Elder Abuse
Conditions
Brief summary
To test an interactive intervention to screen for Elder Abuse and Mistreatment (EM) in the Primary Care (PC) setting to promote self-identification and self-disclosure of EM.
Detailed description
The aim of this study is to perform a feasibility evaluation (N=80) of the VOICES screening tool among older adults in the primary care setting. If VOICES is feasible for identifying suspicion of EM in primary care setting, then it will be able to connect more victims of EM to necessary services and potentially prevent a multitude of poor EM outcomes
Interventions
BEHAVIORALVirtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure (VOICES)
Virtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure (VOICES) screening tool.
Sponsors
National Institute on Aging (NIA)
Yale University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
VOICES Elder Abuse Intervention
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age 60 years or older * Alert and oriented to person and place * Abbreviated Mental Test (AMT-4) score of 4 * Able to consent and communicate in English * Agrees and able to use the iPad
Exclusion criteria
* subjects who live in nursing homes or other long-term care sitting and do not reside in community setting * patients will be excluded if they cannot safely undergo the studies required for participation * subjects with clear signs of EM * Patient or clinician refusal to participate * severe hearing and vision impairment * COVID-19 positive
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participation | 5-10 minutes before VOICES intervention use. | Participation will be determined by the number of patients enrolled in VOICES. Successful enrollment of 80 older adults (N=80). |
| Usage | 5-10 minutes directly following VOICES intervention. | Usage will be determined by the number of patients enrolled in the study that complete the VOICES tool. Our target is to enroll 80 older adults (N=80). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Practicality | Actual time duration is assessed during VOICES use by the computer program (the actual duration of the patient's time using VOICES). Estimation of completed time is completed 5-10 minutes directly following VOICES intervention use. | Practicality will be assessed by observing the ease of VOICES use by patients. To do this, a series of steps will be watched to determine the efficiency of implementation measured by the average time (1) to consent & orient participants to the tool and (2) needed to complete VOICES documented by the Research Assistant; and (3) patients perceived time of VOICES as measured on post-survey. Each of these will be reported as part of the overall outcome. |
| Acceptability | 5-10 minutes directly following VOICES intervention use. | Participant satisfaction will be measured using post-use satisfaction survey. Responses will be measured via two 5-point Likert scales where generally higher values represent better outcomes: Scale 1- Satisfaction: Where 1= Very Dissatisfied, 2= Dissatisfied, 3= Neutral, 4= Satisfied, and 5= Very Satisfied. Scale 2- Agreement: Where 1= Strongly Disagree, 2= Disagree, 3= Neutral, 4= Agree, and and 5= Strongly Agree. |
| Accuracy | Measure collected up to directly following VOICES intervention to 1 week following VOICES intervention. | To understand the accuracy of the VOICES tool, a preliminary evaluation of the accuracy of VOICES as a screening tool in correctly classifying elder mistreatment (EM) cases that were referred to Adult Protective Services (APS). The percent correct classification will be reported. |
| Efficacy of the Brief Negotiation Interview | Measure collected 5-10 minutes directly following VOICES intervention. | To look at how many patients changed their readiness to disclose after completing the Brief Negotiation Interview (BNI) |
| Demand | 5-10 minutes directly following VOICES intervention use. | Demand will be assess through examining how likely will VOICES be used by patients. To do this, the size of target population of elder mistreatment (EM) victims in the Primary Care setting will be measured by the percent who screen positive for EM and the percent who receive the Brief Negotiation Interview (BNI) portion of VOICES. The BNI is a method designed to enhance identifying EM among older adults-- the process intends to encourage reflection of the user with their behaviors and whether they are willing to seek change by identifying with and reporting their abuse. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Older Adults in Primary Care Setting The number of eligible older adults enrolled in the Virtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure (VOICES) study in the primary care setting. | 80 |
| Total | 80 |
Baseline characteristics
| Characteristic | Older Adults in Primary Care Setting |
|---|---|
| Age, Continuous | 75.1 years STANDARD_DEVIATION 7.87 |
| Confidence in Using Technology | 6.74 units on a scale STANDARD_DEVIATION 2.83 |
| Education Associate's Degree | 7 Participants |
| Education College degree (bachelor's program) | 9 Participants |
| Education Doctorate or professional degree | 11 Participants |
| Education Graduate degree (master's program) | 26 Participants |
| Education High School Graduate or GED | 10 Participants |
| Education High School not Completed | 3 Participants |
| Education Some college or associate's degree program | 14 Participants |
| Employment Status Full-time | 13 Participants |
| Employment Status Part-time | 6 Participants |
| Employment Status Retired/Not Employed | 61 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 76 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Has Health Care Assistant No | 6 Participants |
| Has Health Care Assistant Unknown | 3 Participants |
| Has Health Care Assistant Yes | 71 Participants |
| Has Living Will No | 30 Participants |
| Has Living Will Unknown | 5 Participants |
| Has Living Will Yes | 45 Participants |
| Household Income Between 100k to 149k | 14 Participants |
| Household Income Between 25k to 34k | 3 Participants |
| Household Income Between 35k to 49k | 3 Participants |
| Household Income Between 50k to 74k | 15 Participants |
| Household Income Between 75k to 99k | 6 Participants |
| Household Income Less than 25k | 11 Participants |
| Household Income More than 150k | 15 Participants |
| Household Income Refused/Unknown | 13 Participants |
| Internet Usage 1-2 Times a Month | 2 Participants |
| Internet Usage 1-2 Times a Week | 4 Participants |
| Internet Usage Every Day | 63 Participants |
| Internet Usage Rarely | 11 Participants |
| Living Arrangement Assisted living | 4 Participants |
| Living Arrangement In my home | 74 Participants |
| Living Arrangement In someone else's home | 2 Participants |
| Marital Status Divorced | 13 Participants |
| Marital Status Married or Co-habituating | 45 Participants |
| Marital Status Other | 0 Participants |
| Marital Status Refused/Unknown | 0 Participants |
| Marital Status Separated | 3 Participants |
| Marital Status Single or Never Married | 11 Participants |
| Marital Status Widowed | 8 Participants |
| Number of Household Members | 2 persons STANDARD_DEVIATION 0.84 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 13 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 66 Participants |
| Region of Enrollment United States | 80 participants |
| Sex: Female, Male Female | 49 Participants |
| Sex: Female, Male Male | 31 Participants |
| Veteran Status No | 70 Participants |
| Veteran Status Yes | 10 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 80 |
| other Total, other adverse events | 0 / 80 |
| serious Total, serious adverse events | 0 / 80 |
Outcome results
Primary
Participation
Participation will be determined by the number of patients enrolled in VOICES. Successful enrollment of 80 older adults (N=80).
Time frame: 5-10 minutes before VOICES intervention use.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Older Adults Approached for the Study | Participation | 80 Participants |
95% CI: [73.7, 88.8]
Primary
Usage
Usage will be determined by the number of patients enrolled in the study that complete the VOICES tool. Our target is to enroll 80 older adults (N=80).
Time frame: 5-10 minutes directly following VOICES intervention.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Older Adults Approached for the Study | Usage | 80 Participants |
95% CI: [95.4, 100]
Other Pre-specified
Acceptability
Participant satisfaction will be measured using post-use satisfaction survey. Responses will be measured via two 5-point Likert scales where generally higher values represent better outcomes: Scale 1- Satisfaction: Where 1= Very Dissatisfied, 2= Dissatisfied, 3= Neutral, 4= Satisfied, and 5= Very Satisfied. Scale 2- Agreement: Where 1= Strongly Disagree, 2= Disagree, 3= Neutral, 4= Agree, and and 5= Strongly Agree.
Time frame: 5-10 minutes directly following VOICES intervention use.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Older Adults Approached for the Study | Acceptability | Level of confidentiality and privacy provided while using VOICES (Scale 1) | 4.45 units on a scale | Standard Deviation 0.96 |
| Older Adults Approached for the Study | Acceptability | The time it took to complete using the VOICES tool (Scale 1) | 4.67 units on a scale | Standard Deviation 0.69 |
| Older Adults Approached for the Study | Acceptability | Ability to complete VOICES on their own on the iPad, without staff assistance (Scale 1) | 4.60 units on a scale | Standard Deviation 0.74 |
| Older Adults Approached for the Study | Acceptability | Time to complete the tool on the iPad was short (Scale 2) | 4.42 units on a scale | Standard Deviation 0.82 |
| Older Adults Approached for the Study | Acceptability | Participant felt engaged in the tool throughout the process (Scale 2) | 4.29 units on a scale | Standard Deviation 0.96 |
| Older Adults Approached for the Study | Acceptability | Audio and visual aids of the tool were helpful (Scale 2) | 4.15 units on a scale | Standard Deviation 0.98 |
| Older Adults Approached for the Study | Acceptability | Participant felt fonts, size and colors of text in the tool were appropriate and readable (Scale 2) | 4.64 units on a scale | Standard Deviation 0.72 |
| Older Adults Approached for the Study | Acceptability | Using this tool on the iPad was very easy (Scale 2) | 4.71 units on a scale | Standard Deviation 0.66 |
| Older Adults Approached for the Study | Acceptability | I was comfortable answering questions on the iPad (Scale 2) | 4.75 units on a scale | Standard Deviation 0.61 |
| Older Adults Approached for the Study | Acceptability | Using the iPad and the headphones provided more privacy (Scale 2) | 4.41 units on a scale | Standard Deviation 0.84 |
| Older Adults Approached for the Study | Acceptability | Participant feels comfortable discussing mistreatment with a doctor or medical professional (Scale2) | 4.46 units on a scale | Standard Deviation 0.78 |
| Older Adults Approached for the Study | Acceptability | VOICES is appropriate for learning about mistreatment (Scale 2) | 4.54 units on a scale | Standard Deviation 0.67 |
| Older Adults Approached for the Study | Acceptability | VOICES is appropriate to be used in primary care setting (Scale 2) | 4.11 units on a scale | Standard Deviation 1.06 |
| Older Adults Approached for the Study | Acceptability | The participant was able to complete VOICES on the iPad on their own (Scale 2) | 4.54 units on a scale | Standard Deviation 0.83 |
| Older Adults Approached for the Study | Acceptability | Using VOICES on the iPad was a frustrating experience (Scale 2) | 1.74 units on a scale | Standard Deviation 1.1 |
| Older Adults Approached for the Study | Acceptability | The instructions provided by VOICES digital coach were clear and easy to follow (Scale 2) | 4.70 units on a scale | Standard Deviation 0.56 |
| Older Adults Approached for the Study | Acceptability | Participant confidence understanding mistreatment and resources after using VOICES (Scale 2) | 4.41 units on a scale | Standard Deviation 0.85 |
| Older Adults Approached for the Study | Acceptability | Participant feels safer after using VOICES on the iPad (Scale 2) | 3.80 units on a scale | Standard Deviation 1.08 |
| Older Adults Approached for the Study | Acceptability | The participant learned new, useful things about elder mistreatment (Scale 2) | 4.05 units on a scale | Standard Deviation 0.98 |
| Older Adults Approached for the Study | Acceptability | Participant would like to see VOICES used by others in the community (ie. doctor's office) (Scale 2) | 4.47 units on a scale | Standard Deviation 0.76 |
Other Pre-specified
Accuracy
To understand the accuracy of the VOICES tool, a preliminary evaluation of the accuracy of VOICES as a screening tool in correctly classifying elder mistreatment (EM) cases that were referred to Adult Protective Services (APS). The percent correct classification will be reported.
Time frame: Measure collected up to directly following VOICES intervention to 1 week following VOICES intervention.
Population: The number of participants who used VOICES to completion and screened positive for suspicion of elder mistreatment (n=6).
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Older Adults Approached for the Study | Accuracy | Participants substantiated for elder mistreatment by the social worker | 6 Participants |
| Older Adults Approached for the Study | Accuracy | Participants referred to APS by the social worker | 1 Participants |
| Older Adults Approached for the Study | Accuracy | Cases referred to APS that were substantiated and opened | 1 Participants |
95% CI: [3.6, 62.4]
Other Pre-specified
Demand
Demand will be assess through examining how likely will VOICES be used by patients. To do this, the size of target population of elder mistreatment (EM) victims in the Primary Care setting will be measured by the percent who screen positive for EM and the percent who receive the Brief Negotiation Interview (BNI) portion of VOICES. The BNI is a method designed to enhance identifying EM among older adults-- the process intends to encourage reflection of the user with their behaviors and whether they are willing to seek change by identifying with and reporting their abuse.
Time frame: 5-10 minutes directly following VOICES intervention use.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Older Adults Approached for the Study | Demand | Participants who screened positive for suspicion of elder mistreatment | 6 Participants |
| Older Adults Approached for the Study | Demand | Participants who self-identified with elder mistreatment | 3 Participants |
| Older Adults Approached for the Study | Demand | Participants who self-reported elder mistreatment | 3 Participants |
| Older Adults Approached for the Study | Demand | Participants who received the Brief Negotiated Interview (BNI) pathway | 4 Participants |
95% CI: [3.5, 15.4]
Other Pre-specified
Efficacy of the Brief Negotiation Interview
To look at how many patients changed their readiness to disclose after completing the Brief Negotiation Interview (BNI)
Time frame: Measure collected 5-10 minutes directly following VOICES intervention.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Older Adults Approached for the Study | Efficacy of the Brief Negotiation Interview | 1 Participants |
95% CI: [4.6, 69.9]
Other Pre-specified
Practicality
Practicality will be assessed by observing the ease of VOICES use by patients. To do this, a series of steps will be watched to determine the efficiency of implementation measured by the average time (1) to consent & orient participants to the tool and (2) needed to complete VOICES documented by the Research Assistant; and (3) patients perceived time of VOICES as measured on post-survey. Each of these will be reported as part of the overall outcome.
Time frame: Actual time duration is assessed during VOICES use by the computer program (the actual duration of the patient's time using VOICES). Estimation of completed time is completed 5-10 minutes directly following VOICES intervention use.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Older Adults Approached for the Study | Practicality | Actual VOICES Duration | 9.31 minutes | Standard Deviation 4.33 |
| Older Adults Approached for the Study | Practicality | Actual Consent Duration | 14.09 minutes | Standard Deviation 4.54 |
| Older Adults Approached for the Study | Practicality | Participant estimated time to completion | 18.38 minutes | Standard Deviation 11.55 |