Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic.

Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics.

Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic.

Methods: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020.

Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital.

Patient prescriber agreements, also known as opioid contracts or opioid treatment agreements, have been recommended as a strategy for mitigating non-medical opioid use (NMOU). The purpose of our study was to characterize the proportion of patients with PPAs, the rate of non-adherence, and clinical predictors for PPA completion and non-adherence. This retrospective study covered consecutive cancer patients seen at a palliative care clinic at a safety net hospital between 1 September 2015 and 31 December 2019.

Victimization in Unethical Unlicensed Small Residential Care Homes in the United States: The Case for Whole System Disruption.

In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations.

A statewide elder mistreatment virtual assessment program: Legal, ethical, and practical issues.

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies.

Capacity evaluations for adult protective services: videoconference or in-person interviews.

The Geriatrician clinicians of the Texas Elder Abuse and Mistreatment Institute - Forensic Assessment Center Network (TEAM-FACN) in Houston, have many years of experience providing capacity assessment services for Adult Protective Services (APS) and Texas courts. A process has developed which is efficient, consistent, and evidence-informed. In the last two years, telecommunication has been added to this process to conduct assessments of APS clients in areas of Texas remote from the Houston area.

Stemming the Tide of Elder Mistreatment: A Medical School-State Agency Collaborative.

In 1995, the Texas Department of Family and Protective Services: Adult Protective Service Agency began a partnership with the Baylor College of Medicine geriatrics program to form the Texas Elder Abuse and Mistreatment (TEAM) Institute. The medical school-state agency partners overcame institutional and bureaucratic barriers to work collaboratively on mutually beneficial projects, including research and publications. Interprofessional students gained first-hand experience about abuse and neglect cases.

A Statewide Elder Mistreatment Virtual Assessment Program: Preliminary Data.

Objectives: To describe the Texas Elder Abuse and Mistreatment Institute Forensic Assessment Center Network (TEAM-FACN), a novel statewide elder mistreatment (EM) virtual assessment program using low-cost videophone technology and innovative web-based coordination to connect an Adult Protective Services (APS) agency and its clients, rural and urban, to a centralized geriatric and EM expert medical team for virtual in-home assessments.

Design: Descriptive.

Setting: Community.

Medical implications of elder abuse: self-neglect.

Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencies across the United States, is an often unrecognized geriatric syndrome characterized by squalor and unsafe living circumstances. It is a result of medical, neurologic, or psychiatric disorders coupled with lack of capacity for self-care and self-protection in the absence of necessary services or medical care, and leads to increased morbidity and mortality. Clinicians should evaluate self-neglecters and plan interventions based on comprehensive geriatric assessment and capacity assessment.

Four subtypes of self-neglect in older adults: results of a latent class analysis.

Objectives: To determine whether there are subtypes of elder self-neglect (SN) with different risk factors that can be targeted using medical and social interventions.

Design: Cohort study using archived data of Adult Protective Services (APS) substantiated cases of elder SN between January 1, 2004, and December 31, 2008.

Setting: Houston, Harris County, Texas.

Recognizing and reporting elder abuse and neglect.

Elder abuse (physical, sexual, or psychological) and neglect (by caretakers or self-neglect) are major public health problems. Most cases are not identified by clinicians and reported to the appropriate government agencies. There are some barriers to clinician identification and reporting of cases of elder abuse or neglect.