VOICES: Enhancing Elder Mistreatment Detection for Older Adults with a Digital Intervention

Transcript

• 00:01Voices, enhancing elder mistreatment detection
• 00:04for older adults with a
• 00:05digital intervention by Fuad Abujarid,
• 00:08department of emergency medicine,
• 00:11June twenty twenty five, presented
• 00:13by Chelsea Edwards.
• 00:19This study was supported by
• 00:21the National Institute on Aging.
• 00:25And for some background,
• 00:27what is elder mistreatment?
• 00:29Generally, elder mistreatment is defined
• 00:31as a direct action, inaction,
• 00:33or negligence toward an older
• 00:34adult that harms
• 00:36them or places them at
• 00:37risk of harm either by
• 00:38a person in a position
• 00:39of presumed trust or an
• 00:41outside
• 00:42individual targeting the victim based
• 00:44on age or disability.
• 00:46This includes physical abuse, emotional
• 00:48abuse, sexual abuse, financial exploitation,
• 00:51neglect, and abandonment.
• 00:55For some statistics on elder
• 00:56mistreatment, about one in ten
• 00:58Americans are estimated to suffer
• 01:00from elder mistreatment,
• 01:02and those with dementia are
• 01:03at even higher risk. About
• 01:05two thirds suffer from elder
• 01:06mistreatment.
• 01:07Ninety percent of perpetrators are
• 01:09family members or someone close
• 01:10to them, and it's estimated
• 01:12that one in twenty four
• 01:13cases of elder abuse are
• 01:14reported.
• 01:15They're associated with three hundred
• 01:17percent higher mortality risk and
• 01:19increased rates of health system
• 01:21use. And in the first
• 01:22time in US history, older
• 01:24adults are projected to outnumber
• 01:26children by twenty thirty four,
• 01:28compounding this issue even further.
• 01:32Our current challenges with elder
• 01:34mistreatment, despite being a major
• 01:35public health problem,
• 01:36elder adults are not likely
• 01:38to self report due to
• 01:39a number of challenges.
• 01:41Older adults with cognitive impairments
• 01:43have increased risk of elder
• 01:44mistreatment,
• 01:45and identification of mistreatment remains
• 01:47low. For each case of
• 01:49mistreatment, an estimated twenty three
• 01:51cases are left undetected.
• 01:53Providers often face barriers
• 01:55to identifying elder mistreatment during
• 01:57emergency department visits, including time
• 01:59constraints and lack of education
• 02:01or training.
• 02:02Current screening methods are primarily
• 02:04provider focused. However, screening can
• 02:06facilitate education on elder abuse,
• 02:08access to social services, and
• 02:10protective measures.
• 02:13By addressing these gaps, we
• 02:15adopted an evidence informed digital
• 02:17intervention for self reporting in
• 02:18the ED and other clinical
• 02:20settings such as the primary
• 02:21care clinic.
• 02:23Our goal is to motivate
• 02:24older adults with or without
• 02:25cognitive impairments to self report
• 02:27their experiences with mistreatment.
• 02:32Our tablet based intervention was
• 02:34developed to increase self reporting
• 02:36of elder mistreatment for older
• 02:38adults regardless of their experience
• 02:39with technology.
• 02:41Voices uses a unique digital
• 02:42coach to encourage mistreatment reporting
• 02:44with features such as educational
• 02:46content,
• 02:47screening, multimedia elements, and brief
• 02:50psychoeducational
• 02:51interviewing.
• 02:53Voices is a onetime eight
• 02:54minute educational and screening intervention,
• 02:57and it is self administered
• 02:58by the older adult independently
• 03:00and privately.
• 03:01In addition to this, we
• 03:02included older adults in the
• 03:04development
• 03:05process,
• 03:06ensuring that this is a
• 03:07user centered design.
• 03:12Voices is not intended to
• 03:14replace the screening process, but
• 03:15instead integrate into the clinical
• 03:17workflow
• 03:18to enhance detection,
• 03:19particularly among those who have
• 03:21no signs of abuse.
• 03:24In our prior research,
• 03:26we evaluated using voices among
• 03:28older adults in various settings,
• 03:30such as the emergency department,
• 03:32primary care clinic, and a
• 03:33memory clinic.
• 03:34Our locations included the Yale
• 03:36New Haven Health System and
• 03:37the Adler Geriatric Assessment Center.
• 03:40Our process involved having research
• 03:42assistants orient the patient to
• 03:44voices on the tablet, and
• 03:45then the patient completed voices
• 03:47independently.
• 03:48Caregivers, if present, were asked
• 03:50to leave the room during
• 03:51the study session to ensure
• 03:52privacy.
• 03:54For cognitive impairment assessments, we
• 03:56use the abbreviated mental test
• 03:58four and the Montreal cognitive
• 03:59assessment.
• 04:00We evaluated outcomes of feasibility,
• 04:03satisfaction,
• 04:04ease of use, and appropriateness.
• 04:06We demonstrated
• 04:07high satisfaction in various clinical
• 04:10settings.
• 04:10Across multiple studies in the
• 04:12emergency department, we recruited a
• 04:14thousand cognitively intact participants over
• 04:17sixty years and older.
• 04:19We also evaluated
• 04:20eighty participants in the primary
• 04:22care setting,
• 04:23and we evaluated thirty participants
• 04:25with cognitive impairments in the
• 04:27memory clinic pilot.
• 04:29As you can see on
• 04:30this graph, it demonstrates that
• 04:32participants felt that using voices
• 04:34was easy. They were able
• 04:36to complete using voices independently
• 04:38without help,
• 04:40and the instructions provided by
• 04:41the digital coach were clear
• 04:43and easy to follow and
• 04:44that they felt safer after
• 04:46using voices.
• 04:48Study comparisons in the emergency
• 04:49department and primary care clinic
• 04:51also demonstrate high satisfaction across
• 04:54multiple domains.
• 04:56Additionally, we found that patients
• 04:58felt that their education after
• 04:58using voices was much higher.
• 04:58They felt that they received
• 04:59after using voices was much
• 05:01higher. They felt that they
• 05:03received better education and learned
• 05:05more about the types of
• 05:07abuse
• 05:08and the resources available to
• 05:10them.
• 05:14Older adults with or without
• 05:16cognitive impairments who used voices
• 05:18were highly satisfied and felt
• 05:19the tool was feasible for
• 05:20use in emergency department and
• 05:22primary care settings.
• 05:24Voices represents a promising digital
• 05:27health solution for elder abuse
• 05:28screening and has the potential
• 05:28to significantly enhance the
• 05:30to significantly enhance the screening
• 05:32process for elder mistreatment
• 05:34and increase detection of cases
• 05:36that are normally missed.
• 05:37Voices caters to older adults
• 05:39with varying levels of technical
• 05:41proficiency,
• 05:42and we believe that future
• 05:43integration of voices can promote
• 05:45a safer and more supportive
• 05:46environment for older adults with
• 05:48the potential to decrease mortality
• 05:50risk for older adults experiencing
• 05:52mistreatment and increased rates of
• 05:54health system use.
• 05:56We believe that future research
• 05:58evaluating the efficacy of voices
• 06:00and long term outcomes of
• 06:01the benefits and harms will
• 06:03be helpful to further expand
• 06:05our work.
• 06:08In conclusion,
• 06:10voices is feasible for detecting
• 06:12elder mistreatment and cognitively intact
• 06:14older adults and those with
• 06:15cognitive impairments
• 06:17with MOCA scores between fourteen
• 06:19through twenty five. We believe
• 06:21that voices can also provide
• 06:22additional services,
• 06:24especially to those without signs
• 06:25of elder mistreatment.
• 06:27And we also believe that
• 06:28voices can be used for
• 06:29early detection and prevention of
• 06:31severe mistreatment for those in
• 06:33this high risk population.
• 06:38Thank you.