Developing, Implementing, and Evaluating a Caregiver and Elder Abuse Screening, Risk Assessment and Treatment to Improve Outcomes for Older and Vulnerable Adults with MCI/ADRD - ABSTRACT Elder abuse (EA) is chronically undetected and underreported in primary care settings, especially in older and vulnerable adults with mild cognitive impairment (MCI), such as those with traumatic brain injury and those with Alzheimer’s Disease and Related Dementias (ADRD). Elder abuse increases risks for hospitalization and mortality among older and vulnerable adults. To aid screening and provision of a brief educational intervention with adults experiencing cognitive decline, the Screening, Brief Intervention, Referral to Treatment (SBIRT) model may be an effective model to guide primary prevention of elder abuse. Following a SBIRT model, the proposed CAPA-OV (Caregiver and Patient Abuse assessment For Older and Vulnerable populations) will build on research from the EA and intimate partner violence (IPV) fields. The long-term goal of this project is to establish and test 1) a valid primary care-based EA screening tool with an embedded caregiver risk assessment and 2) a two-part effective brief intervention focused on both patients and caregivers to mitigate EA among older and vulnerable adults with MCI/ADRD. Using primary care clinics in a racially, ethnically, and socioeconomically diverse area of southeast Texas, specific aims during the R61 phase are to: Aim 1: Explore dynamic risks and protective factors of EA with older and vulnerable adults with MCI/ADRD based on qualitative interviews with adults with MCI/ADRD and caregivers and develop and validate an EA risk assessment model using 20% Medicare claims data. Aim 2: Develop a SBIRT-type intervention, the CAPA-OV, with an adapted caregiver risk assessment, for use with patients with MCI/ADRD and caregivers in primary care settings. Aim 3: Pilot test the feasibility, fidelity, barriers, and effects of implementing CAPA-OV in three primary care clinics. Based on results from the R61, minor adaption of CAPA-OV will be completed prior to implementation across primary care settings. Specific aims during the R33 phase include: Aim 4: use a pragmatic trial to test the hypothesis that patient-caregiver dyads randomized to receive CAPA-OV will show reductions in exposure to EA, improvements in physical and mental health, and enhancements in quality of life, relative to patient-caregiver dyads receiving standard of care at 6-, 12-, and 18-month follow-up. Aim 5: Evaluate the process and outcomes of implementing CAPA-OV using mixed-methods approaches guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) theoretical frameworks. In developing the first efficacious asymptomatic screening and intervention in English and Spanish that improves EA detection and reduces harms for older adults with MCI/ADRD, we will reduce the public health burden of EA. Our study innovatively addresses both vulnerable and older adults and their caregivers, addressing major risk factors for EA and subsequent health problems, and support the implementation of CAPA-OV to other primary care settings.
