The specific aims of this research are to 1) identify risk factors for Elder Mistreatment (EM) in an observational cohort of community living elders, and 2) develop a stratification system based on these risk factors to identify elders who are most vulnerable. A secondary aim is to estimate the incidence of reported EM in the cohort. The broad, long term objectives of this research is the development and implementation of physician initiated interventions based on remediable risk factors so that incipient EM may be recognized and prevented. Between 1.5 and 2 million elders are abused or neglected annually in the United States. Previous case-control and cross sectional studies have produced an inconsistent picture of the patient at risk; the role of dependency remains especially controversial. A longitudinal study of EM has never been conducted due to methodologic and financial constraints. The city of New Haven affords a unique opportunity to study EM longitudinally because Connecticut has the oldest mandatory EM reporting law in the country and it is the site of an NIA funded observational cohort of 2,811 elders now in its 10th year. By linking these data sets, it will be possible to identify elders who were interviewed yearly with standardized assessments of medical, functional, and psychosocial health, and later found to have sustained EM through mandatory reporting. We anticipate that time dependent changes in pre-outcome characteristics that reflect increasing subject dependency (i.e. cognitive and functional decline), will be powerful predictors of EM. Using multivariable techniques, a comprehensive model for stratifying elders into levels of risk for EM will be constructed that considers the interaction of changing clinical and non-clinical predictors. Subsequent projects during the award period include a study of EM outcomes, a clinic-based RCT of EM prevention based on identified risk factors, and a case control study of non-cognitive symptoms of dementia as risk factors for EM. Clinical components of the application include geriatric attending at the West Haven VAMC, Yale-New Haven Hospital, and the program's nursing home. Formal and informal teaching to medical students and house staff will occur at these and other sites. Course work in advanced research methods and family violence is planned. Besides these strengths, the Yale Geriatric Environment has several successful investigators in aging within the School of Medicine and Public Health. The sponsors possess expertise in clinical epidemiology and domestic violence and are dedicated to the intellectual and professional development of the applicant. The candidate's strengths are superb clinical training, training in research methods as a Robert Wood Johnson Clinical Scholar, and a long-standing interest in geriatric and societal health problems. An NIA academic award will permit his maturation into an independent investigator who will conduct policy relevant research in aging, reflecting the belief that physicians have a broad obligation to society that extends beyond that traditional doctor patient dyad.
| Lachs, Mark S; Williams, Christianna S; O'Brien, Shelley et al. (2002) Adult protective service use and nursing home placement. Gerontologist 42:734-9 |
