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1.  Elder Financial Exploitation: Implications for Future Policy and Research in Elder Mistreatment 
Recent advances in the understanding of elder mistreatment have demonstrated that financial exploitation tends to be one of the most common forms of mistreatment affecting older populations. Agencies such as the World Bank and World Health Organization show significant concern regarding financial exploitation and its connection to physical and emotional injury to victims. The World Bank uses the term “financial violence” as a means of generally describing the harm caused to an individual as a result of financial exploitation or abuse. The proportion of financial exploitation in relation to other forms of elder mistreatment is defined in our research. We discuss the potential impact of elder financial exploitation on victims as well as explore the implications for future research and policy development focused on financial aspects of elder mistreatment and call for further study in the concept of financial exploitation as a violent act.
PMCID: PMC3117613  PMID: 21731794
2.  Advancing the Field Elder Abuse: Future Directions and Policy Implications 
Elder abuse, sometime called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse, neglect (caregiver neglect and self-neglect), and financial exploitation. Evidence suggests that 1 out of 10 older adult experiences some form of elder abuse, and only 1 of out 25 cases are actually reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy dealing with the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow/Health and Aging Policy Fellow working with Administration on Community Living (ACL) (Previously known at Administration on Aging (AoA)) for the last two years, I will describe the major functions of the ACL; and highlight on two major pieces of federal legislation: The Older Americans Act (OAA) and the Elder Justice Act (EJA). Moreover, I will highlight major research gaps and future policy relevant research directions for the field of elder abuse.
doi:10.1111/j.1532-5415.2012.04211.x
PMCID: PMC3498608  PMID: 23110488
elder abuse; health policy; national health and aging policy fellow
3.  Periodic health examination, 1994 update: 4. Secondary prevention of elder abuse and mistreatment. Canadian Task Force on the Periodic Health Examination. 
OBJECTIVE: To provide recommendations for family physicians on the detection, assessment and management of abuse or mistreatment in patients over 65 years of age. OPTIONS: Detection of elder abuse by history and examination or by specific protocols; intervention through mandatory reporting, removing the victim from the situation or acting as an advocate for the patient. OUTCOMES: Termination of abusive situation and prevention of further abuse. EVIDENCE: A MEDLINE search was conducted with the use of medical subject headings "elder abuse" and "epidemiology" for articles published from January 1980 to October 1992 and headings "elder abuse" and "clinical trials" for articles published from January 1980 to February 1994. Standard references and review articles and their bibliographies were scrutinized, and experts were consulted. VALUES: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. Since senior citizens are among the most disadvantaged people in Canadian society, prevention of abuse and promotion of their autonomy were the highest values selected. BENEFITS, HARMS AND COSTS: The principal benefits are cessation and prevention of abuse. Potential harms include the loss of a personal residence, the erosion of an established family structure and the loss of autonomy for the victim. RECOMMENDATIONS: There is poor evidence to include case finding for elder abuse in or exclude it from the periodic health examination. However, it is prudent for physicians to be alert for indications of elder abuse and, if such abuse is discovered, to take measures to prevent further abuse.
PMCID: PMC1337405  PMID: 7954135
4.  Elder mistreatment and emotional symptoms among older adults in a largely rural population: The South Carolina Elder Mistreatment Study 
Journal of interpersonal violence  2010;26(11):2321-2332.
While two recent major studies provide some insight into the prevalence and correlates of elder mistreatment, the relationship between elder mistreatment and mental health remains unclear. This study begins to address this issue by examining the relationship between elder mistreatment (i.e., a recent history of emotional and physical abuse) and negative emotional symptoms (e.g., anxiety and depression) among 902 older adults aged 60 and above residing in South Carolina. Results demonstrate that emotional, but not physical abuse is, significantly correlated with higher levels of emotional symptoms. This relationship is sustained when controlling for established demographic and social/dependency risk factors. These data suggest that mistreated older adults also suffer from greater emotional symptoms and highlight the need for more research in this area.
doi:10.1177/0886260510383037
PMCID: PMC3005541  PMID: 20829233
Elder; mistreatment; emotion; rural
5.  Screening for Elder Mistreatment among Older Adults Seeking Legal Assistance Services 
Introduction: The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to elder mistreatment (EM). The purpose of this study was to assess the prevalence and correlates of EM among a sample of older adults using legal assistance services in Atlanta, Georgia.
Methods: Researchers administered surveys to consenting older adults (aged 60+) in 5 metro Atlanta community centers that hosted legal assistance information sessions as part of the Elderly Legal Assistance Program. The surveys screened for risk factors and prevalence of EM risk using valid and reliable measures and included additional questions regarding demographics characteristics and healthcare use behaviors.
Results: Surveys were completed by 112 participants. Findings reveal that 32 (28.6%) respondents met the criteria for elder abuse / neglect risk; 17 (15.2%) respondents met criteria for depression; and 105 (93.7%) had visited a healthcare provider during the past 6 months.
Conclusion: The rates of EM risk in this sample were higher than those previously reported in research. Findings support continued examination of unique risks that may be present among older adults who may be possibly facing legal issues. Additionally, the reported frequency of healthcare visits among participants reveals a promising opportunity to examine development of a more widespread EM screening approach to be conducted in non-emergency settings. Interdisciplinary collaboration is required to inform screening approaches that account for complexities that EM cases present.
doi:10.5811/westjem.2013.2.15640
PMCID: PMC3735377  PMID: 23930143
6.  Understanding elder abuse in family practice 
Canadian Family Physician  2012;58(12):1336-1340.
Abstract
Objective
To discuss what constitutes elder abuse, why family physicians should be aware of it, what signs and symptoms might suggest mistreatment of older adults, how the Elder Abuse Suspicion Index might help in identification of abuse, and what options exist for responding to suspicions of abuse.
Sources of information
MEDLINE, PsycINFO, and Social Work Abstracts were searched for publications in English or French, from 1970 to 2011, using the terms elder abuse, elder neglect, elder mistreatment, seniors, older adults, violence, identification, detection tools, and signs and symptoms. Relevant publications were reviewed.
Main message
Elder abuse is an important cause of morbidity and mortality in older adults. While family physicians are well placed to identify mistreatment of seniors, their actual rates of reporting abuse are lower than those in other professions. This might be improved by an understanding of the range of acts that constitute elder abuse and what signs and symptoms seen in the office might suggest abuse. Detection might be enhanced by use of a short validated tool, such as the Elder Abuse Suspicion Index.
Conclusion
Family physicians can play a larger role in identifying possible elder abuse. Once suspicion of abuse is raised, most communities have social service or law enforcement providers available to do additional assessments and interventions.
PMCID: PMC3520657  PMID: 23242889
7.  Prevalence and Associated Factors of Elder Mistreatment in a Rural Community in People's Republic of China: A Cross-Sectional Study 
PLoS ONE  2012;7(3):e33857.
Background
Current knowledge about elder mistreatment is mainly derived from studies done in Western countries, which indicate that this problem is related to risk factors such as a shared living situation, social isolation, disease burden, and caregiver strain. We know little about prevalence and risk factors for elder mistreatment and mistreatment subtypes in rural China where the elder population is the most vulnerable.
Methods
In 2010, we conducted a cross-sectional survey among older adults aged 60 or older in three rural communities in Macheng, a city in Hubei province, China. Of 2245 people initially identified, 2039 were available for interview and this was completed in 2000. A structured questionnaire was used to collect data regarding mistreatment and covariates. Logistic regression analysis was used to identify factors related to elder mistreatment and subtypes of mistreatment.
Results
Elder mistreatment was reported by 36.2% (95% CI: 34.1%–38.3%) of the participants. Prevalence rates of psychological mistreatment, caregiver neglect, physical mistreatment, and financial mistreatment were 27.3% (95% CI: 25.3%–29.2%), 15.8% (95% CI: 14.2%–17.4%), 4.9% (95% CI: 3.9%–5.8%) and 2.0% (95% CI: 1.3%–2.6%), respectively. The multivariate logistic regression analysis revealed that depression, being widowed/divorced/single/separated, having a physical disability, having a labor intensive job, depending solely on self-made income, and living alone were risk factors for elder mistreatment. Different types of elder mistreatment were associated with different risk factors, and depression was the consistent risk factor for the three most common mistreatment subtypes.
Conclusion
Older adults in rural China self-report a higher rate of mistreatment than their counterparts in Western countries. Depression is a main risk factor associated with most subtypes of mistreatment. Our findings suggest that prevention and management of elder mistreatment is a challenge facing a rapidly aging Chinese population.
doi:10.1371/journal.pone.0033857
PMCID: PMC3309016  PMID: 22448276
8.  Healthcare Professionals’ Perspectives on Barriers to Elder Abuse Detection and Reporting in Primary Care Settings 
The purpose of this study was to explore through interviews of healthcare professionals their perspectives on elder abuse to achieve a better understanding of the problems of reporting and generate ideas for improving the process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed and thematic analysis was used to identify the following core themes: professional orientation, assessment, interpretation, systems, and knowledge and education. The impact by healthcare professionals in recognizing and reporting elder abuse and obtaining resources for those mistreated can be profound. Nurses tended to perceive elder abuse as uncommon and generally did not feel it was their role nor did they have time to assess patients for potential abuse. Physicians felt that other patient care issues, time limitations and maintaining trust in the clinician-patient relationship outweighed the importance of detecting and pursuing suspected cases of elder abuse. Social workers, although having the most knowledge and experience related to elder abuse, relied on nurses and physicians to detect potential abusive situations and to work with them in making appropriate referrals. The three disciplines acknowledged the need for more and better education about elder abuse detection and reporting. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.
doi:10.1080/08946566.2011.608044
PMCID: PMC3298114  PMID: 22206510
elder abuse; elder mistreatment; primary care; reporting
9.  Workshop report: environmental exposures and cancer prevention. 
Environmental Health Perspectives  2003;111(1):105-108.
The Workshop on Environmental Exposures and Cancer was held by Cancer Care Ontario (CCO) 25-26 April 2001. An expert panel convened to achieve consensus on a list of important environmental exposures, priority environmental exposures in Ontario, and recommendations for CCO in the areas of surveillance, research, and prevention activities to address these environmental exposures. Panel members developed a working definition of environmental exposure and criteria to prioritize the identified exposures. The process followed in the workshop provided CCO with important direction for its surveillance, research, and prevention activities to address environmental exposures and cancer. It is hoped that the environmental exposures and the opportunities identified through this workshop process will guide policy makers, program personnel, and researchers interested in and struggling with the challenges associated with surveillance, research, and prevention of environmental exposures.
PMCID: PMC1241313  PMID: 12515687
10.  Educating novice practitioners to detect elder financial abuse: a randomised controlled trial 
BMC Medical Education  2014;14:21.
Background
Health and social care professionals are well positioned to identify and intervene in cases of elder financial abuse. An evidence-based educational intervention was developed to advance practitioners’ decision-making in this domain. The objective was to test the effectiveness of a decision-training educational intervention on novices’ ability to detect elder financial abuse. The research was funded by an E.S.R.C. grant reference RES-189-25-0334.
Methods
A parallel-group, randomised controlled trial was conducted using a judgement analysis approach. Each participant used the World Wide Web to judge case sets at pre-test and post-test. The intervention group was provided with training after pre-test testing, whereas the control group were purely given instructions to continue with the task. 154 pre-registration health and social care practitioners were randomly allocated to intervention (n78) or control (n76). The intervention comprised of written and graphical descriptions of an expert consensus standard explaining how case information should be used to identify elder financial abuse. Participants’ ratings of certainty of abuse occurring (detection) were correlated with the experts’ ratings of the same cases at both stages of testing.
Results
At pre-test, no differences were found between control and intervention on rating capacity. Comparison of mean scores for the control and intervention group at pre-test compared to immediate post-test, showed a statistically significant result. The intervention was shown to have had a positive moderate effect; at immediate post-test, the intervention group’s ratings had become more similar to those of the experts, whereas the control’s capacity did not improve. The results of this study indicate that the decision-training intervention had a positive effect on detection ability.
Conclusions
This freely available, web-based decision-training aid is an effective evidence-based educational resource. Health and social care professionals can use the resource to enhance their ability to detect elder financial abuse. It has been embedded in a web resource at http://www.elderfinancialabuse.co.uk.
doi:10.1186/1472-6920-14-21
PMCID: PMC3923244  PMID: 24485005
11.  The National Elder Mistreatment Study: Race and Ethnicity Findings 
Journal of elder abuse & neglect  2013;25(4):281-293.
The prevalence of elder mistreatment with respect to race and ethnicity was examined in an unweighted sample of 5,777 participants (5,776 participants in weighted sample). Random Digit Dialing methodology was used to select a representative sample of community-dwelling older adults, and the survey was available in English and Spanish. Mistreatment types included emotional, physical, and sexual abuse. Race and ethnicity based differences were largely absent, and the only observed increase was for physical mistreatment among Non-White older adults; however this association was not sustained in multivariate analyses controlling for income, health status, and social support. Findings are in contrast to prior reports of increased risk of mistreatment in minority populations, and point to correlated and modifiable factors of social support and poor health as targets for preventive intervention.
doi:10.1080/08946566.2013.770305
PMCID: PMC3694735  PMID: 23768412
elder mistreatment; race; ethnicity; sexual abuse; physical abuse
12.  Critical Care Nurses’ Perspectives on Elder Abuse 
Nursing in Critical Care  2012;17(4):172-179.
Aims
to explore through interviews of critical care nurses their perspectives on elder abuse to achieve a better understanding of the problems of reporting and generate ideas for improving the process.
Background
In 44 states and the District of Columbia healthcare providers are required by law to report elder abuse but the patient, patient’s family, and healthcare providers all have barriers to reporting allegations of elder abuse.
Design
This study design is qualitative.
Method
Through a mailed survey, critical care nurses were invited to participate in a taped in-depth qualitative interview.
Results
Ten nurses were interviewed. A thematic analysis was used to describe the following core themes: types of elder abuse, suspicions of elder abuse, reporting of elder abuse, barriers to reporting elder abuse, legislation, and improvement in practice.
Conclusions
Critical care nurses are aware of elder abuse and somewhat systematically evaluate for abuse at admission to their unit. They recognize signs and symptoms of abuse and are suspicious when it is warranted. They are aware of why an older person does not want to report abuse and take this into consideration when soliciting information. Facts, values, and experience influence personally defining abuse, suspicion, and dependence for each individual healthcare professional.
Relevance to Clinical Practice
Critical care unit protocols and/or policies and procedure for reporting elder abuse are needed in critical care settings and are warranted for providing quality of care.
doi:10.1111/j.1478-5153.2012.00511.x
PMCID: PMC3376393  PMID: 22698159
Elder abuse; qualitative study; mandatory reporting; critical care
13.  Clinical Research Nursing: A Critical Resource in the National Research Enterprise 
Nursing Outlook  2011;60(3):149-156.e3.
Translational clinical research has emerged as an important priority for the national research enterprise, with a clearly stated mandate to deliver prevention strategies, treatments and cures based on scientific innovations faster to the public. Within this national effort, a lack of consensus persists concerning the need for clinical nurses with expertise and specialized training in study implementation and the delivery of care to research participants. This paper reviews efforts to define and document the role of practicing nurses in implementing studies and coordinating clinical research in a variety of clinical settings and differentiates this clinical role from the role of nurses as scientists and principal investigators. We propose an agenda for building evidence that having nurses provide and coordinate study treatments and procedures can potentially improve research efficiency, participant safety, and the quality of research data. We also provide recommendations for the development of the emerging specialty of clinical research nursing.
doi:10.1016/j.outlook.2011.10.003
PMCID: PMC3348260  PMID: 22172370
14.  Determining Prevalence and Correlates of Elder Abuse Using Promotores: Low Income Immigrant Latinos Report High Rates of Abuse and Neglect 
Low-income Latino immigrants are understudied in elder abuse research. Limited English proficiency, economic insecurity, neighborhood seclusion, a tradition of resolving conflicts within the family, and mistrust of authorities may impede survey research and suppress abuse reporting. To overcome these barriers, we recruited and trained promotores, local Spanish-speaking Latinos, to interview a sample of Latino adults age 66 and older residing in low-income communities. The promotores conducted door-to-door interviews in randomly selected census tracts in Los Angeles to assess the frequency of psychological, physical, and sexual abuse, financial exploitation, and caregiver neglect. Overall, 40.4% of Latino elders experienced some form of abuse and/or neglect within the previous year. Nearly 25% reported psychological abuse, 10.7% indicated physical assault, 9% reported sexual abuse, 16.7% indicated financial exploitation, and 11.7% were neglected by their caregivers. Younger age, higher education, and experiencing sexual or physical abuse before age 65 were significant risk factors for psychological, physical, and/or sexual abuse. Years lived in the United States, younger age, and prior abuse were associated with increased risk of financial exploitation. Years spent living in the U.S. was a significant risk factor for caregiver neglect. Abuse prevalence was much higher in all mistreatment domains than findings from previous research on community-dwelling elders, suggesting that low-income Latino immigrants are highly vulnerable to elder mistreatment, or that respondents are more willing to disclose abuse to promotores who represent their culture and community.
doi:10.1111/j.1532-5415.2012.04025.x
PMCID: PMC3396729  PMID: 22697790
Hispanic/Latino; promotores; elder abuse; elder mistreatment; elder neglect
15.  Screening for elder mistreatment in dental and medical clinics 
Gerodontology  2012;29(2):96-105.
Objective
Elder mistreatment (EM) is a potentially fatal and largely unrecognised problem in the United States. The purpose of this study was to determine the prevalence of EM in busy clinics and specifically, we report on the feasibility of screening for EM as well as the appropriate instrumentation for screening.
Background Data
Prevalence estimates for elder mistreatment vary, but recent data from a national sample of community-residing adults over age 60 indicate that 11.4% of older adults report some form of elder mistreatment (1). There is a paucity of research related to screening in dental and medical clinics to understand the prevalence in such practice settings.
Methods
A cross-sectional study from January 2008 to March 2009. We enrolled 241 patients at two clinics: a medical clinic (N=102) and the dental clinics (N=139). A mini-mental status exam was conducted with a minimum of 18 or better for inclusion. An elder mistreatment screen was next used (EAI-R for medical, HS-EAST for dental).
Results
For the 241 patients, we were able to compare data from the EAI-R with the HS-EAST. This pilot work demonstrates the feasibility of screening for EM in busy clinics and we documented patient enrolment of 20% in the medical clinics, and 66% in dental clinics. Patients are willing to answer extremely-sensitive questions related to elder mistreatment, and are also willing to use computer technology for interviewing.
Conclusion
Dental and medical clinics are important practice venues to screen for elder mistreatment.
doi:10.1111/j.1741-2358.2010.00405.x
PMCID: PMC3325327  PMID: 22225431
elder mistreatment; screening; quality of life; geriatrics
16.  CRIMALDDI: a prioritized research agenda to expedite the discovery of new anti-malarial drugs 
Malaria Journal  2013;12:395.
The CRIMALDDI Consortium has been a three-year project funded by the EU Framework Seven Programme. It aimed to develop a prioritized set of recommendations to speed up anti-malarial drug discovery research and contribute to the setting of the global research agenda. It has attempted to align thinking on the high priority issues and then to develop action plans and strategies to address these issues. Through a series of facilitated and interactive workshops, it has concluded that these priorities can be grouped under five key themes: attacking artemisinin resistance; creating and sharing community resources; delivering enabling technologies; exploiting high throughput screening hits quickly; and, identifying novel targets. Recommendations have been prioritized into one of four levels: quick wins; removing key roadblocks to future progress; speeding-up drug discovery; and, nice to have (but not essential). Use of this prioritization allows efforts and resources to be focused on the lines of work that will contribute most to expediting anti-malarial drug discovery. Estimates of the time and finances required to implement the recommendations have also been made, along with indications of when recommendations within each theme will make an impact. All of this has been collected into an indicative roadmap that, it is hoped, will guide decisions about the direction and focus of European anti-malarial drug discovery research and contribute to the setting of the global research agenda.
doi:10.1186/1475-2875-12-395
PMCID: PMC3830512  PMID: 24191947
CRIMALDDI; Malaria; Drug discovery; Research agenda
17.  Elder abuse: do general practitioners know or care? 
A pilot survey in Tower Hamlets, London, indicated that many general practitioners (GPs) might not be recognizing abuse of elderly patients through lack of training. The survey was replicated on a large scale in Birmingham, to allow further analysis. 561 Birmingham GPs were mailed questionnaires and responses from 291 were analysed, providing data from 95% of the practices. The findings were similar to those in Tower Hamlets: just under half had diagnosed elder abuse in the previous year. Regression analysis of the combined data-sets (n = 363) indicated that the strongest factor predicting GP diagnosis of abuse was knowledge of 5 or more risk situations (odds ratio 6.77, 95% confidence interval 4.19, 10.93). The findings of these surveys suggest that research-based education and training would help GPs to become better at identifying and managing elder abuse.
PMCID: PMC1288067  PMID: 10740572
18.  Prevalence of Elder Abuse and Neglect in Seniors with Psychiatric Morbidity - Example from Central Moravia, Czech Republic 
Background:
Elder abuse and neglect (EAN) comprises emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. Elder abuse and neglect in seniors with psychiatric morbidity was not monitored in the Czech Republic at all, despite the literature shows mental morbidity as one of the important risk factor for developing elder abuse and neglect.
Methods:
We designed comparative cross sectional study comprising 305 seniors hospitalized in Mental Hospital Kromeriz in June 2011 – group of 202 seniors hospitalized due to mental disorder in psychogeriatric ward and group of 103 seniors hospitalized due to somatic disorder in internal ward. Content analysis of medical records was done in both groups of seniors, with regards to symptoms of elder abuse. Then, we discussed the topic of elder abuse with 30 nurses of psychogeriatric ward in focus group interview.
Results:
Between two compared groups of seniors we detected statistically higher prevalence of elder abuse in seniors with psychiatric morbidity (48 cases, 23.8% prevalence of EAN), compared to somatically ill seniors (3 cases, 2.9%). As for nursing staff, 5 from 30 nurses (16.7%) have never heard about symptoms of elder abuse and neglect, 10 from 30 nurses (33.3%) had just a partial knowledge about elder abuse and neglect and its symptoms, the rest of nurses (15 from 30 nurses, 50.0%) had good knowledge about elder abuse and neglect and its symptoms.
Conclusion:
Elder abuse and neglect seems to be a relevant problem in senior population with mental disorders. Development of educational programs for nursing and medical staff about Elder abuse and neglect (symptoms of EAN, early detection of EAN, knowledge how to report cases of EAN) could improve the situation and help mentally ill seniors to better quality of life.
PMCID: PMC3469028  PMID: 23113221
Demography of ageing; Ageism; Elder abuse and neglect; Psychiatric morbidity; Somatical morbidity
19.  The Relationship between Housing and Health: Children at Risk 
Environmental Health Perspectives  2004;112(15):1583-1588.
In November 2002, the National Center for Healthy Housing convened a 2-day workshop to review the state of knowledge in the field of healthy housing. The workshop, supported with funds from the U.S. Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control and National Center for Environmental Health, was unique in that it focused solely on the effect of housing on children’s health and the translation of research findings into practical activities in home construction, rehabilitation, and maintenance. Participants included experts and practitioners representing the health, housing, and environmental arenas. Presentations by subject-matter experts covered four key areas: asthma, neurotoxicants, injury, and translational research. Panel discussions followed the presentations, which generated robust dialogue on potential future research opportunities and overall policy gaps. Lack of consensus on standard measurements, incomplete understanding about the interaction of home hazards, inadequate research on the effectiveness of interventions, and insufficient political support limit current efforts to achieve healthy housing. However, change is forthcoming and achievable.
doi:10.1289/ehp.7157
PMCID: PMC1247625  PMID: 15531446
asthma; childhood exposure; environmental toxicants; healthy housing; lead poisoning
20.  Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem 
Resident-to-resident aggression (RRA) between long-term care residents includes negative and aggressive physical, sexual, or verbal interactions that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient. Although this problem potentially has high incidence and prevalence and serious consequences for aggressors and victims, it has received little direct attention from researchers to date. This article reviews the limited available literature on this topic as well as relevant research from related areas including: resident violence toward nursing home staff, aggressive behaviors by elderly persons, and community elder abuse. We present hypothesized risk factors for aggressor, victim, and nursing home environment, including issues surrounding cognitive impairment. We discuss methodological challenges to studying RRA and offer suggestions for future research. Finally, we describe the importance of designing effective interventions, despite the lack currently available, and suggest potential areas of future research.
doi:10.1016/j.avb.2007.12.001
PMCID: PMC2741635  PMID: 19750126
aggressive behavior; nursing homes; dementia; epidemiology
21.  Careers in academic general practice: problems, constraints, and opportunities. 
BMJ : British Medical Journal  1994;309(6964):1270-1272.
Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and post-graduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.
Images
PMCID: PMC2541836  PMID: 7710564
22.  Bariatric surgery: an IDF statement for obese Type 2 diabetes 
Diabetic Medicine  2011;28(6):628-642.
The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m2 or more.
doi:10.1111/j.1464-5491.2011.03306.x
PMCID: PMC3123702  PMID: 21480973
23.  Delivering HIV services to vulnerable populations: an evaluation and research agenda. 
Public Health Reports  2002;117(2):114-122.
In May 2000, the HIV/AIDS Bureau of the Health Resources and Services Administration convened HIV experts from throughout the country to identify new and emerging areas of research needed to guide policy and programmatic decisions on HIV service delivery to vulnerable populations. This article describes the process used to develop an evaluation/research agenda, discusses key findings and recommendations of the conference, and proposes a set of principles to guide the design and conduct of future investigations. Conference participants identified nine major evaluation/research themes that span the continuum of HIV behavioral prevention services and treatment. They recommended focusing future research on questions relevant to populations experiencing rapid rates of increase in HIV infection (for example, women, people of color, and adolescents and young adults) and considering explanatory factors at multiple levels of analysis (individual, clinician, organization, service delivery system, and environment).
PMCID: PMC1497421  PMID: 12356995
24.  Global Oral Health Inequalities 
Advances in Dental Research  2011;23(2):211-220.
The IADR Global Oral Health Inequalities Task Group on Dental Caries has synthesized current evidence and opinion to identify a five-year implementation and research agenda which should lead to improvements in global oral health, with particular reference to the implementation of current best evidence as well as integrated action to reduce caries and health inequalities between and within countries. The Group determined that research should: integrate health and oral health wherever possible, using common risk factors; be able to respond to and influence international developments in health, healthcare, and health payment systems as well as dental prevention and materials; and exploit the potential for novel funding partnerships with industry and foundations. More effective communication between and among the basic science, clinical science, and health promotion/public health research communities is needed. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. Recommendations are made for both clinical and public health implementation of existing research and for caries-related research agendas in clinical science, health promotion/public health, and basic science.
doi:10.1177/0022034511402016
PMCID: PMC3144035  PMID: 21490233
Dental caries; health inequalities; health disparities; implementation research; translational research
25.  Canadian integrative oncology research priorities: results of a consensus-building process 
Current Oncology  2013;20(4):e289-e299.
Background
In Canada, many diverse models of integrative oncology care have emerged in response to the growing number of cancer patients who combine complementary therapies with their conventional medical treatments. The increasing interest in integrative oncology emphasizes the need to engage stakeholders and to work toward consensus on research priorities and a collaborative research agenda. The Integrative Canadian Oncology Research Initiative initiated a consensus-building process to meet that need and to develop an action plan that will implement a Canadian research agenda.
Methods
A two-day consensus workshop was held after completion of a Delphi survey and stakeholder interviews.
Results
Five interrelated priority research areas were identified as the foundation for a Canadian research agenda: EffectivenessSafetyResource and health services utilizationKnowledge translationDeveloping integrative oncology models
Research is needed within each priority area from a range of different perspectives (for example, patient, practitioner, health system) and in a way that reflects a continuum of integration from the addition of a single complementary intervention within conventional cancer care to systemic change. Strategies to implement a Canadian integrative oncology research agenda were identified, and working groups are actively developing projects in line with those strategic areas. Of note is the intention to develop a national network for integrative oncology research and knowledge translation.
Conclusions
The identified research priorities reflect the needs and perspectives of a spectrum of integrative oncology stakeholders. Ongoing stakeholder consultation, including engagement from new stakeholders, is needed to ensure appropriate uptake and implementation of a Canadian research agenda.
doi:10.3747/co.20.1378
PMCID: PMC3728057  PMID: 23904767
Integrative oncology; research priorities; consensus development; Canada; complementary medicine; cam

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