BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: BACKGROUND:Frail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. The Elder-Friendly Care (EFC) program was designed to improve the care, experiences, and outcomes of frail older adults. The project supported 8 Early Adoption Sites (EAS) in a large Canadian healthcare organization by providing multiple strategies, educational opportunities, and resources. The purpose of this study was to assess the usefulness of EFC educational materials and resources, staff practice changes and perceptions in pilot sites, and readiness for scale and spread. METHODS:The study was conducted from May 2017 to June 2018 using a mixed-methods approach incorporating the Kirkpatrick Model of Training/Evaluation. A total of 76 Direct Care Staff participated in the staff survey, which assessed their awareness of, satisfaction with, and utilization of EFC principles, resources, and practices. Additionally, 12 interviews were conducted with staff who were directly involved in site implementation of EFC. RESULTS:Most survey participants were aware (86%, n = 63) of the EFC program, and 85% (n = 41) indicated they or their site/unit had implemented EFC. Out of these 41 participants, the most common practice changes identified were: incorporating alternatives to restraint (81%, n = 33), decreased use of pharmacological restraint (78%, n = 32), and patient and family care planning (76%, n = 31). Participants that attended all 3 EFC Learning Workshops (LWs) were significantly more likely to recommend the EFC Toolkit to others (87% versus 40%; χ2 = 8.82, p < 0.01) compared to participants attending less than 3 EFC LWs. Interview participants indicated that the program was well structured and flexible as sites/units could adopt changes that suited their individual sites, needs, contexts, and challenges. CONCLUSIONS:The educational materials and resources used for the EFC project are useful and appreciated by the Direct Care Staff. Further, participants perceive the EFC intervention as effective in creating positive practice change and useful in reducing hospital-related complications for older patients. Future implementation will investigate the impact of EFC on system-level outcomes in acute care.

背景与目标： 背景：体弱的老年患者存在与入院原因无关的身体和认知功能下降的风险。老年护理（EFC）计划旨在改善脆弱的老年人的护理，经验和结果。该项目通过提供多种策略，教育机会和资源，为加拿大一家大型医疗组织的8个早期采用站点（EAS）提供了支持。这项研究的目的是评估EFC教育材料和资源的有效性，工作人员在试点实践中的变化和看法，以及对规模和传播的准备程度。
方法：该研究于2017年5月至2018年6月进行，采用了结合Kirkpatrick培训/评估模型的混合方法。共有76名直接护理人员参加了员工调查，该调查评估了他们对EFC原则，资源和实践的认识，满意度和使用情况。此外，对直接参与EFC现场实施的工作人员进行了12次采访。
结果：大多数调查参与者知道（86％，n = 63），而85％（n = 41）表示他们或他们的站点/单位已实施EFC。在这41名参与者中，确定的最常见的实践改变是：纳入约束替代方法（81％，n = 33），减少药物约束的使用（78％，n = 32），以及患者和家庭护理计划（76％） ，n = 31）。与参加少于三个EFC LW的参与者相比，参加所有三个EFC学习研讨会（LW）的参与者更有可能向其他人推荐EFC工具包（87％比40％；χ2== 8.82，p <0.01）。受访者表示，该计划结构合理且灵活，因为站点/单位可以采用适合其各自站点，需求，环境和挑战的更改。
结论：用于EFC项目的教育材料和资源非常有用，并受到直接护理人员的赞赏。此外，参与者认为EFC干预可以有效地产生积极的实践变化，并有助于减少老年患者的医院相关并发症。未来的实施将调查EFC对急性护理系统级结局的影响。

BACKGROUND & AIMS: BACKGROUND::Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. OBJECTIVES::The goal was to understand caregivers' concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges of professional ethics within the care setting. RESEARCH DESIGN::A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland. PARTICIPANTS AND RESEARCH CONTEXT::A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels. ETHICAL CONSIDERATIONS::Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland] (2014-015). FINDINGS::Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation. DISCUSSION::Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics. CONCLUSION::Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities.

背景与目标： 背景：在护理机构中忽视和虐待长者是媒体中经常发生的问题。照料机构中的老年人由于身体，认知和言语上的限制而容易受到伤害。这种漏洞可能使他们更容易受到严重依赖的看护人的虐待。
目的：:目的是了解护理人员对确保正确和适当治疗的关注，以及他们对老年人的忽视和虐待的经历。本文探讨了护理环境中职业道德的资源和挑战。
研究设计：：进行了一项研究，以探索在瑞士西北地区为养老院，老年病院和急救服务的老年患者提供的护理质量。
参与者和研究背景：：总共23次半结构化访谈是针对不同经验水平的护理人员进行的。
道德方面的考虑：：道德上的批准由主管的地区道德委员会Ethikkomission Nordwest-Zentralschweiz EKNZ [西北和中部道德委员会]（2014-015）批准。
结果：：我们的数据分析提出了三个主题：专业身份，专业背景和专业关系。我们的发现表明这三个主题之间存在共同的脆弱性，这是护理人员与老年患者之间相互作用的特征。研究参与者认为，错误，忽视和虐待的发生是他们自身脆弱性的后果，因为他们无法满足过度紧张的工作环境的要求。
讨论：:这种相互脆弱性的不同方面都作为职业道德的挑战进行了描述和严格讨论。
结论：早期教育，持续培训以及机构的更好管理和回应对于保持专业水平同时处理相互脆弱性是必要的。

BACKGROUND & AIMS: :This article describes the cross-cultural adaptation, for use in Brazil, of the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST), used to identify risk of domestic violence against the elderly. Evaluating the conceptual and item equivalences, the article concludes that they are pertinent in the Brazilian context. Semantic equivalence covered the terms' correspondence in referential/denotative meaning and the items' general/connotative correspondence per se. Measurement equivalence was investigated by means of psychometric properties. As with the original instrument in English, the factor analysis revealed three dimensions. Six of the seven items loaded satisfactorily in factor 1 ("situation of potential abuse" scale). Internal consistency proved reasonable, with discreet intra-observer reproducibility. The second factor representing the dimension of "violation of personal rights or direct abuse" showed similar performance. Even so, the study identified an exchange of items between these scales and crossed loads. A third scale that was supposed to encompass the "characteristics of vulnerability" did not show the same performance. The conclusion was that even without demonstrating complete equivalence, the H-S/EAST could already be recommended, at least in part, in the Brazilian context.

背景与目标： ：本文介绍了Hwalek-Sengstock老年人虐待筛查测试（H-S / EAST）在巴西使用的跨文化适应方法，该方法用于识别针对老年人的家庭暴力风险。在评估概念和项目等效性时，文章得出结论，它们与巴西语境有关。语义对等涵盖术语在指称/指称意义上的对应关系以及项目在本质上的指称/对应关系。通过心理计量学特性研究了测量当量。与原始的英语仪器一样，因子分析揭示了三个方面。在因子1（“潜在滥用情况”量表）中令人满意地加载了七个项目中的六个。内部一致性证明是合理的，并具有谨慎的观察者内部可重复性。代表“侵犯个人权利或直接滥用”的第二个因素也表现出相似的表现。即使这样，研究仍确定了这些秤和交叉负载之间的项目交换。本来应该包含“漏洞特征”的第三个量表却没有显示出相同的性能。结论是，即使不证明完全等效，也可以在巴西方面至少部分地建议使用H-S / EAST。

BACKGROUND & AIMS: :Elder patients with comorbidities are a rapidly growing population for in- and outpatient care. Diagnosis, treatment and integrated care are challenges which are only met by a multidisciplinary approach, which includes specialists from different medical professions and health professionals. A high number of comorbidities are a risk factor for drug interactions and fragmentisation of patient care between different medical disciplines. This is in particular relevant for patients with rheumatic diseases. So far it is not known whether treatment strategies such as the aim of remission induction in RA can be transferred as it is to the care of elder patients. Moreover, the safety and effectiveness of drugs used for the treatment of rheumatology patients has not yet been intensively studied. To meet the challenge of the care of a growing group of elder and multimorbid patients with rheumatic diseases, the reimbursement systems for in- and outpatient care must be adapted to allow multidisciplinary approaches. A concept for such a multidisciplinary procedure for inpatients with rheumatic diseases is introduced.

背景与目标： ：患有合并症的老年患者正在迅速增加的住院和门诊护理人数。诊断，治疗和综合护理是挑战，只有多学科方法才能应对，其中包括来自不同医学专业和卫生专业人员的专家。大量合并症是不同医学学科之间药物相互作用和患者护理分散的危险因素。这对于风湿性疾病患者尤其重要。到目前为止，还不知道是否可以将治疗策略（如RA中诱导缓解的目的）直接转移到老年患者的护理中。而且，尚未广泛研究用于治疗风湿病患者的药物的安全性和有效性。为了应对越来越多的风湿性疾病的老年和多病患者的护理挑战，必须调整住院和门诊护理的报销系统，以允许采用多学科方法。引入了针对风湿病患者的这种多学科程序的概念。

BACKGROUND & AIMS: Importance:Older adults, especially those with frailty, have a higher risk for complications and death after emergency surgery. Acute Care for the Elderly models have been successful in medical wards, but little evidence is available for patients in surgical wards. Objectives:To develop and assess the effect of an Elder-Friendly Approaches to the Surgical Environment (EASE) model in an emergency surgical setting. Design, Setting, and Participants:This prospective, nonrandomized, controlled before-and-after study included patients 65 years or older who presented to the emergency general surgery service of 2 tertiary care hospitals in Alberta, Canada. Transfers from other medical services, patients undergoing elective surgery or with trauma, and nursing home residents were excluded. Of 6795 patients screened, a total of 684 (544 in the nonintervention group and 140 in the intervention group) were included. Data were collected from April 14, 2014, to March 28, 2017, and analyzed from November 16, 2018, through May 30, 2019. Interventions:Integration of a geriatric assessment team, optimization of evidence-based elder-friendly practices, promotion of patient-oriented rehabilitation, and early discharge planning. Main Outcomes and Measures:Proportion of participants experiencing a major complication or death (composite) in the hospital, Comprehensive Complication Index, length of hospital stay, and proportion of participants who required an alternative level of care on discharge. Covariate-adjusted, within-site change scores were computed, and the overall between-site, preintervention-postintervention difference-in-differences (DID) were analyzed. Results:A total of 684 patients were included in the analysis (mean [SD] age, 76.0 [7.6] years; 327 women [47.8%] and 357 men [52.2%]), of whom 139 (20.3%) were frail. At the intervention site, in-hospital major complications or death decreased by 19% (51 of 153 [33.3%] vs 19 of 140 [13.6%]; P < .001; DID P = .06), and mean (SE) Comprehensive Complication Index decreased by 12.2 (2.5) points (P < .001; DID P < .001). Median length of stay decreased by 3 days (10 [interquartile range (IQR), 6-17] days to 7 [IQR, 5-14] days; P = .001; DID P = .61), and fewer patients required an alternative level of care at discharge (61 of 153 [39.9%] vs 29 of 140 [20.7%]; P < .001; DID P = .11). Conclusions and Relevance:To our knowledge, this is the first study to examine clinical outcomes associated with a novel elder-friendly surgical care delivery redesign. The findings suggest the clinical effectiveness of such an approach by reducing major complications or death, decreasing hospital stays, and returning patients to their home residence. Trial Registration:ClinicalTrials.gov Identifier: NCT02233153.

背景与目标： 重要性：老年人，特别是身体虚弱的成年人，在急诊手术后发生并发症和死亡的风险更高。老年急性护理模式在医疗病房中已经取得成功，但在外科病房中患者的证据很少。
目的：在紧急外科手术环境中，开发和评估老年人友好手术环境方法（EASE）的效果。
设计，背景和参与者：这项前瞻性，非随机，对照前后研究包括65岁或65岁以上的患者，这些患者曾就诊于加拿大艾伯塔省2家三级护理医院的紧急普外科。其他医疗服务，进行择期手术或外伤的患者以及疗养院居民的转诊费用均不包括在内。在筛选的6795名患者中，总共包括684名（非干预组544名，干预组140名）。数据收集自2014年4月14日至2017年3月28日，并于2018年11月16日至2019年5月30日进行了分析。
干预措施：整合老年医学评估团队，优化循证老年人友好做法，促进以患者为中心的康复，及及早出院计划。
主要结果和措施：在医院中遇到严重并发症或死亡（复合）的参与者比例，综合并发症指数，住院时间和出院时需要替代治疗的参与者比例。计算协变量调整后的站点内变化得分，并分析总体站点间，干预前-干预后差异（DID）。
结果：共纳入684例患者（平均[SD]年龄，76.0 [7.6]岁； 327例女性[47.8％]和357例男性[52.2％]），其中139例（20.3％）。在干预现场，院内重大并发症或死亡减少了19％（153人中的51人[33.3％]比140人中的19人[13.6％]； P <.001； DID P = .06）和平均值（SE）综合并发症指数降低了12.2（2.5）点（P <.001; DID P <.001）。中位住院时间减少了3天（从10 [四分位间距（IQR），6-17]天降低至7 [IQR，5-14]天； P = 0.001，DID P = 61），并且需要更少的患者出院时的替代照护水平（153人中的61人[39.9％]比140人中的29人[20.7％]； P <<。001； DID P ==。11）。
结论与相关性：据我们所知，这是第一项研究与新型老年人友好型手术护理重新设计相关的临床结局的研究。研究结果表明通过减少主要并发症或死亡，减少住院时间以及将患者送回家中，这种方法的临床有效性。
试用注册：ClinicalTrials.gov标识符：NCT02233153。

BACKGROUND & AIMS: OBJECTIVES:Prior elder mistreatment (EM) research has not examined subjective assessments of problem seriousness from the perspective of victims. This study sought to describe the variation in appraisals of perceived EM seriousness among victims of emotional abuse, physical abuse, and neglect and to examine factors that influence varying appraisals using neutralization theory. METHODS:Data came from a subsample of EM victims (n = 191) drawn from a representative, population-based study (n = 4,156) of community-dwelling, cognitively intact older adults in New York State. The Conflict Tactics Scale and Duke Older Americans Resources and Services scales were adapted to assess EM. Subjective appraisal of abuse/neglect was measured according to ordinal levels of victim-perceived seriousness and predicted using ordinal regression. RESULTS:Emotional abuse was appraised less seriously among victims who were both functionally impaired and dependent upon the perpetrator, lived with the perpetrator, and of increasing age. Emotional abuse was perceived with greater seriousness among victims enduring more frequent/varied abuse and when the perpetrator was distally-related. Neglect was appraised with lower seriousness among female victims and greater seriousness if perpetrated by a paid homecare attendant or in scenarios involving more frequent/varied unmet needs. DISCUSSION:Findings carry implications for understanding victim help-seeking behavior and informing EM measurement.

背景与目标： 目的：以前的虐待老人研究没有从受害者的角度研究主观评估问题严重性的方法。这项研究试图描述在情感虐待，身体虐待和忽视中受害者对EM严重性的评估差异，并使用中和理论来研究影响评估变化的因素。
方法：数据来自EM受害者的子样本（n = 191），该子样本来自于纽约州社区居住，认知完好的老年人的一项基于人群的代表性研究（n = 4,156）。冲突战术量表和美国老年人公爵资源和服务量表进行了调整，以评估新兴市场。根据受害人感觉到的严重程度的顺序对主观评估虐待/忽视，并使用顺序回归进行预测。
结果：在功能受损并依赖犯罪者，与犯罪者同住并年龄增长的受害者中，对情感虐待的评价不那么严重。受害者遭受的情感虐待更加严重，忍受着更频繁/多变的虐待，并且肇事者与末梢有关。对被忽视的评价是，女性受害人的严重性较低，如果由带薪家庭护理人员实施，或在涉及更频繁/变化的未满足需求的情况下，则严重性较高。
讨论：发现对于理解受害者的寻求帮助行为和通知EM测量具有启示意义。

BACKGROUND & AIMS: BACKGROUND:Elder mistreatment (EM) is a pervasive global health issue and a violation of basic human rights. Our prior study indicates that EM is alarmingly common in an urban Chinese population, yet little is known about risk and/or protective factors for EM. OBJECTIVE:This study's goal was to examine the association of social support with the risk of EM and underlying hypothesis is that greater social support is associated with a lower risk for EM. METHODS:A cross-sectional descriptive study was performed in a major urban medical center in Nanjing, China. A total of 412 subjects aged 60 years or older who presented to the general medical clinic were surveyed. Social support was assessed using validated instruments Social Support Index (SSI); direct questions were asked about their mistreatment since age 60 using the modified Vulnerability to Abuse Screening Scale (VASS). RESULTS:EM was found in 35% of the participants. After adjusting for potential confounding factors, several factors were associated with a lower risk of mistreatment: having someone to listen to and talk to (OR = 0.18, 95% CI, 0.08-0.39), having someone to get you good advice from (OR = 0.15 (0.07-0.34)), having someone to show love and affection to (OR = 0.30 (0.12-0.75)), having someone available who can help with daily chores (OR = 0.43 (0.22-0.85)), having contact with someone they can trust and confide in (OR = 0.08 (0.03-0.23)), and having someone they can count on for emotional support (OR = 0.11 (0.04-0.28)). Regarding total social support scores (range 1-32), every point higher in social support was associated with a 6% lower risk for EM (OR = 0.94 (0.91-0.97)). Greater social support was associated with a 59% lower risk for EM (OR = 0.41 (0.19-0.90)). CONCLUSION:Greater social support may be a protective factor against EM in this population. Prospective studies are needed to confirm this finding. Interventions that improve social support may prevent EM.

背景与目标： 背景：虐待老年人是一个普遍存在的全球性健康问题，是对基本人权的侵犯。我们的先前研究表明，EM在中国城市人口中非常普遍，但对EM的风险和/或保护因素知之甚少。
目的：本研究的目的是检验社会支持与EM风险之间的关系，基本假设是，社会支持越大与EM风险越低相关。
方法：在中国南京市的一个主要城市医疗中心进行了横断面描述性研究。共有412名年龄在60岁以上的普通科门诊患者接受了调查。社会支持是使用经过验证的工具社会支持指数（SSI）进行评估的；使用修改后的虐待滥用筛查量表（VASS），询问了有关他们自60岁起遭受虐待的直接问题。
结果：在35％的参与者中发现了EM。在对潜在的混杂因素进行调整之后，有几个因素与较低的误诊风险相关：让某人听和说话（OR = 0.18，95％CI，0.08-0.39），让某人向您提供良好建议（OR = 0.15（0.07-0.34）），有人对（OR = 0.30（0.12-0.75））表示爱意和爱心，有人可以帮助您处理日常琐事（OR = 0.43（0.22-0.85）），保持联系与他们可以信任和信任的人（OR = 0.08（0.03-0.23）），以及可以依靠的人寻求情感支持（OR = 0.11（0.04-0.28））。关于总的社会支持得分（范围为1-32），社会支持的每提高一个点，就将EM风险降低6％（OR = 0.94（0.91-0.97））。更大的社会支持与EM风险降低59％相关（OR = 0.41（0.19-0.90））。
结论：更大的社会支持可能是该人群抗EM的保护因素。需要进行前瞻性研究以证实这一发现。改善社会支持的干预措施可以预防新兴市场。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: PURPOSE:Prehospital emergency medical services (EMS) personnel, as initial responders to calls for assistance, are in an ideal position to identify abused or neglected elderly. A survey of prehospital personnel in Michigan was conducted to determine the scope of this problem, levels of awareness, and willingness to report cases of elder abuse. METHODS:The study population was a random sample of 500 prehospital personnel throughout one state. A blinded, self-administered survey was completed by emergency medical technicians (EMTs) and paramedics outlining their practice characteristics, prevalence of abuse in their community, and training available specific to elder abuse. Attitudes concerning the understanding and reporting of geriatric abuse were measured using a Likert-type scale. RESULTS:A total of 156 surveys (31%) was completed; 68% of the respondents were paramedics. Respondents had an average of 8.7 years (range: 9 months-30 years) of prehospital emergency-care experience, and evaluated an average of 11 patients (range: 1-59) older than 65 years of age each week. Seventy-eight percent had seen a suspected case of elder abuse or negligence during their careers; 68% had seen a case during the past 12 months (mean: 2.3 cases/yr; range: 0-24 cases/yr). However, surveyed personnel reported only 27% of suspected cases to authorities last year (mean: 0.62 cases/yr). Reasons for not reporting included 1) unsure which authorities take reports; 2) unclear definitions; 3) unaware of mandatory reporting laws; and 4) lack of anonymity. Ninety-five percent of respondents stated that training related to elder abuse was not available through their EMS agency. CONCLUSION:Paramedics and EMTs lack complete understanding of their role in the identification and reporting of elder abuse. This information should be emphasized during EMS training and reinforced through continuing education.

背景与目标： 目的：院前紧急医疗服务（EMS）人员，是寻求帮助的最初响应者，非常适合识别受虐待或被忽视的老人。对密歇根州的院前人员进行了一项调查，以确定该问题的范围，认识水平以及报告虐待老人情况的意愿。
方法：研究人群是在一个州内随机抽取500名院前人员的样本。紧急医疗技术人员（EMT）和护理人员完成了一项盲目，自我管理的调查，概述了他们的执业特点，社区中的虐待流行率以及针对老年人虐待的专门培训。使用李克特型量表测量有关理解和报告老年病滥用的态度。
结果：共完成156项调查（31％）； 68％的受访者是护理人员。受访者平均有8.7年（范围：9个月至30年）的院前急诊服务经验，并且每周平均评估11名年龄在65岁以上的患者（范围：1-59）。 78％的人在其职业生涯中曾有过涉嫌虐待或疏忽老年人的案件；在过去的12个月中，有68％的人看过病例（平均：2.3例/年；范围：0-24例/年）。但是，去年接受调查的人员仅向当局报告了27％的可疑病例（平均：0.62例/年）。不报告的原因包括：1）不确定哪个当局进行报告； 2）定义不明确； 3）不了解强制性的汇报法律； 4）缺乏匿名性。 95％的受访者表示，无法通过其EMS机构进行与虐待老人相关的培训。
结论：医务人员和EMT对他们在识别和报告老年人虐待中的作用缺乏完全的了解。在EMS培训期间应强调此信息，并通过继续教育加以加强。

BACKGROUND & AIMS: :Elderly patients have beliefs that, if not incorporated into the pain assessment, can block pain management by interfering with the patient's willingness to acknowledge pain and provide complete and accurate information about the pain experience. Patient beliefs that can block pain management include beliefs about self-concept and the aging process; the patient role; health professionals; pain; and consequences of treatment, including addiction, xerostomia, falls, constipation, and sexual and personality problems. Optimal pain management in the elderly is based on a complete assessment of pain, which may take several patient-nurse visits. Patients tend to reveal more information about health problems with succeeding visits, even if the patient is seen by a different person each time.

背景与目标： ：老年患者认为，如果不将其纳入疼痛评估中，则会干扰患者承认疼痛的意愿并提供有关疼痛经历的完整而准确的信息，从而阻碍疼痛的治疗。可能阻碍疼痛治疗的患者信念包括对自我概念和衰老过程的信念；患者的角色；卫生专业人员；疼痛;以及治疗的后果，包括成瘾，口干，跌倒，便秘以及性和人格问题。老年人的最佳疼痛管理是基于对疼痛的完整评估，这可能需要进行几次患者护理就诊。即使随后每次都有不同的人来见诊，患者也倾向于在后续就诊时揭示有关健康问题的更多信息。

BACKGROUND & AIMS: AIM:The present study examined the cognitive, physical and psychological characteristics associated with elder self-neglect in a USA Chinese older population. METHODS:The Population Study of Chinese Elderly in Chicago is a population-based epidemiological study of Chinese older adults in the greater Chicago area. In total, 3159 Chinese older adults aged 60 years and older were interviewed from 2011 to 2013. Personal and home environment was rated on hoarding, personal hygiene, house in need of repair, unsanitary conditions and inadequate utility. RESULTS:The prevalence of elder self-neglect of all severities was higher among older adults who were with worsening health status, lower cognitive function, lower physical function and more depressive symptoms. Poorer health status (mild self-neglect OR 1.20, 95% CI 1.06-1.35; moderate/severe self-neglect: OR 1.52, 95% CI 1.30-1.77), lower physical function (activities of daily living moderate/severe self-neglect OR 1.09, 95% CI 1.05-1.13; instrumental activities of daily living mild OR 1.04, 95% CI 1.03-1.06; instrumental activities of dailiy living moderate/severe OR 1.06, 95% CI 1.04-1.07), lower cognitive function (mild self-neglect OR 1.05, 95% CI 1.03-1.07; moderate/severe self-neglect OR 1.07, 95% CI 1.04-1.09) and more depressive symptoms (mild self-neglect OR 1.05, 95% CI 1.02-1.07; moderate/severe self-neglect OR 1.08, 95% CI 1.06-1.11) were significantly associated with increased risk for elder self-neglect of all severities. CONCLUSION:Older adults with lower levels of cognitive, physical, and psychological health were more likely to report elder self-neglect and its phenotypes. Future research is required to examine risk/protective factors associated with elder self-neglect. Geriatr Gerontol Int 2016; 16: 1051-1062.

背景与目标： 目的：本研究调查了美国华裔老年人中与老年人自我忽视相关的认知，身体和心理特征。
方法：芝加哥华人老年人口研究是对大芝加哥地区中国老年人的流行病学研究。从2011年至2013年，总共对3159名60岁及以上的中国老年人进行了访谈。对个人和家庭环境进行了评估，包括ho积，个人卫生，需要维修的房屋，不卫生的条件和不充分的公用设施。
结果：健康状况恶化，认知功能下降，身体功能下降和抑郁症状更严重的老年人中，所有严重程度的老年人自我忽视的患病率较高。健康状况较差（轻度自我忽视或1.20，95％CI 1.06-1.35；中度/重度自我忽视：OR 1.52，95％CI 1.30-1.77），身体机能低下（日常生活活动度中度/严重自我忽视） OR 1.09，95％CI 1.05-1.13;轻度日常生活能力; OR 1.04，95％CI 1.03-1.06;中/重度dailiy的器具活动; OR 1.06，95％CI 1.04-1.07），认知功能低下（轻度）自我疏忽或1.05，95％CI 1.03-1.07;中度/重度自我疏忽OR 1.07，95％CI 1.04-1.09）和更抑郁的症状（轻度自我疏忽OR 1.05，95％CI 1.02-1.07;中度/严重的自我忽视OR 1.08，95％CI 1.06-1.11）与所有严重程度的老年人自我忽视的风险增加显着相关。
结论：认知，身体和心理健康水平较低的老年人更有可能报告老年人的自我忽视及其表型。需要进一步的研究来检查与老年人自我忽视相关的风险/保护因素。 Geriatr Gerontol Int 2016； 16：1051-1062。

BACKGROUND & AIMS: INTRODUCTION:Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences. METHODS AND ANALYSIS:This is a community-based prospective cohort study using randomly selected households from the national census. A multistage sampling method was employed to obtain a total of 2496 older adults living in the rural Kuala Pilah district. The study is divided into two phases: cross-sectional study (baseline), and a longitudinal follow-up study at the third and fifth years. Elder mistreatment was measured using instrument derived from the previous literature and modified Conflict Tactic Scales. Outcomes of elder mistreatment include mortality, physical function, mental health, quality of life and health utilisation. Logistic regression models are used to examine the relationship between risk factors and abuse estimates. Cox proportional hazard regression will be used to estimate risk of mortality associated with abuse. Associated annual rate of hospitalisation and health visit frequency, and reporting of abuse, will be estimated using Poisson regression. ETHICS AND DISSEMINATION:The study has been approved by the Medical Ethics Committee of the University of Malaya Medical Center (MEC Ref 902.2) and the Malaysian National Medical Research Register (NMRR-12-1444-11726). Written consent was obtained from all respondents prior to baseline assessment and subsequent follow-up. Findings will be disseminated to local stakeholders via forums with community leaders, and health and social welfare departments, and published in appropriate scientific journals and presented at conferences.

背景与目标： 简介：尽管现在已被公认为全球健康问题，但对老年人虐待的研究仍然不足，特别是在中低收入地区。本文的目的是报告有关马来西亚老年人口中老年人虐待的基于人群的队列研究的设计和方法。这项研究旨在收集数据和证据，以估计虐待老人的发生率和发生率，确定其个人，家庭和社会决定因素，并量化其健康后果。
方法和分析：这是一项基于社区的前瞻性队列研究，使用了从国势普查中随机选择的家庭。采用多阶段抽样方法，获得了总共2496名居住在瓜拉毕拉（Kuala Pilah）农村地区的老年人。该研究分为两个阶段：横断面研究（基线），以及第三和第五年的纵向随访研究。使用从先前文献中获得的工具和修改后的冲突战术量表对老年人的虐待进行了测量。虐待老人的结果包括死亡率，身体机能，心理健康，生活质量和健康利用。 Logistic回归模型用于检查风险因素与滥用估算之间的关系。考克斯比例风险回归将用于估计与滥用相关的死亡风险。将使用Poisson回归估计相关的每年住院率和健康就诊频率以及虐待报告。
道德与传播：这项研究已得到马来亚大学医学中心医学伦理委员会（MEC Ref 902.2）和马来西亚国家医学研究注册（NMRR-12-1444-11726）的批准。在基线评估和后续随访之前，所有受访者均已获得书面同意。研究结果将通过与社区领导人，卫生和社会福利部门举行的论坛散发给当地利益相关者，并在适当的科学期刊上发表并在会议上发表。

BACKGROUND & AIMS: BACKGROUND:The key to ensuring quality care for older adults is a nursing workforce that collaborates across professions and provider levels (Wright M.C., Phillips-Bute, B.G., Petrusa, E.R., Griffin, K.L., Hobbs, G.W., & Taekman, J.M. (2008). Assessing teamwork in medical education and practice: Relating behavioural teamwork ratings and clinical performance. Med Teach, 29, 1-9). PURPOSE:To improve communication and teamwork among interprofessional health care providers (HCPs) by using innovative teambuilding activities over three years. METHODS: PARTICIPANTS:97 multi-disciplinary HCPs from five long term or home care agencies in an underserved region of New England. PARTICIPANTS attended six interactive sessions focused on teambuilding skills through the use of role play, case studies, games, exercises and teambuilding strategies. The J. A. Hartford Foundation's (John A. Hartford Foundation. (2001). The John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) Program. Available at: http://www.nygec.org/index.cfm?section_id=26&sub_section_id=18&page_id=98) Geriatric Interdisciplinary Team Training (GITT) instrument and Interdisciplinary Teamwork IQ test were used to measure changes in knowledge and attitudes. RESULTS:T tests performed on matched pre/post GITT instruments (n=26) revealed no significant change, although scores improved slightly from pre: (71%) to post test (73.3%) (p=.39). Teamwork IQ scores also improved slightly though not significantly. Qualitative data gathered suggest that teambuilding exercises were helpful in practice and allowed for better understanding of other provider roles. CONCLUSIONS:Rarely is a variety of health care disciplines invited to participate in educational opportunities together. The interprofessional small group methodology used is a replicable model with potential to overcome barriers in communication and teamwork skills.

背景与目标： 背景：确保老年人获得高质量护理的关键是跨专业和提供者级别合作的护理人员队伍（Wright MC，Phillips-Bute，BG，Petrusa，ER，Griffin，KL，Hobbs，GW和Taekman，JM（2008 ）。在医学教育和实践中评估团队合作：将行为团队评估与临床表现联系起来（Med Teach，29，1-9）。
目的：通过三年内的创新团队建设活动，改善跨行业医疗保健提供者（HCP）之间的沟通和团队合作。
方法：
参与者：来自新英格兰服务欠缺地区的五个长期或家庭护理机构的97个多学科HCP。参与者通过角色扮演，案例研究，游戏，练习和团队建设策略参加了六个以团队建设技能为重点的互动会议。 JA Hartford基金会的（John A. Hartford基金会。（2001）。John A. Hartford基金会的老年跨学科团队培训（GITT）计划。可从以下网站获得：http://www.nygec.org/index.cfm?section_id=26&sub_section_id = 18＆page_id = 98）老年跨学科团队训练（GITT）仪器和跨学科团队合作智商测试用于衡量知识和态度的变化。
结果：在匹配的GITT前后器械（n = 26）上进行的T检验显示无显着变化，尽管评分从之前（71％）到后期（73.3％）略有改善（p = .39）。团队合作智商得分也略有提高，尽管没有显着提高。收集的定性数据表明，团队建设练习在实践中很有帮助，并且可以更好地理解其他提供者的角色。
结论：很少有各种各样的卫生保健学科被邀请一起参加教育机会。跨行业的小组方法是一种可复制的模型，具有克服沟通和团队合作技能障碍的潜力。

BACKGROUND & AIMS: OBJECTIVES:To explore strategies used by clinical programs to justify operations to decision-makers using the example of the Hospital Elder Life Program (HELP), an evidence-based, cost-effective program to improve care for hospitalized older adults. DESIGN:Qualitative study design using 62 in-depth, semistructured interviews conducted with HELP staff members and hospital administrators between September 2008 and August 2009. SETTING:Nineteen HELP sites in hospitals across the United States and Canada that had been recruiting patients for at least 6 months. PARTICIPANTS:HELP staff and hospital administrators. MEASUREMENTS:Participant experiences sustaining the program in the face of actual or perceived financial threats, with a focus on factors they believe are effective in justifying the program to decision-makers in the hospital or health system. RESULTS:Using the constant comparative method, a standard qualitative analysis technique, three major themes were identified across interviews. Each focuses on a strategy for successfully justifying the program and securing funds for continued operations: interact meaningfully with decision-makers, including formal presentations that showcase operational successes and informal means that highlight the benefits of HELP to the hospital or health system; document day-to-day, operational successes in metrics that resonate with decision-maker priorities; and garner support from influential hospital staff that feed into administrative decision-making, particularly nurses and physicians. CONCLUSION:As clinical programs face financially challenging times, it is important to find effective ways to justify their operations to decision-makers. Strategies described here may help clinically effective and cost-effective programs sustain themselves and thus may help improve care in their institutions.

背景与目标： 目的：以医院老年人生命计划（HELP）为例，探索临床计划用于为决策者合理操作的策略，该计划是一项循证，成本有效的计划，旨在改善住院老年人的护理。
设计：定性研究设计，方法是在2008年9月至2009年8月之间对HELP员工和医院管理人员进行了62次深入的半结构化访谈。
地点：美国和加拿大的医院中有19个HELP站点，这些站点至少招募了6个月的患者。
参与者：帮助员工和医院管理员。
度量：参与者面对实际或预见的财务威胁维持该计划的经验，重点是他们认为有效地向医院或卫生系统中的决策者证明该计划合理性的因素。
结果：使用恒定的比较方法，标准的定性分析技术，在访谈中确定了三个主要主题。每个小组都着重于一项战略，以成功证明该计划的合理性并为持续的运营筹集资金：与决策者进行有意义的互动，包括展示运营成功的正式演讲和强调HELP对医院或卫生系统的好处的非正式手段；记录与决策者优先事项相关的指标的日常运营成功；并获得有影响力的医院工作人员的支持，这些人员参与行政决策，尤其是护士和医生。
结论：由于临床计划面临财务困难时期，因此重要的是找到有效的方法向决策者证明其运作的合理性。此处描述的策略可能有助于临床有效且具有成本效益的计划维持下去，从而有助于改善其机构中的护理。