 6.1-m walking speed and 1-km walk time.Results:Prospective analyses indicated that poor fitness (poorest-third) in one-leg stand and trunk side-bending tests were the most powerful predictors of back pain. Regarding disability, poor fitness in dynamic back extension and overweight in terms of BMI ≥ 27 increased the risk.Conclusions:Tests of balance, trunk flexibility and trunk muscle endurance, as well as BMI can be implemented as screening tools for identifying persons with increased risk of back pain and related disability.

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Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults

Geriatrics ◽

10.3390/geriatrics3040090 ◽

2018 ◽

Vol 3 (4) ◽

pp. 90 ◽

Cited By ~ 4

Author(s):

Aarthi Madhavan ◽

Giselle Carnaby ◽

Karishma Chhabria ◽

Michael Crary

Keyword(s):

Older Adults ◽

Construct Validity ◽

Internal Consistency ◽

Screening Tool ◽

Community Dwelling ◽

Screening Tools ◽

Face Validity ◽

Psychometric Validation ◽

Patient Reported ◽

Community Dwelling Older Adults

Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed ‘pre-clinical dysphagia’. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach’s α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.

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Neighborhood Experiences of People Over Age 50: Factor Structure and Validity of a Scale

The Gerontologist ◽

10.1093/geront/gnz111 ◽

2019 ◽

Vol 60 (8) ◽

pp. e559-e571 ◽

Cited By ~ 1

Author(s):

Daniel Rong Yao Gan ◽

John Chye Fung ◽

Im Sik Cho

Keyword(s):

Older Adults ◽

Psychometric Properties ◽

Population Health ◽

Factor Structure ◽

Well Being ◽

Living Environment ◽

Community Dwelling ◽

Neighborhood Environment ◽

Dimensional Structure ◽

Urban Contexts

Abstract Background and Objectives Various aspects of the neighborhood environment have been shown to correlate with older adults’ health. Socio-ecological models of health posit that interventions in the living environment can influence population health. Yet, there are no scales to comprehensively measure older people’s experiences of their neighborhoods especially in dense urban contexts. This study analyzes the psychometric properties and factor structure of a holistic measure of Older People’s Neighborhood Experience (OpenX) to understand constituent factors of residential satisfaction and well-being in dense urban contexts. Research Design and Methods Participants were 1,011 community-dwelling older adults aged 50 and older in Singapore. Face-to-face interviews were conducted. Questions were drawn to measure physical and social aspects of the neighborhood as well as sociodemographic variables. Exploratory and confirmatory factor analyses were conducted to obtain a shorter version; content validity, internal consistency, and external validity were assessed. Results The OpenX has a 4-dimensional structure, explaining 45.5% of the variance of neighborhood experience. They are communal affordance, embeddedness, environment pleasantness, and time outdoors. Good reliability and validity were found, including Cronbach’s alpha of 0.827. The correlation between neighborhood experience and objectively measured proximity to parks and fitness corners approached significance (p = .082). Discussion and Implications The 16-item OpenX demonstrated good psychometric properties. With reference to the transdisciplinary neighborhood health framework, it is useful for assessing older adults’ neighborhood environment, identifying neighborhoods for pilot population health interventions, and understanding how the neighborhood environment affects older adults’ health.

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Perceived Effectiveness of Elder Abuse Interventions in Psychological Distress and the Design of Culturally Adapted Interventions: A Qualitative Study in the Chinese Community in Chicago

Journal of Aging Research ◽

10.1155/2013/845425 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 9

Author(s):

XinQi Dong ◽

E-Shien Chang ◽

Esther Wong ◽

Melissa Simon

Keyword(s):

Older Adults ◽

Psychological Distress ◽

Qualitative Study ◽

Elder Abuse ◽

Well Being ◽

Community Dwelling ◽

Perceived Effectiveness ◽

Chinese Community ◽

Community Based ◽

Chinese Older Adults

This qualitative study examines US Chinese older adults’ views on the perceived effectiveness, challenges, and cultural adaptations of elder abuse interventions to psychological distress in the Chinese community in Chicago. A community-based participatory research approach was implemented to partner with the Chinese community. A total of 37 community-dwelling Chinese older adults (age 60+) participated in focus group discussions. Data analysis was based on grounded theory framework. Our findings suggest that older adults perceived social support, empowerment, and community-based interventions design as most effective to promote psychological well-being of victims. The perceived preferences were similar between elder abuse victims and non-victims. Strategies to culturally adapt evidence-based interventions were proposed with respect to nurturing filial piety values, familial integrations, and increased independence. Research and educational outreach initiatives were also discussed. This study has wide policy and practice implications for designing and deploying interventions to reduce psychological distress with respect to elder abuse outcome. Cultural relevancy of health interventions is important in the context of the Chinese communities. Collective federal, state, and community efforts are needed to support the culturally appropriate design and implementation of interventions suitable for the needs of the Chinese older adults.

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Depression and frailty in older adults: A population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0247766 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247766

Author(s):

Fabiana Araújo Figueiredo Da Mata ◽

Marilia Miranda Forte Gomes ◽

Jair Lício Ferreira Santos ◽

Yeda Aparecida de Oliveira Duarte ◽

Mauricio Gomes Pereira

Keyword(s):

Older Adults ◽

Cohort Study ◽

Depressive Symptoms ◽

Incidence Rate ◽

Prospective Cohort ◽

Well Being ◽

Sao Paulo ◽

Community Dwelling ◽

São Paulo

Background Studies have shown an association between depression and frailty, even though the literature has not reached a consensus regarding how these syndromes interact. Although prospective cohort studies on this topic are still scarce, they could contribute to understanding this relationship. We aimed to observe whether depressive symptoms are risk factors for the onset of frailty among older adults living in São Paulo, Brazil. Methods Prospective cohort study using the “Health, Well-being and Aging” (SABE) Study databases of 2006 and 2010. The sample was representative of the community-dwelling older adults living in São Paulo, and it is composed of non-frail men and women aged 60 years and older without cognitive decline. We calculated the frailty incidence rate between older adults with and without depressive symptoms and calculated the incidence rate ratio. Multiple analysis was carried out through Poisson regression with robust variance estimation. Results The initial sample (n = 1,109) presented a mean age of 72 years (from 60 to 96) and 61.1% were women. The final sample was composed of 830 individuals, and the mean follow-up time in the study was 3.8 years. After adjusting the model, depressive symptoms did not predict the onset of frailty at follow-up. Conclusion Depressive symptoms were not shown to be a risk factor for frailty among older adults living in São Paulo in this study.

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Older Adults’ Subjective Well-being Following an Exergame Intervention “Bandit the Dolphin”: Focus Group Findings

Innovation in Aging ◽

10.1093/geroni/igaa057.549 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 169-170

Author(s):

Brittany Drazich ◽

Breanna Crane ◽

Kyle Moored ◽

Karl Shieh ◽

Janiece Taylor ◽

...

Keyword(s):

Mental Health ◽

Older Adults ◽

Mental Illness ◽

Focus Groups ◽

Well Being ◽

Community Dwelling ◽

Mental Illness Stigma ◽

Subjective Well Being ◽

Future Health ◽

Adult Participants

Abstract Due to generational mental illness stigma and under diagnosis of mental illness, older adults do not always receive the mental health help that they need. One unique technology that has the potential to improve mood in older adults is exergames, or exercise video games. The objective of this sub-study (main study: Stimulation With Intricate Movements “SWIM” Study) was to explore older adults’ mood following an exergame intervention called “Bandit the Dolphin,” created by the Johns Hopkins KATA Studio. Researchers conducted three focus groups with 14 community-dwelling older adult participants who took part in the SWIM Study exergame intervention. The semi-structured focus groups were transcribed, coded, and analyzed using deductive and inductive techniques described by Ray Maietta’s “sort and sift, think and shift” method. Three themes related to playing “Bandit the Dolphin” and mood emerged. First, participants described their perceived association between activity and mood. Participants felt that both active and passive activities, “Bandit the Dolphin” and otherwise, improved their mood through the “fun” factor, and through feelings of achievement. Second, the participants described that the competition and frustration of playing “Bandit the Dolphin” increased eventual feelings of achievement. Third, participants described how feelings of immersion, or being absorbed in the game, helped them forget their other life concerns. These findings provide a better understanding of older adults’ perceived relationship between an exergame intervention, “Bandit the Dolphin,” and short-term improved mood. Future health and engineering researchers should explore exergames as a potential tool to improve the mental health of older adults.

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Forgiveness Interventions for Older Adults: A Review

Journal of Clinical Medicine ◽

10.3390/jcm10091866 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1866

Author(s):

Javier López ◽

Maria Inés Serrano ◽

Isabel Giménez ◽

Cristina Noriega

Keyword(s):

Older Adults ◽

Intervention Studies ◽

Satisfaction With Life ◽

Meta Analysis ◽

Specific Treatment ◽

Community Dwelling ◽

Group Treatments ◽

Receive Treatment ◽

Community Dwelling Older Adults

A meta-analysis of the efficacy of forgiveness interventions in older adults was conducted. International databases (Medline, PsycINFO, Scopus, Web of Science) were searched for studies published from 1990 to 2020 that attempted to promote forgiveness in older adults. Most intervention studies are group treatments targeted towards community-dwelling older adults. Participants in these studies are mainly women. The intervention objectives and contents vary widely and often criteria are not well-defined. Participants that received forgiveness interventions reported significantly higher levels of forgiveness than participants that did not receive treatment. Additionally, forgiveness interventions resulted in more changes in depression, stress and anger than no intervention conditions. Forgiveness treatment also enhances positive states (satisfaction with life, subjective happiness, and psychological wellbeing). The reported effects are moderate. The specific treatment model (e.g., Enright’s, Worthington’s) and format (e.g., group-based interventions and individually delivered programs) do not differentially predict better outcomes. In conclusion, future intervention studies should include more male participants and utilize a broader range of follow-up periods. Caution must be exercised because of the limited number of studies developed to date; researchers must be cautious when generalizing the results.

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