BACKGROUND & AIMS: :Elder neglect and abuse represent a widespread, largely undiagnosed problem in the United States. Factors contributing to misdiagnosis and underreporting include denial by both the victim and the perpetrator, clinicians' reluctance to report victims, disbelief by medical providers, and clinicians' lack of awareness of warning signs. Physical abuse is most recognizable, yet neglect is most common. Psychological and financial abuse may be more easily missed. Elder neglect and abuse have many clinical presentations, ranging from the overt appearance of bruises and fractures, to the subtle appearance of dehydration, depression, and apathy. Risk factors are varied and may be categorized by victim or perpetrator. Dependency, on the part of the victim or perpetrator, and caregiver stress are frequent common denominators in abusive situations. Increasingly, Institutionalization is recognized as a risk factor for neglect and abuse. Most states require primary care providers to report suspected elder abuse. Awareness of the risk factors and clinical manifestations allows primary care physicians to provide early detection and intervention for elder neglect and abuse.

背景与目标： ：老年人的忽视和虐待在美国是一个普遍存在的，很大程度上未被诊断的问题。导致误诊和漏报的因素包括受害人和犯罪者均否认，临床医生不愿报告受害人，医疗提供者不相信，以及临床医生对警告标志的认识不足。身体虐待最容易识别，但疏忽是最常见的。心理和经济上的虐待可能更容易被错过。老年人的忽视和虐待有许多临床表现，从瘀伤和骨折的明显表现到脱水，沮丧和冷漠的微妙表现。风险因素各不相同，可以按受害人或作案者分类。在虐待情况下，受害者或施暴者的依赖性以及照料者的压力是常见的共同点。制度化越来越被认为是忽视和虐待的风险因素。大多数州要求基层医疗服务提供者报告可疑的老年人虐待行为。对危险因素和临床表现的了解使初级保健医生能够为老年人的忽视和虐待提供早期发现和干预。

BACKGROUND & AIMS: :A 10-yr-old boy with end-stage liver cirrhosis due to Wilson's disease received a living donor liver transplantation (LDLT) at our institution. The donor was his father and the graft was a left lateral segment. The liver transplantation procedure and the postoperative course were uneventful. Two months after the procedure, he developed a first episode of bowel obstruction that was treated with conservative therapy. During a second episode of bowel obstruction, he also presented respiratory distress. A plain chest X-ray revealed the presence of small intestine loops in the right thoracic cavity and bowel obstruction due to diaphragmatic hernia was diagnosed. Repair of the diaphragmatic hernia was performed and the patient has been doing well after the surgery. Diaphragmatic hernia after LDLT is rare but should be recognized as a possible complication when a left lobe or a left lateral segment graft is used.

背景与目标： ：一名因威尔逊氏病而患有晚期肝硬化的10岁男孩在我们机构接受了活体供体肝移植（LDLT）。捐献者是他的父亲，而移植物是左侧段。肝移植过程和术后过程均顺利进行。手术后两个月，他出现了首例肠梗阻，并接受了保守治疗。在肠梗阻的第二次发作中，他还出现了呼吸窘迫。胸部X线平片显示右胸腔中存在小肠loop，并诊断为diaphragm肌疝引起的肠梗阻。进行了diaphragm肌疝的修复，患者术后状况良好。 LDLT后的肌疝很少见，但当使用左叶或左外侧节段移植物时应被认为是可能的并发症。

BACKGROUND & AIMS: BACKGROUND:A possible connection on vascular basis between impaired kidney function and cognitive dysfunction has been suggested in previous studies. Contradictory results regarding specific cognitive domains have been reported. The aim for this study was to investigate the association between kidney function and specific cognitive domains. METHODS:In this cross-sectional design, data from the general population based cohort study "Good aging in Skåne" (GÅS) was used. The sample included 2931 subjects ages 60 to 93 randomly selected from the southern part of Sweden. Estimated glomerular filtration rate (eGFR) for both creatinine and cystatine C was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The subjects underwent a test battery of neuropsychological tests assessing global cognitive function, learning and memory, language, complex attention, executive function, perceptual motor and meta-memory. Adjustments were made for age, sex, education and country of origin. RESULTS:After adjustment for demographic variables, impaired kidney function was associated with 0.41 points worse result in MMSE, 0.56 points worse result in recognition, 0.66 points worse result in word fluency, 0.45 points worse result in digit cancellation, 0.99 points worse result in pattern comparison, and 3.71 s longer time to finish TMT B-A. Associations to cognitive function was also noted for mildly impaired kidney function defined as eGFR 45- < 60 ml/min/1,73m2. No association was found between kidney function and meta-memory. CONCLUSIONS:Impaired kidney function as well as the severity of impaired kidney function is associated with impairment in learning and memory, language, complex attention, executive function and global cognitive function, but not meta-memory.

背景与目标： 背景：在先前的研究中已经提出了在血管基础上肾功能受损与认知功能障碍之间可能存在的联系。关于特定认知领域的矛盾结果已有报道。这项研究的目的是调查肾功能和特定认知领域之间的关联。
方法：在此横断面设计中，使用了基于一般人群的队列研究“斯科讷的良好衰老”（GÅS）中的数据。该样本包括从瑞典南部随机抽取的2931名年龄在60至93岁之间的受试者。肌酐和半胱氨酸C的估计肾小球滤过率（eGFR）使用慢性肾脏病流行病学协作（CKD-EPI）公式计算。受试者接受了一系列神经心理学测试，以评估整体认知功能，学习和记忆，语言，复杂注意力，执行功能，知觉运动和元记忆。对年龄，性别，教育程度和原籍国进行了调整。
结果：在调整了人口统计学变量后，肾功能受损与MMSE下降0.41分，识别能力下降0.56分，英语流利程度下降0.66分，数字消除效果下降0.45分，模式下降0.99点有关比较，以及完成TMT BA所需的时间延长了3.71秒。还发现与轻度肾功能受损相关的认知功能相关性定义为eGFR 45- <60 ml / min / 1,73m2。在肾功能和元记忆之间未发现关联。
结论：肾功能受损以及肾功能受损的严重程度与学习和记忆，语言，复杂注意力，执行功能和整体认知功能受损有关，但与元记忆无关。

BACKGROUND & AIMS: BACKGROUND:Elder abuse is a serious violation of human rights and a worldwide issue. Upon hospital admission, elderly patients become vulnerable and susceptible to abuse. Understanding the issues perceived as abuse by the elderly patients and their family members allows us to identify, manage, and prevent elder abuse; especially in hospital settings. The present study aimed to identify and describe the abuse of hospitalized elders from the perspective of patients and their family members. METHODS:The present exploratory qualitative study was conducted from October 2017 to September 2018 at six different teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The target population was elderly patients in different wards across various hospitals and their family members. Based on the purposive sampling method, 16 hospitalized elderly patients and 11 family members were recruited and interviewed. The data were analyzed using the inductive content analysis method in accordance with the process described by Elo and Kyngas (J Adv Nurs 62:107-15, 2008). RESULTS:Based on the analysis of the interview data, four main categories were extracted and classified as Micro-level, Meso-level, Exo-level, and Macro-level issues. CONCLUSION:Hospitalized elder abuse is a multi-dimensional phenomenon caused by personal and professional factors as well as issues related to the inadequate physical environment and organizational structure. To prevent the occurrence of elderly abuse, it is recommended to train hospital staff, rearrange the physical environment, reform the organizational structure, and better plan and manage the financial, physical, and human resources.

背景与目标： 背景：虐待老年人是对人权的严重侵犯，是一个世界性的问题。入院后，老年患者变得容易受虐待。了解老年患者及其家人所认为的虐待问题，使我们能够识别，管理和预防老年人的虐待；特别是在医院环境中。本研究旨在从患者及其家人的角度识别和描述住院长者的虐待情况。
方法：本探索性定性研究于2017年10月至2018年9月在伊朗设拉子设拉子医学大学附属的六家不同教学医院进行。目标人群是各医院及其家属在不同病房的老年患者。根据目的抽样方法，招募了16位住院的老年患者和11位家庭成员并进行了访谈。根据Elo和Kyngas描述的方法（J Adv Nurs 62：107-15，2008），使用归纳含量分析方法分析数据。
结果：在对访谈数据进行分析的基础上，提取了四个主要类别，并将其分类为微观，中观，外向和宏观问题。
结论：住院老年人虐待是一种由个人和专业因素以及与身体环境和组织结构不足有关的问题引起的多维现象。为了防止发生虐待老人的行为，建议对医院工作人员进行培训，调整身体环境，改革组织结构，并更好地计划和管理财务，物质和人力资源。

BACKGROUND & AIMS: Background:Self-neglect and suicidal ideations are important public health issues among the aging population. This study aims to examine the association between self-neglect, its phenotypes, and suicidal ideation among U.S. Chinese older adults. Methods:Guided by a community-based participatory research approach, the Population Study of Chinese Elderly in Chicago (PINE) study is a population-based epidemiological study conducted from 2011 to 2013 among 3,159 Chinese older adults aged 60 years and older in the Greater Chicago area. Self-neglect was assessed by a 27-item instrument, describing five phenotypes with hoarding, poor personal hygiene, unsanitary condition, lack of utilities, and need of home repair. Suicidal ideation was assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9) and the Geriatric Mental State Examination-Version A (GMS-A). Logistic regression is utilized to analyze the association. Results:Higher level of self-neglect was found significantly associated with increased risk of self-reported suicidal ideation within 2 weeks (odds ratio 2.97 [1.54-5.72]); 12 months (odds ratio 2.82 [1.77-4.51]); and lifetime (odds ratio 2.74 [1.89-3.95]). For phenotypes, the study found that poorer personal hygiene and severer level of unsanitary conditions were associated with increased risk of suicidal ideation at all three time periods. Conclusion:This study suggests that self-neglect and its phenotypes are significantly associated with suicidal ideation among Chinese older adults. Longitudinal studies are needed to explore the mechanisms through which self-neglect links with suicidal ideation.

背景与目标： 背景：自我忽视和自杀观念是老年人口中重要的公共卫生问题。这项研究旨在研究美国华裔老年人中自我忽视，其表型与自杀意念之间的关联。
方法：在社区参与研究方法的指导下，芝加哥中国老年人群研究（PINE）是一项于2011年至2013年在大芝加哥地区3159名60岁以上的中国老年人开展的基于人群的流行病学研究。区域。使用27个项目的仪器对自我忽视进行了评估，描述了五种表型，包括ho积，个人卫生差，卫生条件差，缺乏公用设施和需要上门维修。自杀意念由患者健康问卷9（PHQ-9）和老年精神状态检查A版（GMS-A）的第九项评估。 Logistic回归用于分析关联。
结果：发现较高的自我疏忽水平与2周内自报自杀念头的风险增加显着相关（优势比为2.97 [1.54-5.72]）； 12个月（赔率2.82 [1.77-4.51]）；和寿命（赔率比2.74 [1.89-3.95]）。对于表型，研究发现，在所有三个时间段内，个人卫生状况较差和不卫生状况较严重与自杀意念的风险增加有关。
结论：这项研究表明，自我疏忽及其表型与中国老年人自杀意念显着相关。需要进行纵向研究，以探索自我忽视与自杀观念联系的机制。

BACKGROUND & AIMS: OBJECTIVES:To determine whether elder abuse can predict mortality and disability over the ensuing 12 years. DESIGN:Population-based prospective cohort study of women aged 70 to 75 in 1996; survival analysis. SETTING:Australia. PARTICIPANTS:Twelve thousand sixty-six women with complete data on elder abuse. MEASUREMENTS:Elder abuse was assessed using the 12-item Vulnerability to Abuse Screening Scale (VASS) subscales: vulnerability, coercion, dependence, and dejection. Outcomes were death and disability (defined as an affirmative response to "Do you regularly need help with daily tasks because of long-term illness, disability or frailty?"). RESULTS:In 1996, 8% reported vulnerability, 6% coercion, 18% dependence, and 22% dejection. By October 2008, 3,488 (29%) had died. Mortality was associated with coercion (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.06-1.40) and dejection (HR = 1.12, 95% CI = 1.03-1.23), after controlling for demographic characteristics, social support, and health behavior but not after adding chronic conditions to the coercion model. Over the 12 years, 2,158 of 11,027 women who had reported no disability in 1996 reported disability. Women who reported vulnerability (HR = 1.25, 95% CI = 1.06-1.49) or dejection (HR = 1.55, 95% CI = 1.38-1.73) were at greater risk of disability, after controlling for demographic characteristics, social support, and health behavior. The relationship remained significant for dejection when chronic conditions and mental health were included in the model (HR = 1.40, 95% CI = 1.24-1.58). CONCLUSION:Specific components of vulnerability to elder abuse were differently associated with rates of disability and mortality over the ensuing 12 years.

背景与目标： 目的：确定虐待老人是否可以预测接下来的12年内的死亡率和残疾。
设计：1996年基于人群的前瞻性队列研究，研究对象为70至75岁的女性。生存分析。
地点：澳大利亚。
参与者：12.6万名妇女，其中有关于虐待老年人的完整数据。
度量：老年人虐待是使用12个项目的虐待滥用筛查量表（VASS）进行评估的：脆弱性，强迫，依赖性和沮丧感。结果是死亡和残疾（定义为对“您是否因长期生病，残疾或虚弱而经常需要日常工作的帮助吗？”的肯定回答）。
结果：1996年，有8％的人报告了脆弱性，6％的胁迫，18％的依赖和22％的沮丧。截至2008年10月，死亡3,488（29％）。在控制了人口统计学特征，社会支持之后，死亡率与强迫（危险比（HR）= 1.21，95％置信区间（CI）= 1.06-1.40）和沮丧感（HR = 1.12，95％CI = 1.03-1.23）相关。 ，以及健康行为，但不会在强制模型中添加慢性病之后。在过去的12年中，1996年未报告残疾的11027名妇女中有2158人报告了残疾。在控制了人口统计学特征，社会支持和健康之后，报告为脆弱性（HR = 1.25，95％CI = 1.06-1.49）或沮丧（HR = 1.55，95％CI = 1.38-1.73）的女性患残疾的风险更高。行为。当模型中包括慢性病和精神健康时，这种关系对于抑郁症仍然很明显（HR = 1.40，95％CI = 1.24-1.58）。
结论：在随后的12年中，遭受老年人虐待的脆弱性的特定组成部分与残疾率和死亡率有不同的关系。

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