Feature Review: Interventions for preventing abuse in the elderly

Lack of good research on which programs or strategies are useful in preventing or reducing elder abuse

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.

A team of Cochrane authors based in Australia and Malaysia worked with Cochrane Public Health to identify specific programs or strategies that are useful to prevent or reduce abuse in people 60 years and over, either aimed at the elderly themselves or people with whom they interact, such as caregivers or nursing home staff. Both randomised trials and other comparative studies that lasted at least 12 weeks were included.

 Included in this Cochrane Review is seven studies which had recruited about 1,900 elderly participants and 700 other people, such as caregivers and family members, across various settings. The quality of the evidence varied with most being low or very low quality, which means that we have to be cautious about what they found on the effects of the interventions.

 Overall there is inadequate trustworthy evidence to assess the effects of elder abuse interventions on occurrence or recurrence of abuse, although there is some evidence to suggest it may change the combined measure of anxiety and depression of caregivers. The included studies suggests it is uncertain whether targeted educational interventions improve the knowledge of health and allied professionals and caregivers about elder abuse and if it actually leads to changes in the way they behave thereafter, leading  to the elderly being abused less. Similarly, supporting and educating elderly victims of abuse appear to lead to more reporting of abuse, however it is unclear if the higher reporting meant more abuse occurred or a greater willingness to report the abuse as it occurred.

 “It was disappointingly that for such a common and worrying problem, that an abundance of good research was lacking,” said Philip Baker from Queensland University of Technology in Australia and the lead author of the Cochrane Review. “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.”


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