Assisted Living, Resident to Resident Elder Mistreatment
Conditions
Brief summary
Resident-to-resident elder mistreatment (R-REM) is a significant problem in long-term services and support settings (LTSS), and likely to cause physical and or psychological distress. The proposed project tests an intervention developed for use by LTSS staff. As such, it represents an important step in the process of developing approaches for ameliorating and preventing R-REM in assisted living residences which house residents with dementia and related behavioral disorders, and is thus likely to have significant public health impact.
Interventions
OTHERR-REM training
three training modules for front-line long-term care staff to aid in recognition, management and reporting of R-REM
Sponsors
Cornell University
Weill Medical College of Cornell University
National Institute on Aging (NIA)
Hebrew Home at Riverdale
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Masking description
Research Assistants
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* all long term residents residing at each facility at baseline, for those unable to consent, proxy consent will be sought
Exclusion criteria
* residents receiving hospice care, * facilities will have the option to exclude individuals for selected reasons, (e.g., severe psychosis)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Falls, Accidents, and Injuries | Six months before baseline through twelve month follow-up | Impact on falls, accidents, and injuries as measured by incident reports |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Affect | Baseline, 6- and 12- month follow-up | Impact on participant affect as measured by the Feeling Tone Questionnaire (FTQ). A 16-item scale with a theoretical range of 0-32. Higher score indicates lower affect (depressed direction). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Staff Knowledge Module 1 | Pre and post training evaluation: Immediately before and immediately after training | Module 1: Recognizing R-REM 10-item knowledge test related to recognizing resident-to-resident elder mistreatment The potential (theoretical) total score range is 0-10 with a higher score indicating more knowledge (better outcome) |
| Staff Recognition, Reporting and Care Planning of Resident-to-resident Elder Mistreatment Events | baseline through 1-year follow-up | Statistical Analysis 1: Count of participants with events reported by the staff through the informant interview measure Statistical Analysis 2: Count of events reported through the Behavior Recognition Documentation Sheets (BRDS) |
| Staff Knowledge Module 2 | Administered immediately before and immediately after training was provided | Module 2: Management of R-REM 10-item knowledge tests The potential (theoretical) range is 0-10 with a higher score indicating more knowledge (better outcome) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| R-REM Training Intervention to Improve Recognition and Reporting 3 module training for frontline staff in assisted living facilities related to recognizing and management of resident-to-resident elder mistreatment, including the Support, Evaluate, Act, Report, Care plan, and Help to avoid (SEARCH) approach | 495 |
| Usual Care Usual care arm. Assisted Living facilities assigned to Usual Care. | 435 |
| Total | 930 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 83 | 78 |
| Overall Study | discharge from facility | 84 | 84 |
| Overall Study | Withdrawal by Subject | 4 | 1 |
Baseline characteristics
| Characteristic | R-REM Training Intervention to Improve Recognition and Reporting | Total | Usual Care |
|---|---|---|---|
| Age, Continuous | 87.68 years STANDARD_DEVIATION 6.92 | 88.00 years STANDARD_DEVIATION 7.21 | 88.36 years STANDARD_DEVIATION 7.52 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 9 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 363 Participants | 683 Participants | 320 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 130 Participants | 238 Participants | 108 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 5 Participants | 12 Participants | 7 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 11 Participants | 8 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 11 Participants | 13 Participants | 2 Participants |
| Race (NIH/OMB) White | 476 Participants | 894 Participants | 418 Participants |
| Region of Enrollment United States | 495 Participant | 930 Participant | 435 Participant |
| Sex: Female, Male Female | 392 Participants | 738 Participants | 346 Participants |
| Sex: Female, Male Male | 103 Participants | 192 Participants | 89 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 83 / 495 | 78 / 435 |
| other Total, other adverse events | 0 / 495 | 0 / 435 |
| serious Total, serious adverse events | 0 / 495 | 0 / 435 |
Outcome results
Primary
Falls, Accidents, and Injuries
Impact on falls, accidents, and injuries as measured by incident reports
Time frame: Six months before baseline through twelve month follow-up
Population: Analyses were intent to treat. All those randomized were included.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| R-REM Training to Improve Recognition and Reporting | Falls, Accidents, and Injuries | 141 participants |
| Usual Care | Falls, Accidents, and Injuries | 115 participants |
p-value: 0.417Mixed Models Analysis
Secondary
Affect
Impact on participant affect as measured by the Feeling Tone Questionnaire (FTQ). A 16-item scale with a theoretical range of 0-32. Higher score indicates lower affect (depressed direction).
Time frame: Baseline, 6- and 12- month follow-up
Population: The FTQ was collected only on the subset of participants who were capable of response
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R-REM Training to Improve Recognition and Reporting | Affect | Baseline | 6.29 score on a scale | Standard Deviation 5.16 |
| R-REM Training to Improve Recognition and Reporting | Affect | 6-month follow up | 6.37 score on a scale | Standard Deviation 5.92 |
| R-REM Training to Improve Recognition and Reporting | Affect | 12-month follow-up | 5.30 score on a scale | Standard Deviation 4.1 |
| Usual Care | Affect | Baseline | 6.65 score on a scale | Standard Deviation 4.79 |
| Usual Care | Affect | 6-month follow up | 6.44 score on a scale | Standard Deviation 4.95 |
| Usual Care | Affect | 12-month follow-up | 6.11 score on a scale | Standard Deviation 4.47 |
Other Pre-specified
Staff Knowledge Module 1
Module 1: Recognizing R-REM 10-item knowledge test related to recognizing resident-to-resident elder mistreatment The potential (theoretical) total score range is 0-10 with a higher score indicating more knowledge (better outcome)
Time frame: Pre and post training evaluation: Immediately before and immediately after training
Population: Front-line staff in Intervention group nursing homes. Please note that this n differs from the participant n (assisted living residents) described in the flow diagram because this outcome is based on a different sample (staff).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| R-REM Training to Improve Recognition and Reporting | Staff Knowledge Module 1 | 6.17 score on a scale | Standard Deviation 1.97 |
| Usual Care | Staff Knowledge Module 1 | 7.53 score on a scale | Standard Deviation 1.95 |
Comparison: Analysis of adjusted mean differences using a paired t test procedurep-value: <0.00195% CI: [-1.708, -0.998]paired t test
Other Pre-specified
Staff Knowledge Module 2
Module 2: Management of R-REM 10-item knowledge tests The potential (theoretical) range is 0-10 with a higher score indicating more knowledge (better outcome)
Time frame: Administered immediately before and immediately after training was provided
Population: Front-line staff in Intervention group nursing homes. Please note that this n differs from the participant n (assisted living residents) described in the flow diagram because this outcome is based on a different sample (staff).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| R-REM Training to Improve Recognition and Reporting | Staff Knowledge Module 2 | 7.59 score on a scale | Standard Deviation 2 |
| Usual Care | Staff Knowledge Module 2 | 8.04 score on a scale | Standard Deviation 1.52 |
p-value: 0.00595% CI: [-0.774, -0.138]paired t test
Other Pre-specified
Staff Recognition, Reporting and Care Planning of Resident-to-resident Elder Mistreatment Events
Statistical Analysis 1: Count of participants with events reported by the staff through the informant interview measure Statistical Analysis 2: Count of events reported through the Behavior Recognition Documentation Sheets (BRDS)
Time frame: baseline through 1-year follow-up
Population: Nursing home staff informants.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| R-REM Training to Improve Recognition and Reporting | Staff Recognition, Reporting and Care Planning of Resident-to-resident Elder Mistreatment Events | 478 Participants |
| Usual Care | Staff Recognition, Reporting and Care Planning of Resident-to-resident Elder Mistreatment Events | 415 Participants |
p-value: 0.006495% CI: [0.1797, 1.0931]Poisson regression
p-value: 0.00195% CI: [-5.5827, -2.4509]Poisson regression