Iowa family physician's reporting of elder abuse: 20-year follow-up.

The purpose of this project was to assess changes over 20 years, between family physicians perceived magnitude of elder mistreatment, physician knowledge of state laws, barriers to reporting suspected cases, and what is done in practice. Questionnaires were mailed to 1,080 physician members of the Iowa Academy of Family Physicians. Thirty-six percent of physicians returned the questionnaire. These respondents had a mean age of 51 years, were licensed for 19 years, and 51% were male. Twenty-nine percent of physicians ask their patients direct questions about elder abuse in 2022 compared to 14% in 2002. Identifying an elder abuse case was associated with asking direct questions about abuse and the belief that prompt action would be taken. Knowledge of elder abuse legislation was associated with reporting of all abuse cases, along with thinking there were clear definitions of abuse and that reporting benefits patients.

Machine Learning Prediction of Fall Risk in Older Adults Using Timed Up and Go Test Kinematics.

Falls among the elderly population cause detrimental physical, mental, financial problems and, in the worst case, death. The increasing number of people entering the higher risk age-range has increased clinicians' attention to intervene. Clinical tools, e.g., the Timed Up and Go (TUG) test, have been created for aiding clinicians in fall-risk assessment. Often simple to evaluate, these assessments are subject to a clinician's judgment. Wearable sensor data with machine learning algorithms were introduced as an alternative to precisely quantify ambulatory kinematics and predict prospective falls. However, they require a long-term evaluation of large samples of subjects' locomotion and complex feature engineering of sensor kinematics. Therefore, it is critical to build an objective fall-risk detection model that can efficiently measure biometric risk factors with minimal costs. We built and studied a sensor data-driven convolutional neural network model to predict older adults' fall-risk status with relatively high sensitivity to geriatrician's expert assessment. The sample in this study is representative of older patients with multiple co-morbidity seen in daily medical practice. Three non-intrusive wearable sensors were used to measure participants' gait kinematics during the TUG test. This data collection ensured convenient capture of various gait impairment aspects at different body locations.

Iowa Dependent Adult Abuse Prosecutions From 2006 Through 2015: Health Care Providers' Concern.

BACKGROUND: In most states, health care providers are required to report abuse. Some states provide investigation feedback/findings to the reporter. The reporters rarely know if the perpetrator is convicted. The purposes of this study are to determine the incidence of Iowa dependent adult abuse prosecutions from 2006 through 2015, the incidence of convictions, and the association between dependent adult abuse prosecutions with county census and government characteristics. DESIGN AND METHODS: Through the Iowa Court Information Systems, dependent adult abuse prosecution data were purchased for a 10-year time period. County demographics were obtained through the US Census and government data were Iowa State Association of Counties and the US Department of Agriculture. RESULTS: During 2006-2015, there were 368 dependent adult abuse prosecution cases accounting for 482 original charges. Exploitation greater than $100 was the dependent adult abuse charge most frequently cited. Within the 10 years, it accounted for 60% of the original charges. Of the 482 disposed charges, 251 (52%) of the charges were dismissed. A total of 122 (14%) counts resulted in probation, 73 resulted in prison, and 37 in jail. CONCLUSIONS: For the first time, information about dependent adult abuse prosecutions in Iowa is available. The latter 5 years, 2011 to 2015, of dependent adult abuse prosecutions are significantly higher than the first 5 years, 2006 to 2010. This project encourages health care providers to report dependent adult abuse to law enforcement if appropriate as well as adult protective services.

Multidisciplinary team legislative language associated with elder abuse investigations.

Professionals from different disciplines providing care and services to persons at risk for or victims of elder abuse have formed various multidisciplinary teams (MDTs). The purpose of the study was to identify the adult protective services-related statutory trends in presence of MDT content and to determine the association of MDT legislation on the rates of reported, investigated, and substantiated domestic elder abuse. Aggregate reports of elder abuse and state statutes for 1999 and 2007 were retrieved from 50 states and the District of Columbia. Statutes of eight states in 2000 and nine in 2008 included text about MDTs. In 2007, investigation rates for those states having MDT text in the statutes were significantly higher than those states without. The incidence of MDTs in the country is unknown. Legislative text is but one factor associated with differences in elder abuse report, investigation, or substantiation rates.

Predictors of treatments acceptable to patients for late-life depression.

OBJECTIVES: Describe older patients' perceptions about depression and characteristics associated with acceptance of treatments. DESIGN: Cross-sectional study. SETTING: Three primary care clinics in Iowa. PARTICIPANTS: Consecutive sample of 529 primary care patients. MEASUREMENTS: Depression screening tool (a 9-item patient health questionnaire [PHQ-9]) and questionnaire including sociodemographic data, patient attitudes about depression, and acceptability of different treatments. RESULTS: Mean age was 71.9 years (range 60-93 years), 314 (59%) female. Among the 529 participants, 93 (17.5%) had history of depression and 60 (11.3%) had PHQ-9 scores of 10 or greater. Participants believed depression is a disease for which they would use medication and counseling. Accepting medications from primary physicians was strongly associated with a past history of depression (P < 0.01) and with agreeing that depression needs treatment (P < 0.01). Counseling was not acceptable for those believing that they can control depression on their own (P < 0.01). Older patients (P < 0.001) and those with higher education levels (P < 0.01) were less likely to accept herbs or supplements as treatment options. Willingness to discuss treatments with family was associated with not using alcohol as a treatment and acceptance of all other treatment options (P < 0.001). CONCLUSIONS: Attitude that depression is a disease and the willingness to discuss depression with family may enhance treatment acceptance.

Critical care nurses' perspectives on elder abuse.

AIMS: To explore through interviews of critical care nurses their perspectives on elder abuse to achieve a better understanding of the problems of reporting and generate ideas for improving the process. BACKGROUND: In 44 states and the District of Columbia health care providers are required by law to report elder abuse but the patient, patient's family and health care providers all have barriers to reporting allegations of elder abuse. DESIGN: This study design is qualitative. METHOD: Through a mailed survey, critical care nurses were invited to participate in a taped in-depth qualitative interview. RESULTS: Ten nurses were interviewed. A thematic analysis was used to describe the following core themes: types of elder abuse, suspicions of elder abuse, reporting of elder abuse, barriers to reporting elder abuse, legislation and improvement in practice. CONCLUSIONS: Critical care nurses are aware of elder abuse and somewhat systematically evaluate for abuse at admission to their unit. They recognize signs and symptoms of abuse and are suspicious when it is warranted. They are aware of why an older person does not want to report abuse and take this into consideration when soliciting information. Facts, values and experience influence personally defining abuse, suspicion and dependence for each individual health care professional. RELEVANCE TO CLINICAL PRACTICE: Critical care unit protocols and/or policies and procedure for reporting elder abuse are needed in critical care settings and are warranted for providing quality of care.

Health care professionals' perspectives on barriers to elder abuse detection and reporting in primary care settings.

The purpose of this study was to explore health care professionals' perspectives on elder abuse to achieve a better understanding of the problems of reporting and to generate ideas for improving the detection and reporting process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed, and thematic analysis was used to identify the following core themes: preconceptions, assessment, interpretation, systems, and knowledge and education. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.

Substance abuse associated with elder abuse in the United States.

BACKGROUND: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. OBJECTIVE: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. METHODS: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. RESULTS: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. CONCLUSION: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community's environment, especially if older persons are involved. SCIENTIFIC SIGNIFICANCE: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

Late-life depressive symptoms: an international study.

OBJECTIVES: Evaluate differences in depressive symptoms, compare sociodemographic and health-related variables associated with depressive symptoms and report level of impact of depressive symptoms on daily activities. METHODS: Cross-sectional study using a self-administered questionnaire and Patient Health Questionnaire-9 (PHQ-9) diagnostic survey on 1115 patients aged 60-93 years who attended a primary care clinic in Korea, Russia or USA. RESULTS: At least mild depression (PHQ-9 score of ≥ 5) occurred in 28% of Koreans, 65% of Russian and 27% of US participants. Russians scored more depressed on all PHQ-9 items (P < 0.01) and more suicidal thoughts (P < 0.001), while Koreans had less feelings of worthlessness (P < 0.001). Depression predictors included poorer self-rated health [odds ratio (OR) 2.47, 95% confidence interval (CI) 1.84-3.33, P < 0.0001], chronic diseases (OR 1.34, CI 1.21-1.48, P < 0.0001), female gender (OR 1.56, CI 1.15-2.12, P = 0.0046) and religious attendance (OR 0.88, CI 0.79-0.97, P = 0.0099) for all subjects. Being employed was protective in Korea (OR 0.41, CI 0.21-0.77, P = 0.0061) and being married (OR 0.42, CI 0.27-0.66, P = 0.0002) and of older age (OR 0.95, CI 0.93-0.98, P = 0.0006) protective in US participants. Vascular disease was associated with depressive symptoms in Russia (OR 3.47, CI 1.23-9.80, P = 0.0187). In regression analyses stratified by country for a given level of depressive symptoms, the Russian sample had less impact on daily activities (Russia R (2) = 0.107 versus Korea R (2) = 0.211 and US R (2) = 0.419) P = 0.029. CONCLUSIONS: Depressive symptoms were more common in Russia than in Korea and USA but had less impact on daily functioning. Cultural or environmental factors may account for this finding.

Elder abuse research: a systematic review.

The purpose of this research was to provide a systematic review of, and assign an evidence grade to, the research articles on elder abuse. Sixteen health care and criminal justice literature databases were searched. Publications were reviewed by at least two independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria; omitting duplicates, 590 publications were annotated and graded.

Management of skin and soft tissue infections in community practice before and after implementing a "best practice" approach: an Iowa Research Network (IRENE) intervention study.

CONTEXT: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major pathogen among skin and soft tissue infections (SSTIs). Most CA-MRSA infections are managed initially on an outpatient basis. It is critical that primary care clinicians recognize and appropriately treat patients suspected of having such infections. OBJECTIVE: To identify and evaluate best methods and procedures for primary care clinicians to manage skin and soft tissue infections. DESIGN, SETTING, AND PATIENTS: Preintervention/postintervention study in eight Iowa Research Network offices conducted between October 2007 and August 2010. We reviewed medical records of 216 patients with SSTI before a set of interventions (preintervention) and 118 patients after the intervention (postintervention). INTERVENTIONS: Included a focus group meeting at each office, distribution of a modified Centers for Disease Control and Prevention (CDC) algorithm, "Outpatient Management of MRSA Skin and Soft Tissue Infections," education handouts, and an office policy for patients with skin infections. MAIN OUTCOME MEASURES: Proportion of subjects who were prescribed an antibiotic that would cover MRSA at the initial visit and proportion who were prescribed an antibiotic that would cover MRSA at any time. RESULTS: Three hundred sixty-eight forms (244 preintervention and 124 postintervention) were returned; 216 (89%) preintervention forms and 118 (95%) postintervention forms were usable. Multivariable logistic regression models found statistically significant and independent factors associated with MRSA coverage at the initial visit included being in the postintervention rather than the preintervention group, having an abscess component compared with cellulitis alone, having a culture sent, being prescribed two or fewer antibiotics, and not being hospitalized. CONCLUSIONS: The CDC algorithm was feasible for offices to use. Following a discussion of SSTI management in the outpatient setting, use of MRSA coverage increased both initially and overall. Thus, involving clinicians in a discussion about guidelines rather than simply providing guidelines or a didactic session may be a useful way to change physician practices.

Primary care clinicians' perspectives on management of skin and soft tissue infections: an Iowa Research Network study.

UNLABELLED: An estimated 95,000 people developed methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005 of which 14% were community-associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year. PURPOSE: To explore health care providers' perspectives on management of skin and soft tissue infections to gain a better understanding of the problems faced by busy providers in primary care settings. METHODS: Focus group meetings were held at 9 family physician offices in the Iowa Research Network. Seventy-eight clinicians including physicians, nurses, nurse practitioners, and house officers attended. Meeting audiotapes were transcribed and coded by 3 investigators, and a MRSA-management taxonomy was developed. FINDINGS: The main themes that emerged from the focus groups included epidemiology, diagnosis, treatment, management, prevention, special populations, and public relations. The incidence of MRSA infections was perceived to have increased over the past decade. However, diagnosis and treatment protocols for physicians in the outpatient setting have lagged behind, and no well-accepted diagnostic or treatment algorithms were used by physicians attending the focus groups. CONCLUSION: The clinicians in this study noted considerable confusion and inconsistency in the management of skin and soft tissue infections, particularly those due to MRSA.

Essential Data Elements for Reporters of Elder Abuse.

Most states' adult or elder protective services and aging agency personnel prepare annual reports about their protective services. These reports vary by state and have different terms for the reporter of abuse. Reviewing annual reports from 46 states and the District of Columbia, 248 different terms were used for the reporter of abuse. To develop essential data elements for reporters of abuse, a literature search, a compilation of state elder abuse annual report list of abuse reporters, and a sorting exercise were conducted. Eleven terms were recommended for the different reporters of abuse, encouraging all state administrators and caseworkers to reach consensus to standardize the language.

Patient clock drawing and accuracy of self-report compared with chart review for colorectal cancer (CRC) screening.

The purpose of this study was to test the accuracy of patient colorectal cancer (CRC) screening self-report and CRC screening documented in their medical record for those who are cognitively impaired and those who are not based on the clock drawing task. A cross-sectional study where patient survey and medical record information were linked was conducted in 16 primary care offices. Of the 960 patients mailed questionnaires, there were 493 respondents who completed the questionnaire and clock drawing, had a chart review, and had no help in drawing the clock or completing the questionnaire. Chart review was conducted for CRC screening in physician offices. Clock drawings were scored 0-7 according to the Watson method. Accuracy of ever being screened for CRC or being up-to-date for CRC screening was determined by comparing self-report with medical records and calculating sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate. Seventy-five clocks were abnormal, scoring 4 or more. Agreement between self-reported colonoscopy and medical record review was higher in subjects with normal clock drawings than those with abnormal clock drawings. When examining predictors of agreement/disagreement for colonoscopy screening, abnormal clock drawing was the single predictor for higher disagreement.

Multidisciplinary reports of nursing home mistreatment.

OBJECTIVES: The purpose of this research was to learn about nursing home employees' knowledge and perspectives on mandatory reporting of elder abuse. DESIGN: Mailed questionnaire and personal interviews. SETTING: Two nursing facilities in Iowa. PARTICIPANTS: All employees of the two nursing facilities. MEASUREMENTS: A 28-item questionnaire that included questions on demographics, personal experiences with suspected elder abuse and reporting, legislation, facility protocols, and opinions on mandatory reporting was mailed to participants. An interview composed of 11 open-ended questions was conducted in the nursing facilities. RESULTS: Forty-nine (15%) of the 335 employees who were sent the mailing returned the questionnaire and 22 (7%) participated in the interview. Over half (53%) of those who returned questionnaires reported suspecting a case of abuse in the facility where they currently work. Of these, 35% stated that they had not reported all the cases they suspected. Interviews of the 22 employees were about 15 minutes in length and took place at the nursing facility. Four themes emerged from these interviews, including the need for more staff education/training on the subject of elder abuse, difficulty in making judgments about whether the situation needs to be reported, barriers to reporting, and a sense that some abuse situations may occur because the staff is overworked, inexperienced, and/or frustrated from dealing with difficult residents. CONCLUSION: Nursing home employees are knowledgeable about the mandatory reporter laws, but many remain hesitant to report suspected abuse for various reasons.

Elder abuse telephone screen reliability and validity.

PURPOSES: (a) To identify reliable and valid questions that identify elder abuse, (b) to assess the reliability and validity of extant self-reported elder abuse screens in a high-risk elderly population, and (c) to describe difficulties of completing and interpreting screens in a high-need elderly population. DESIGN AND METHODS: All elders referred to research-trained social workers in a community service agency were asked to participate. Of the 70 elders asked, 49 participated, 44 completed the first questionnaire, and 32 completed the duplicate second questionnaire. A research assistant administered the telephone questionnaires. RESULTS: Twenty-nine (42%) persons were judged abused, 12 (17%) had abuse reported, and 4 (6%) had abuse substantiated. The elder abuse screen instruments were not found to be predictive of assessed abuse or as predictors of reported abuse; the measures tended toward being inversely predictive. Two questions regarding harm and taking of belongings were significantly different for the assessed abused group. IMPLICATIONS: In this small group of high-need community-dwelling elders, the screens were not effective in discriminating between abused and nonabused groups. Better instruments are needed to assess for elder abuse.

State policies and nursing home characteristics associated with rates of resident mistreatment.

BACKGROUND: A federal complaint/incident system was implemented in 2004 with the stated purpose of promoting and protecting the health, safety, and the welfare of residents receiving health care services. This system provided the first national database of mistreatment in the nursing home setting. METHODS: The purpose of this research was to identify state and nursing home characteristics associated with the rates of nursing home resident mistreatment. Outcomes were incident reports filed by nursing home staff and complaints filed by persons other than service providers obtained from the federal complaints/incidents tracking system. Predictor variables used in the analysis of the reporting system included state legislation, census demographic data, and characteristics of the nursing home including aggregate characteristics of the residents. RESULTS: In 2004, based on complaint and incident reports, 1.6% of the nursing home population was reported to be mistreated. The average rates per 1000 residents were 16 reports, 14 investigations, and 4 substantiations. Incident report rates per 1000 ranged from 0.04 in Virginia to 46 in Alabama. Complaint report rates ranged from 0.42 in Hawaii to 52 in New Mexico. Incident outcomes were significantly lower in states that had nursing home statutes that require the facility, rather than the individual, to report mistreatment or in states that defined mistreatment in the nursing home differently from the definitions used by adult protective service statutes. Higher complaint outcomes were associated with lower levels of staffing. After controlling for resident characteristics, mistreatment measures remained associated with nursing home staffing levels but not with elements of statutes. CONCLUSIONS: Documentation of nursing home mistreatment shows substantial differences in report rates across states. These differences cannot be explained by variations in the laws.

County government resources associated with dependent-adult abuse investigations in Iowa.

This study evaluated on a county level the association of Iowa's domestic dependent-adult abuse investigations with the location of adult protective services (APS) offices, rurality, government resources, felony charges and prosecutions, child abuse reports, and census demographics. In 2003, the rate of dependent-adult abuse investigations for Iowa was 0.70 per 1,000 population age 18 and older. Higher rates of child abuse investigations, felony prosecutions, sheriff's annual salary, and lower rates of child abuse substantiations are associated with higher rates of dependent-adult abuse investigations and substantiations.

Nursing home abuse report and investigation legislation.

Nursing home complaint investigation procedures are established by each state's respective legislation. The purpose of this study was to determine the state statutes that had text addressing nursing home report and investigation of abuse and to describe the content of that text. All states and the District of Columbia have statutes addressing the licensure and re-certification of nursing homes. Fourteen of these licensure and re-certification of nursing home state statutes have text specifically addressing the topic of abuse reports and investigation in the nursing homes. Main concepts discussed in those sections were reporting requirements, mandatory reporting, and definitions.

APS participatory network case study review.

The goal of this project was to establish the feasibility of linking a practice-based research network of Adult Protective Service (APS) workers to an academic institution. To determine whether this newly formed APS research network was feasible, a qualitative research project was attempted with network members who had e-mail. An e-mailed single case study with three questions sent to the 356 network members yielded a 31% return rate. APS workers suggested 73 different ideal and actual services for the case study abuse victim. Half of the respondents were unable to implement the ideal service. Barriers were predominantly financial, victim and daughter cooperation, and availability of resources. It is realistic and feasible to establish an adult protective service research network with an interdisciplinary academic research team.