Limited evidence found for interventions to prevent or stop elder abuse

Ayalon L, Lev S, Green O, Nevo U. A systematic review and meta-analysis of interventions designed to prevent or stop elder maltreatment. Age and Ageing. 2016; 45(2): 216-227.

Review question

•       What is known about interventions to prevent or stop elder abuse?

Background

•       Elder abuse or maltreatment is defined as “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (from present review).

•       There are various types of elder abuse, including physical (non-accidental acts that result in pain and injury), emotional (screaming, insulting or threatening), financial (illegal use of financial resources), and sexual (unwanted sexual acts) abuse. Neglect (intentional or unintentional withholding of food, medication or other necessities) is also a type of elder abuse.

•       It has been reported that the prevalence of significant elder abuse is 6% among the general population and 25% among vulnerable older adults.

•       Neglect and psychological and financial abuse are the most common types of elder abuse.

•       This systematic review examines what is known about interventions to prevent or stop elder abuse.

How the review was done

•       Review authors conducted a detailed search of select research databases.

•       Search terms related to elder abuse and interventions used to address them.

•       A total of 8,774 articles were retrieved from the initial search and 24 articles were added from additional searches, and of those 28 studies were included in this review.

•       This review was funded by The Association for the Planning and Development of Services for the Aged. The authors declared no conflicts of interest.

What the researchers found

•       Interventions were broadly grouped into three main categories: 1) interventions designed to improve the ability of professionals to detect or stop elder abuse; 2) interventions targeting older adults who experience elder abuse; and 3) interventions targeting caregivers who abuse older adults.

•       Two studies involved interventions designed to improve the ability of professionals to detect or stop elder abuse. Although this strategy is the most commonly employed at the system level, the body of research evidence remains limited. These two studies both reported non-significant results.

•       Three studies examined interventions targeting older adults who experience elder abuse. These studies were quite diverse in their outcomes and thus no conclusive finding was reported for this strategy.

•       Nineteen studies involved interventions that target caregivers who abuse older adults. Among these studies, one targeted family caregivers, five targeted psychological abuse by paid caregivers, and 13 targeted the use of physical restraint by paid caregivers. The interventions involved educational elements to increase awareness of more appropriate communication methods, alternatives to restraint use, and strategies for dementia care. The most effective interventions appear to be those directly targeting physical restraint by long-term care paid carers.

•       Most interventions in this review focused on older adults with dementia.

Conclusion

•       This review demonstrated that current interventions for elder abuse fall into three broad categories: those targeting professionals who seek to stop elder maltreatment; those targeting older adults experiencing elder maltreatment; and those targeting caregivers who maltreat older adults.

•       The review also identified a significant shortage of research in this field. In addition to the categories identified in this review, specific areas that are still lacking evidence include elder neglect and public awareness of elder abuse.