- Email: [email protected]
Elder mistreatment as an emerging public health concern: Identifying knowledge gaps among caregivers and social services agencies
P234 O3-07-05
Podium Presentations: Tuesday, July 21, 2015 ELDER MISTREATMENT AS AN EMERGING PUBLIC HEALTH CONCERN: IDENTIFYING KNOWLEDGE GAPS AMONG CAREGIVERS AND SOCIAL SERVICES AGENCIES
Linda Kincaid1, Robert Fettgather2, 1De Anza College, Cupertino, CA, USA; 2Mission College, San Jose, CA, USA. Contact e-mail: nanosafety@ gmail.com Project Description: Elder mistreatment is a growing concern, and el-
ders with cognitive impairments are especially susceptible to mistreatment. Case studies establish that caregivers and social service agencies lack needed training on indicators of neglect and abuse. This presentation will clarify indicators of elder mistreatment, the most prevalent types of elder mistreatment, and the most prevalent perpetrators of elder mistreatment. Commonly identified forms of elder mistreatment are neglect, financial abuse, emotional abuse, physical abuse, and sexual abuse. Indicators of abuse are provided by the California’s Department of Justice and by researchers in the field. Case studies indicate knowledge gaps among caregivers, medical professionals, and social services agencies. Knowledge gaps concerning common indicators are apparent in all forms of elder mistreatment. A profound knowledge gap surrounding indicators of sexual abuse requires special leadership from the public health community and the medical profession. Case studies present indicators of mistreatment that were documented by numerous service providers, including caregivers, nurses and physicians. Examples illustrate the need for staff development to better identify indicators of abuse and to appropriately respond to those indicators. Leadership across disciplines is needed for optimal dementia care and protection of this vulnerable population. The National Center on Elder Abuse provided a newsfeed of elder abuse cases selected by professional journalists as relevant to the public interest. A survey of those news stories illustrates the most prevalent forms of elder mistreatment and the most prevalent categories of perpetrators. Prevalence data are necessary for staff development and for optimal allocation of resources. The survey can also serve to set priorities and to inform policy development.
O3-07-06
ADAPTING THE TINETTI TOOL FOR BALANCE AND GAIT FOR PERSONS WITH DEMENTIA
Alison Douglas1,2, Bettina von Kampen3, Carrie McAiney1, Shelley Wright2, 1McMaster University, Hamilton, ON, Canada; 2St. Joseph’s Healthcare, Hamilton, ON, Canada; 3St. Joseph’s Healthcare, Hamilton, ON, Canada. Contact e-mail: [email protected] Background: A recent review of the literature reveals an absence
of standardized measures to assess mobility in persons with advanced dementia. Persons with moderate to severe dementia have significant difficulty adhering to instructions. The aim of the study was to develop a standardized measure of gait and balance for use with persons with dementia. We chose to modify the ‘Tinetti Assessment Tool for Balance and Gait’ (Tinetti, 1986) because many of the items are based on observation. Two items were omitted (covering eyes, push) and one was revised to a more easily observable task (turning 360 degrees to turning 180 degrees). Modification of these items requires analysis of reliability prior to establishing validity. We aim to determine the inter-rater and test-retest reliability of ‘Tinetti Assessment Tool for Balance and Gait- Dementia’ Methods: Recruitment—Potential participants were identified by members of their care team and consent sought from substitute decision makers (SDMs). Participants with dementia were
included and excluded with delirium or medical instability. Data collection—Inter-rater reliability: Participants were observed and scored simultaneously by two raters familiar with the written instructions (physiotherapy, occupational therapy or nursing staff). Test-retest reliability—The test was re-administered after 10 to 30 minutes. Results: A total of n¼20 participants were recruited and included. The mean age of participants was 75, with the majority being female (n¼11, 55%). All were diagnosed with dementia or cognitive impairment. Secondary diagnoses include heart disease, diabetes and Parkinson’s disease. The mean cognitive assessment (SMMSE) score was 8.5/30 (n¼12). Inter-rater reliability of the total score was high (ICC¼ 0.85) as was test-retest reliability (ICC¼0.92). Conclusions: These results are comparable to established reliability of the original Tinetti tool (ICC>0.8) (Kekelmeyer, Kloos, Thomas & Kostyk, 2007). The results indicate that the modified measure has sufficient reliability to commence validity testing. Developing a measure that assesses functional changes in this population is important for determining the impact of mobilization and least restraint programs for people with dementia in long term care. Further study will establish validity of the cut score for predicting falls risk. TUESDAY, JULY 21, 2015 ORAL SESSIONS O3-08 DEMENTIA CARE PRACTICE: DEMENTIA CARE PRACTICES ACROSS CULTURES AND SPECIAL POPULATIONS O3-08-01
TAILORING THE COPING WITH CAREGIVING EVIDENCE-BASED PROGRAM FOR ETHNIC/ RACIAL MINORITY COMMUNITIES
Marian Tzuang1, Kala Mehta2, Nusha Askari3, Dolores GallagherThompson4, 1Stanford Geriatric Education Center, Stanford, CA, USA; 2 University of California, San Francisco, San Francisco, CA, USA; 3Notre Dame de Namur University, Belmont, CA, USA; 4Stanford University, Stanford, CA, USA. Contact e-mail: [email protected] Project Description: Families bear the front of most of the caregiving needs for persons with dementia. For race/ethnic diverse communities in the US, caregiver burden is high due to several underlying processes: 1) race/ethnic diversity is growing in the US; 2) older diverse elders with a diagnosis of neurocognitive disorders are often cared for at home, not in nursing homes; 3) there is a dearth of bilingual/bicultural individuals in professions that address caregiver burden (social workers, psychologists, therapists). In order to test the theoretical underpinnings of applying the Coping with Caregiving evidence based program to minority older adults, we performed a systematic review and critical synthesis of prior Coping with Caregiving curriculae. The four authors read and reviewed all prior available curriculum with a view to applying the past framework to Asian Indian and Chinese (Mandarin speaking) populations. 8 curriculae were reviewed. They varied in length from four to 13 week programs. Their literacy level ranged from 6th grade to 12th grade and above. Two were online and the rest were administered by trained facilitators using an in-person format. Results from a pilot study using these modifications with the South Asian Indian caregivers will be presented at the meeting, but our emphasis will be on describing the process by which cultural adaptations and modifications were made to the original content, and how we took into account multiple types of
Podium Presentations: Tuesday, July 21, 2015 ELDER MISTREATMENT AS AN EMERGING PUBLIC HEALTH CONCERN: IDENTIFYING KNOWLEDGE GAPS AMONG CAREGIVERS AND SOCIAL SERVICES AGENCIES
Linda Kincaid1, Robert Fettgather2, 1De Anza College, Cupertino, CA, USA; 2Mission College, San Jose, CA, USA. Contact e-mail: nanosafety@ gmail.com Project Description: Elder mistreatment is a growing concern, and el-
ders with cognitive impairments are especially susceptible to mistreatment. Case studies establish that caregivers and social service agencies lack needed training on indicators of neglect and abuse. This presentation will clarify indicators of elder mistreatment, the most prevalent types of elder mistreatment, and the most prevalent perpetrators of elder mistreatment. Commonly identified forms of elder mistreatment are neglect, financial abuse, emotional abuse, physical abuse, and sexual abuse. Indicators of abuse are provided by the California’s Department of Justice and by researchers in the field. Case studies indicate knowledge gaps among caregivers, medical professionals, and social services agencies. Knowledge gaps concerning common indicators are apparent in all forms of elder mistreatment. A profound knowledge gap surrounding indicators of sexual abuse requires special leadership from the public health community and the medical profession. Case studies present indicators of mistreatment that were documented by numerous service providers, including caregivers, nurses and physicians. Examples illustrate the need for staff development to better identify indicators of abuse and to appropriately respond to those indicators. Leadership across disciplines is needed for optimal dementia care and protection of this vulnerable population. The National Center on Elder Abuse provided a newsfeed of elder abuse cases selected by professional journalists as relevant to the public interest. A survey of those news stories illustrates the most prevalent forms of elder mistreatment and the most prevalent categories of perpetrators. Prevalence data are necessary for staff development and for optimal allocation of resources. The survey can also serve to set priorities and to inform policy development.
O3-07-06
ADAPTING THE TINETTI TOOL FOR BALANCE AND GAIT FOR PERSONS WITH DEMENTIA
Alison Douglas1,2, Bettina von Kampen3, Carrie McAiney1, Shelley Wright2, 1McMaster University, Hamilton, ON, Canada; 2St. Joseph’s Healthcare, Hamilton, ON, Canada; 3St. Joseph’s Healthcare, Hamilton, ON, Canada. Contact e-mail: [email protected] Background: A recent review of the literature reveals an absence
of standardized measures to assess mobility in persons with advanced dementia. Persons with moderate to severe dementia have significant difficulty adhering to instructions. The aim of the study was to develop a standardized measure of gait and balance for use with persons with dementia. We chose to modify the ‘Tinetti Assessment Tool for Balance and Gait’ (Tinetti, 1986) because many of the items are based on observation. Two items were omitted (covering eyes, push) and one was revised to a more easily observable task (turning 360 degrees to turning 180 degrees). Modification of these items requires analysis of reliability prior to establishing validity. We aim to determine the inter-rater and test-retest reliability of ‘Tinetti Assessment Tool for Balance and Gait- Dementia’ Methods: Recruitment—Potential participants were identified by members of their care team and consent sought from substitute decision makers (SDMs). Participants with dementia were
included and excluded with delirium or medical instability. Data collection—Inter-rater reliability: Participants were observed and scored simultaneously by two raters familiar with the written instructions (physiotherapy, occupational therapy or nursing staff). Test-retest reliability—The test was re-administered after 10 to 30 minutes. Results: A total of n¼20 participants were recruited and included. The mean age of participants was 75, with the majority being female (n¼11, 55%). All were diagnosed with dementia or cognitive impairment. Secondary diagnoses include heart disease, diabetes and Parkinson’s disease. The mean cognitive assessment (SMMSE) score was 8.5/30 (n¼12). Inter-rater reliability of the total score was high (ICC¼ 0.85) as was test-retest reliability (ICC¼0.92). Conclusions: These results are comparable to established reliability of the original Tinetti tool (ICC>0.8) (Kekelmeyer, Kloos, Thomas & Kostyk, 2007). The results indicate that the modified measure has sufficient reliability to commence validity testing. Developing a measure that assesses functional changes in this population is important for determining the impact of mobilization and least restraint programs for people with dementia in long term care. Further study will establish validity of the cut score for predicting falls risk. TUESDAY, JULY 21, 2015 ORAL SESSIONS O3-08 DEMENTIA CARE PRACTICE: DEMENTIA CARE PRACTICES ACROSS CULTURES AND SPECIAL POPULATIONS O3-08-01
TAILORING THE COPING WITH CAREGIVING EVIDENCE-BASED PROGRAM FOR ETHNIC/ RACIAL MINORITY COMMUNITIES
Marian Tzuang1, Kala Mehta2, Nusha Askari3, Dolores GallagherThompson4, 1Stanford Geriatric Education Center, Stanford, CA, USA; 2 University of California, San Francisco, San Francisco, CA, USA; 3Notre Dame de Namur University, Belmont, CA, USA; 4Stanford University, Stanford, CA, USA. Contact e-mail: [email protected] Project Description: Families bear the front of most of the caregiving needs for persons with dementia. For race/ethnic diverse communities in the US, caregiver burden is high due to several underlying processes: 1) race/ethnic diversity is growing in the US; 2) older diverse elders with a diagnosis of neurocognitive disorders are often cared for at home, not in nursing homes; 3) there is a dearth of bilingual/bicultural individuals in professions that address caregiver burden (social workers, psychologists, therapists). In order to test the theoretical underpinnings of applying the Coping with Caregiving evidence based program to minority older adults, we performed a systematic review and critical synthesis of prior Coping with Caregiving curriculae. The four authors read and reviewed all prior available curriculum with a view to applying the past framework to Asian Indian and Chinese (Mandarin speaking) populations. 8 curriculae were reviewed. They varied in length from four to 13 week programs. Their literacy level ranged from 6th grade to 12th grade and above. Two were online and the rest were administered by trained facilitators using an in-person format. Results from a pilot study using these modifications with the South Asian Indian caregivers will be presented at the meeting, but our emphasis will be on describing the process by which cultural adaptations and modifications were made to the original content, and how we took into account multiple types of