Podcast: Interventions for preventing abuse in the elderly

The typical Cochrane Review provides answers about the treatment of a disease but, occasionally, one comes along that tackles other major challenges facing society. One such new review in August 2016 looks at the evidence on various ways to prevent abuse in the elderly. Here’s one of the research team, Philip Baker from Queensland University of Technology in Australia to tell us what they found.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The typical Cochrane Review provides answers about the treatment of a disease but, occasionally, one comes along that tackles other major challenges facing society. One such new review in August 2016 looks at the evidence on various ways to prevent abuse in the elderly. Here’s one of the research team, Philip Baker from Queensland University of Technology in Australia to tell us what they found.

Philip: The maltreatment of older people, also known as elder abuse, is a global problem, affecting large numbers of people worldwide. It’s a single or repeated act and, although it may be caused by employed carers, the abuse is more commonly committed by a relative, such as the son or daughter of the abused person. The maltreatment can take many forms including financial abuse, social abuse, physical abuse, sexual abuse and neglect.
It’s difficult to know just how big the problem is, as it often occurs behind closed doors and conditions such as dementia make it more difficult to monitor. But we know that millions of older people have suffered it and that it will increase significantly as populations age. In response, communities, agencies and governments are looking for ways to prevent abuse and protect the rights of older people. A broad range of programs are on offer: including those that target carers and family members through education, systems to improve financial independency, and work with perpetrators and victims.
We wanted to cover them all in our Cochrane Review, setting out to assess the effectiveness of any approach which was designed to reduce or prevent abuse in organisational or institutional settings, or in the person’s own home. We wanted to focus on studies that had included the measurement of abuse, including through self-report measures, and also looked at other outcomes that may be related to abusive behaviour or could explain how the interventions might reduce the potential for abuse. We included randomised trials and other comparative studies that had lasted at least 12 weeks.
Disappointingly for such a common and worrying problem, we found that good research is generally lacking. We were able to include a total of just seven studies, which had recruited about 1900 elderly participants and 700 other people, such as caregivers and family members, across various settings. We identified one study currently underway in Malaysia.
Three studies focused on the carers of the elderly persons, using educational interventions such as workforce training. One study taught coping skills to family carers of elderly people with dementia, another looked at a program for increasing detection by carers, and two studies worked with victims of abuse to prevent abuse. Most studies measured changes in knowledge and attitudes, with very few measuring the occurrence or reoccurrence of abuse.
The quality of the evidence varied. Most of the studies were low or very low quality, which means that we have to be cautious about what they found on the effects of the interventions.
On a more promising note, we did find that teaching coping strategies to family carers of elderly people with dementia probably reduces anxiety and depression of carers, which conceivably may lead to better outcomes for the elderly. However, it’s not clear if caregivers’ training and programs focusing on improving knowledge are successful. Programs aimed at detecting abuse may indeed lead to better identification of the abused as well as the abusers, but it’s uncertain whether they lead to less abuse. Of the two studies targeting victims through the provision of social-support and education, one recruited only 16 people so it was too small to detect any difference. The other, a community study with a little over 400 residents actually found that those who participated in the intervention had much higher rates of abuse. It’s not clear what this means. Perhaps the program made the situation worse, or maybe it led to more accurate reporting of elder abuse.
In summary, there has been a distinct absence of research evaluating the effects of elder abuse prevention programs, although there is some evidence to suggest that it would be worthwhile to teach coping skills to carers of elderly persons with dementia.
This lack of research needs to change if we are to find effective ways to prevent abuse in the elderly. There is an urgent need for government funding bodies to prioritise research in this area, given the considerable uncertainties that remain in the limited research done to date and the fact that there is very little to guide the development of a best-practice model of care. This means that there is a risk that many of the programs currently delivered do not achieve their intended purpose, or may even make things worse. Prevention strategies need to be properly evaluated and wasteful research avoided if we are to reduce this global problem.

John: Thanks very much Philip. If you’d like to read about the research that has already been done, and watch out for updates of this review should new studies be done, simply go to Cochrane Library dot com and search ‘preventing elderly abuse’.

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