Evaluation of the Detection of Elder Mistreatment Through Emergency Care Technicians Project Screening Tool

• Type of Material: Article
• Authors: Brad Cannell, University of Texas Dallas; Melvin Livingston III, Emory University; Jason Burnett, UTHealth; Megin Parayil, University of Texas Dallas; Jennifer M. Reingle Gonzalez, University of Texas Dallas
• Language: English
• Date: 2020-05-07
• Publisher: American Medical Association
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Cannell B et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2020.4099
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 3
• Issue: 5
• Start Page: e204099
• End Page: e204099
• Grant/Funding Information: This project was supported by award 2014-MU-CX-0102 (Dr Cannell as principal investigator; Drs Livingston and Reingle Gonzalez as co-investigators) from the National Institute of Justice, Office of Justice Programs, US Department of Justice.; This research was also supported by award R01AG059993 (Dr Cannell as principal investigator; Drs Livingston and Reingle Gonzalez as co-investigators) from the National Institute on Aging of the National Institutes of Health.
• Keywords: Prevalence; Life Sciences & Biomedicine; Abuse; Association; General & Internal Medicine; Health; Science & Technology; Medicine, General & Internal
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Epidemiology; Health Sciences, Public Health; Psychology, Behavioral

Abstract

Importance: Elder mistreatment is underdetected and underreported. The more than 800 000 medics providing services in every county in the United States represent an important and underused surveillance system. Objective: To investigate the association between the Detection of Elder Mistreatment Through Emergency Care Technician (DETECT) screening tool use and the number of medic reports made to Adult Protective Services (APS) over a period of approximately 3 years. Design, Setting, and Participants: This quality improvement study used a difference in difference in differences design and included adults aged 65 years and older who were reported to Texas APS in the study region (246 cities in Denton, Johnson, and Tarrant Counties) between December 31, 2014, and February 28, 2018. Exposures: The DETECT screening tool. Main Outcomes and Measures: Reports to APS. Results: The mean (SD) age of the 11 178 older adults included in this study was 76 (8) years (range, 65-105 years); there was no reported data on patient sex. A total of 18 080 reports of elder mistreatment were recorded. Medics within the study region reported more cases of elder mistreatment during the implementation of the screening tool (relative risk [RR], 4.14; 95% CI, 3.25-5.27). After adjusting for changes in the number of elder mistreatment reports in the comparison groups (ie, underlying changes in reporting trends), the number of reports to APS increased (RR, 3.03; 95% CI, 2.06-4.46). The occurrence of elder mistreatment was validated in 83% (95% CI, 75%-91%) of the reports investigated by APS during the periods when medics did not have access to the screening tool compared with 82% (95% CI, 77%-87%) during the periods when medics had access to the screening tool, indicating that there were no differences in the proportion of reports that resulted in a validated APS investigation. Conclusions and Relevance: The findings suggest that incorporating the DETECT screening tool into the routine practices of medics is associated with substantial increases in the frequency with which clinicians report potential cases of elder mistreatment to APS.