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Elder abuse just next door! Part 4: What are the benefits and harms of interventions to those experiencing elder abuse?

The Bottom Line

  • The amount and quality of literature evaluating interventions for elder abuse is very limited.
  • A review of elder abuse interventions found that there was no benefit in the resolution of abuse or on social or psychological client outcomes. This review found that in two studies there were harmful effects in that the intervention group had a higher rate of recurrence of abuse.
  • A recent review of the literature on educational programs for health professionals found that most evaluations focused only on satisfaction measures (e.g., participant ratings of educational sessions for quality or usefulness). We do not know if there is any impact on recognition or reporting of elder abuse (1).

In this final Part 4 of this 4-part series, we examine the benefits and harms of interventions to help those experiencing elder abuse. In Parts 1 and 2, we defined elder abuse and detailed the risk factors and specific types of abuse. In Part 3 we examined the views of Canadians on elder abuse compared to the evidence on the size of this problem.

What types of interventions are available to address elder abuse?

Many different types of interventions have been used to address elder abuse. Interventions are often targeted at four key groups: (a) those experiencing abuse, (b) those who are perpetrating the abuse, (c) health and social care professionals providing care to older persons, and (d) communities or society in general. Examples of elder abuse interventions are listed in Table 1.


Table 1: Examples of elder abuse interventions

Target group
 Examples of elder abuse interventions
 Older persons experiencing elder abuse

Education

Counselling

Case management

Interprofessional and collaborative teams

Referral to health services

Legal counsel

Financial support

Housing assistance

Advocacy

Police support

 Perpetrators of elder abuse
Education
Counselling
Substance abuse management
 Health and social care professionals providing care to older persons
Education
Practice guidelines
Communities or society
Education
Media campaigns
Addressing ageism
Age friendly initiatives

 

What are the interventions for those experiencing elder abuse?

We don't have good information about which elder abuse interventions are effective. Here are some highlights from a recent review of elder abuse interventions (2):

Four studies that have evaluated some interventions that included a psycho-educational support group, legal services, volunteer visitors, mandated reporting or advocacy services showed little improvement. There was no benefit when examining resolution of several outcomes including: 1) continuing abuse, 2) social-psychological client outcomes or 3) relocation. In two studies, there were harmful effects of home visiting plus education or volunteer visiting interventions as shown in a higher rate of recurrence of abuse. This finding must be considered in light of the poor study methods.

What are the interventions for those perpetrating elder abuse?

There has been little rigorous research on interventions for those perpetrating elder abuse. One study looked at the impact of an intervention targeted at caregivers who were at risk of abusing older family members (3). Caregivers received 8 training sessions related to aging, problem solving, stress and anger management and community resources. In this study, there was no evidence of the program's impact on the outcomes of anger, self-esteem, caregiver burden or general mental health.

What are the interventions for health and social care professionals?

A recent systematic review of the literature on educational programs aimed at improving recognition and reporting of elder abuse and neglect among health professionals found that most evaluations focused only on participant satisfaction. Participants identified the value of interactive teaching techniques (e.g., hands-on learning with real or standardized patients), opportunities for discussion and feedback, and involvement of abuse survivors as facilitators or in videos of personal accounts as helpful in their learning. While some of the programs demonstrated improved knowledge of elder abuse, we do not know if there is any impact on recognition or reporting of elder abuse (1).

There are a number of practice guidelines available to help healthcare professionals prevent and address elder abuse (4;5) but the impact of their implementation has not been evaluated.

What are the interventions at a societal or community levels?

There have been a number of media campaigns (e.g., television advertisements) related to elder abuse, but there is no evidence of the impact of these efforts. Broader initiatives such as Age Friendly initiatives and approaches to address ageism have not been evaluated for their impact on elder abuse.

What is the bottom line about elder abuse?

Many different types of interventions have been used to address elder abuse. Despite elder abuse being a common and serious problem, the best way to manage those experiencing and those perpetrating abuse, is not yet clear. More research is needed.

In this four-part series of blog posts we discuss several aspects of elder abuse:

  • In Part 1 we examine the general definition of elder abuse
  • In Part 2 we look at important risk factors associated with elder abuse and different types of abuse
  • In Part 3 we compare what Canadians believe about abuse and the evidence on the size of this health problem in Canada and around the world
  • In Part 4 we discuss the benefits and possible harms of elder abuse interventions


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References

  1. Alt KL, Nguyen AL, Meurer LN. The Effectiveness of Educational Programs to Improve Recognition and Reporting of Elder Abuse and Neglect: A Systematic Review of the Literature. Journal of Elder Abuse & Neglect 2011 Jun 24;23(3):213-33.
  2. Ploeg J, Fear J, Hutchison B, MacMillan H, Bolan G. A systematic review of interventions for elder abuse. J Elder Abuse Negl 2009 Jul;21(3):187-210.
  3. Scogin F, Beall C, Bynum J, Stephens G, Grote NP, Baumhover LA, et al. Training for Abusive Caregivers: An unconventional approach to an intervention dilemma. Journal of Elder Abuse & Neglect 1990 Mar 30;1(4):73-86.
  4. Registered Nurse's Association of Ontario. Preventing and addressing abuse and neglect of older adults: Patient-centred, collaborative, system-wide approaches. 2014. http://rnao.ca/news/media-releases/2014/06/13/recommendations-first-comprehensive-nursing-guideline-elder-abuse-rel.
  5. Daly JM, Merchant ML, Jogerst GJ. Elder abuse research: a systematic review. J Elder Abuse Negl 2011 Oct;23(4):348-65.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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