Elder Mistreatment Screening for Geriatric Assessment

(MISSED Trial)

Overseen By Julia A Hiner, MD

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center, Houston

Disqualifiers: Unwillingness to participate

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The purpose of this study is to demonstrate the feasibility of introducing, implementing, and integrating a brief, existent elder mistreatment screening tool (the National Collaboratory to Address Elder Mistreatment (NCAEM)'s Elder Mistreatment - Screening And Response Tool (EM-SART) Pre-Screen) in the Memorial Herman Hospital (MHH)-Texas Medical Center (TMC)Acute Care of Elders(ACE) (MHH-TMC ACE) unit and to identify older adults who may already be suffering from abuse, neglect, and/or financial exploitation, as well as connecting the study participants to the primary Geriatric Medicine team on the ACE unit such that additional care, evaluation (including additional in-depth mistreatment screening), and intervention can be taken to prevent and minimize further harm prior to discharge. The investigators hope to reduce missed opportunities for mistreatment detection to lead to safer health outcomes and hospital discharges.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is the Elder Mistreatment Screening and Response Tool (EM-SART) safe for use in humans?

The EM-SART has been used in a pilot program at the Louis Stokes Cleveland VA Medical Center, where it was integrated into the workflow for screening older Veterans. The tool was adapted for use by both licensed and nonlicensed clinicians, and no safety concerns were reported during its implementation. ^{1 2 3 4 5}

How is the NCAEM EM-SART Pre-Screen treatment different from other elder mistreatment treatments?

The NCAEM EM-SART Pre-Screen is unique because it is an interdisciplinary tool specifically adapted for use in geriatric emergency departments, allowing both licensed and nonlicensed clinicians to screen for elder mistreatment. It integrates into the electronic health record and is tailored to meet specific policy and resource needs, making it distinct from other screening tools that may not offer such flexibility or integration. ^{1 2 3 6 7}

What data supports the effectiveness of the treatment NCAEM EM-SART Pre-Screen, Elder Mistreatment - Screening And Response Tool Pre-Screen, NCAEM EM-SART?

The research highlights the development and validation of various tools for screening elder mistreatment, indicating a growing focus on creating effective methods for identifying and addressing this issue in healthcare settings. While specific data on the effectiveness of the NCAEM EM-SART is not provided, the emphasis on improving screening tools suggests a positive trend towards better detection and response to elder mistreatment. ^{2 3 6 8 9}

Who Is on the Research Team?

Julia A Hiner, MD

Principal Investigator

The University of Texas Health Science Center, Houston

Are You a Good Fit for This Trial?

This trial is for older adults currently admitted to the MHH-TMC Acute Care of Elders unit who can hear, understand, and answer questions on their own. It's not for those who don't want to participate in research.

Inclusion Criteria

Current admission to the MHH-TMC ACE unit

Ability to independently hear, understand, and verbally answer the 3 participant questions on the NCAEM's EM-SART Pre-Screen screening tool when it is read to them

Exclusion Criteria

I do not want to participate in the research study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation of the NCAEM EM-SART Pre-Screen tool to identify elder mistreatment

12 months

Evaluation

15-minute evaluation of each participant using the NCAEM EM-SART Pre-Screen tool

15 minutes per participant

Follow-up

Participants are monitored for safety and effectiveness after screening

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• NCAEM EM-SART Pre-Screen

Trial Overview The study tests if a brief screening tool (NCAEM's EM-SART Pre-Screen) can be used effectively in a hospital setting to detect elder mistreatment and connect patients with geriatric care before they leave the hospital.

How Is the Trial Designed?

Group I: NCAEM EM-SART Pre-Screen Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

The University of Texas Health Science Center, Houston

Lead Sponsor

Trials

974

Recruited

361,000+

Published Research Related to This Trial

A study involving 241 patients across medical and dental clinics demonstrated that screening for elder mistreatment (EM) is feasible, with a higher enrollment rate of 66% in dental clinics compared to 20% in medical clinics.

Patients were receptive to answering sensitive questions about elder mistreatment, indicating that clinics could serve as effective settings for identifying and addressing this serious issue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening for elder mistreatment in dental and medical clinics. Fulmer, T., Strauss, S., Russell, SL., et al.[2022]

The DETECT tool is being validated for use by medics to identify older adults at risk of elder mistreatment during emergency 911 calls, with a large-scale study involving approximately 59,400 older adults over 36 months.

Follow-up interviews with a subsample of 2,520 participants will assess the accuracy of the DETECT tool in determining elder mistreatment exposure, providing a robust method for improving the safety and well-being of older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol. Cannell, B., Weitlauf, J., Livingston, MD., et al.[2021]

The Vulnerable Elder Protection Team (VEPT) is a novel intervention designed to address elder mistreatment in emergency departments and hospitals, and its evaluation protocol aims to rigorously assess its impact on older adults.

The evaluation protocol includes a comprehensive logic model and multiple follow-up assessments, which may serve as a valuable framework for future studies on similar elder mistreatment programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initial steps in addressing the challenges of elder mistreatment evaluation: Protocol for evaluating the Vulnerable Elder Protection Team. Baek, D., Elman, A., Gottesman, E., et al.[2023]

Healthcare professionals play a crucial role in identifying elder mistreatment (EM), and various screening and assessment tools have been developed to assist them in this task.

There is a need for consensus on effective screening instruments for EM, emphasizing the importance of creating tools that allow for both quick screenings and comprehensive assessments in different clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Progress in elder abuse screening and assessment instruments. Fulmer, T., Guadagno, L., Bitondo Dyer, C., et al.[2022]

Emergency departments currently lack effective tools and processes for consistently screening and intervening in cases of elder abuse and neglect.

The National Collaboratory to Address Elder Mistreatment has created the Elder Mistreatment Emergency Department Assessment Profile (EM-EDAP), an organizational assessment tool designed to help EDs improve their practices in screening and supporting older adults at risk of mistreatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments. Dash, K., Breckman, R., Lees-Haggerty, K., et al.[2022]

A pilot program at the Louis Stokes Cleveland VA Medical Center successfully adapted the Elder Mistreatment Screening and Response Tool (EM-SART) to screen older Veterans for elder abuse, identifying 3.6% of those screened as potentially experiencing abuse.

The program's interdisciplinary approach, involving social workers, nurses, and technicians, has the potential to be expanded across the Veterans Health Administration, improving detection and intervention for elder abuse in a high-risk population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool. Makaroun, LK., Halaszynski, JJ., Rosen, T., et al.[2023]

The Elder Abuse Risk Assessment and Evaluation (EARAE) tool was developed and pilot tested on 189 suspected elder mistreatment cases, demonstrating its effectiveness in capturing abuse indicators and tracking risk factors.

The tool allows for measuring multiple case outcomes and the types of interventions used, highlighting its potential utility in improving elder abuse assessments in aging services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary Outcomes From a Community-Based Elder Abuse Risk and Evaluation Tool. Dauenhauer, J., Heffernan, K., Caccamise, PL., et al.[2020]

The EASI-sa, a self-administered tool for assessing elder abuse, was successfully completed by 210 seniors aged 65 and over, with 82.9% finishing it in under 2 minutes, indicating its feasibility for this age group.

Completing the EASI-sa significantly improved participants' understanding of elder abuse, suggesting that this tool not only assesses risk but also educates seniors about the issue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Seniors' self-administration of the Elder Abuse Suspicion Index (EASI): a feasibility study. Yaffe, MJ., Weiss, D., Lithwick, M.[2015]

The Emergency Department Elder Mistreatment Assessment Tool for Social Workers (ED-EMATS) was developed to help social workers effectively assess elder mistreatment in emergency settings, addressing their lack of training in this area.

This tool is the first of its kind specifically designed for social workers in the emergency department, aiming to enhance their confidence and standardize assessments across professionals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing the Emergency Department Elder Mistreatment Assessment Tool for Social Workers Using a Modified Delphi Technique. Elman, A., Rosselli, S., Burnes, D., et al.[2021]

Citations

1. England pubmed.ncbi.nlm.nih.gov

Screening for elder mistreatment in dental and medical clinics. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Initial steps in addressing the challenges of elder mistreatment evaluation: Protocol for evaluating the Vulnerable Elder Protection Team. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Progress in elder abuse screening and assessment instruments. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Preliminary Outcomes From a Community-Based Elder Abuse Risk and Evaluation Tool. [2020]

8. England pubmed.ncbi.nlm.nih.gov

Seniors' self-administration of the Elder Abuse Suspicion Index (EASI): a feasibility study. [2015]

9. United States pubmed.ncbi.nlm.nih.gov

Developing the Emergency Department Elder Mistreatment Assessment Tool for Social Workers Using a Modified Delphi Technique. [2021]