$5.9 million awarded to adapt elder abuse screening tool for home-based primary care

A five-year, $5.9 million grant will allow researchers at UTHealth Houston School of Public Health to address the need for effective and efficient elder mistreatment screening in primary care – particularly for older adults who are living with Alzheimer’s disease and related dementias.

Brad Cannell, PhD, MPH, an associate professor at UTHealth Houston School of Public Health whose research is based in Dallas, along with MedStar Mobile Health Care and Texas Adult Protective Services, previously created Detection of Elder Abuse Through Emergency Care Technicians (DETECT), a screening tool and protocol designed to help EMTs and paramedics recognize potential elder mistreatment when responding to 911 calls in the field. The new grant, funded by the National Institute on Aging of the National Institutes of Health, will expand that program by adapting DETECT for home-based primary care.

“This new project builds upon the work that we've done in emergency medical settings and adapts it for primary care,” said Cannell, principal investigator of the study. “The screening tool will continue to be based on clinician’s observations of the physical and social environment inside their patient’s homes.” 

Each year, approximately 1 out of every 10 people aged 60 and older experience neglect, financial exploitation, emotional/psychological abuse, physical abuse, and/or sexual abuse – collectively referred to as elder mistreatment. Elder mistreatment is even more common for people living with Alzheimer’s disease and related dementias. The value of screening for elder mistreatment in medical settings has been widely discussed in recent years; however, the lack of research on this topic has prevented a concrete recommendation from the United States Preventive Services Task Force.

In the first two years of the study, Cannell and the team will gather qualitative information from home-based primary care clinicians that will help them redesign DETECT’s current 14 screening items used by medics. The redesign will align DETECT with the needs of nurse practitioners and physicians going into older adult’s homes for primary care visits.

“The circumstances surrounding the emergencies that EMTs and paramedics are responding to are likely very different from the primary care visits that nurse practitioners and physicians will be engaging in,” Cannell said.  “The EMTs and paramedics need to be in and be out in 15 minutes and will likely never see this patient again. Whereas, nurse practitioners and physicians at a primary care visit may be able to spend anywhere from 20 minutes to an hour with the patient and they need to have a rapport and an ongoing relationship with their patients in most cases. So, the settings are very different.”

The study includes seven home-based primary care institutions across four states with over 40 primary care clinicians: UT Southwestern Medical Center in Dallas; UT Physicians in Houston; Harris Health Lyndon B. Johnson in Houston; Baylor College of Medicine in Houston; The University of California, San Francisco; The University of Alabama, Birmingham; and Johns Hopkins University in Baltimore, Maryland.

Once DETECT is adapted based on each state’s individual reporting requirements, as well as the policies of the individual organizations and clinics, researchers will then test the adapted tool in the second half of the study.

“There is some screening going on inside emergency rooms, hospitals, and clinics, but this is an opportunity to provide a window into the home,” Cannell said. “There are so many indicators that can alert us to what's potentially going on in a person's life that affect their health and quality of life that may or may not ever be visible to anyone outside of their home. Our ultimate goal is to help people maintain the highest possible quality of life as they age and live their later years in a manner that is consistent with their goals and values. We believe this is one very important piece of the puzzle.”

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