A Novel Intervention to Identify and Report Suspected Abuse in Older, Primary Care Patients.

BACKGROUND: Previous research has identified several barriers faced by clinicians in detecting and reporting elder abuse, such as lack of knowledge about the process to report suspected cases of abuse and lack of access to experts to consult with. A novel intervention was designed and tested that embedded two Adult Protective Services (APS) specialists in a healthcare system operating primary care clinics serving a large Medicare population. OBJECTIVES: To examine the types of roles the APS specialists played in the healthcare system and the number and types of cases of suspected abuse among older patients that clinicians consulted them about and reported to APS. DESIGN: Cross-sectional, exploratory study. SETTING: Primary care clinics in five regions of Texas. PARTICIPANTS: Older patients of primary care clinics. INTERVENTION: APS specialists and project staff trained clinicians on how to identify and report abuse, neglect, and exploitation among older patients. The specialists were also available in person or by telephone and email to consult with clinicians about patients suspected of being abused by others or being self-neglecting. MEASUREMENTS: Data were obtained by conducting semistructured telephone interviews with APS specialists; and from APS specialists' written documentation/notes of consultations with clinicians regarding suspicion of abuse among patients and whether a report to APS was warranted. RESULTS: The APS specialists trained clinicians on abuse, consulted with clinicians, and served as a liaison between the healthcare system and APS. During the project, clinicians reported 529 older patients to APS, and 386 patients received one or more services documented by APS at case closure. These cases involved 902 allegations of various types of abuse, of which the most common was self-neglect (617 or 68%). CONCLUSION: Embedding APS specialists in a large healthcare system led to clinicians' increased awareness of the importance of identifying and reporting elder abuse, particularly self-neglect. J Am Geriatr Soc 68:1748-1754, 2020.

Entrainment of locomotor activity rhythm in pinealectomized adult Syrian hamsters by daily melatonin infusion.

Melatonin entrains circadian rhythms in several species of rodents, but a role for melatonin as a Zeitgeber in the adult Syrian hamster is debated. The aim of this study was to define the conditions of daily programmed melatonin infusion in which an entrainment of the locomotor activity rhythm is obtained in adult male Syrian hamsters. The animals were pinealectomized, cannulated with a subcutaneous infusion system and submitted to dim red light conditions. They were initially daily infused with vehicle until free-running was established. Then, the animals were divided into three experimental groups, each group corresponding to a specific melatonin dose and infusion duration: (1) 10 microg melatonin/h for 5 h; (2) 30 microg melatonin/h for 5 h; and (3) 50 microg melatonin/h for 1 h. Of the total 64 hamsters, 37 hamsters fully entrained to the melatonin infusion regardless of whether the animals expressed during pre-treatment a free-running period (tau)< or >24 h, 20 animals presented a transient entrainment and seven did not entrain. Of the 37 animals entrained, withdrawal of melatonin re-established free-running rhythms, although often with a different tau compared with that observed during pre-treatment. These results indicate that after a long time of daily infusion, melatonin is able to entrain the free-running rhythm in adult Syrian hamster. The mechanism involved is not known, but the change in tau observed after melatonin treatment in some animals suggests that melatonin, directly or indirectly, affects the functioning of the clock.