Best-Practice Guideline on the Prevention of Abuse and Neglect of Older Adults

Key professional stakeholders roles in promoting older people's autonomy in residential care

BACKGROUND

Older people's autonomy is an ethical and legal principle in everyday residential care, but there is a lack of clarity about the roles and responsibilities of the key professional stakeholder groups involved.

RESEARCH OBJECTIVES

This study aimed to identify and define the roles and responsibilities of the key professional stakeholder groups involved in promoting older people's autonomy in residential care settings.

RESEARCH DESIGN

We used a Delphi method with two iterative rounds of online group discussions and collected data from experts in older people's care in Finland in summer 2020. The data were analyzed using deductive-inductive content analysis methods.

ETHICAL CONSIDERATIONS

According to Finnish legislation, this type of research did not need approval from a research ethics committee. Informed consent from the participants was obtained and they were informed about the voluntary nature and confidentiality of the study and their right to withdraw at any time.

RESULTS

Key professional stakeholders had different roles and responsibilities, but their shared, integrated goal was to achieve older people's autonomy in residential care settings. Their combined roles and responsibilities covered all aspects of promoting older people's autonomy, from care and service planning and daily decision-making to service structures that included ethical competencies and monitoring. Multipronged, variable, coordinated strategies were required to identify, assess, and promote autonomy at different levels of care.

CONCLUSION

Key professional stakeholders need to work together to provide an unbroken chain of care that provides older people with autonomy in residential care settings. In future, more knowledge is needed about how to create structures to achieve the shared goal of older people's autonomy in these settings.

The Context of Elder Maltreatment: an Opportunity for Prevention Science

Elder maltreatment (EM) has been understood as a worldwide major public health threat for decades, yet it remains a form of victimization receiving limited attention, resources, and research. EM, which includes caregiver neglect and self-neglect, has far-reaching and long-lasting impacts on older adults, their families, and communities. Rigorous prevention and intervention research has significantly lagged in proportion to the magnitude of this problem. With rapidly growing population aging, the coming decade will be transformative: by 2030, one in six people worldwide will be aged 60 or older, and approximately 16% will experience at least one form of maltreatment (World Health Organization, 2021). The goal of this paper is to raise awareness of the context and complexities of EM, provide an overview of current intervention strategies based on a scoping review, and discuss opportunities for further prevention research, practice, and policy within an ecological model applicable to EM.

Adverse health correlates of intimate partner violence against older women: Mining electronic health records

Intimate partner violence (IPV) is often studied as a problem that predominantly affects younger women. However, studies show that older women are also frequently victims of abuse even though the physical effects of abuse are harder to detect. In this study, we mined the electronic health records (EHR) available through IBM Explorys to identify health correlates of IPV that are specific to older women. Our analyses suggested that diagnostic terms that are co-morbid with IPV in older women are dominated by substance abuse and associated toxicities. When we considered differential co-morbidity, i.e., terms that are significantly more associated with IPV in older women compared to younger women, we identified terms spanning mental health issues, musculoskeletal issues, neoplasms, and disorders of various organ systems including skin, ears, nose and throat. Our findings provide pointers for further investigation in understanding the health effects of IPV among older women, as well as potential markers that can be used for screening IPV.

Nursing support for older people's autonomy in residential care: An integrative review

BACKGROUND

Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people.

OBJECTIVE

The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care.

METHODS

An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis.

RESULTS

The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome.

CONCLUSIONS

Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices.

IMPLICATIONS FOR PRACTICE

The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.

Interventions to prevent elder abuse in the community: a mixed-methods systematic review

OBJECTIVE

To identify the interventions proposed in the literature aimed at preventing elder abuse among community-residing elders.

METHOD

This was a mixed-methods systematic review that followed the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols checklist. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews. We included studies published between January 2004 and December 2019 in the databases: LILACS, IBECS, CUMED, CINAHL, MEDLINE and SciELO. The methodological quality of each study included was performed using the Mixed Methods Appraisal Tool.

RESULTS

Seven studies formed the final sample. Two groups emerged after the analyses: the primary level intervention group, which used health education and coexisting elder abuse groups; and the secondary intervention level, focused mostly on the mental health care of victims of elder abuse.

CONCLUSION

There is still a shortage of intervention studies to prevent elder abuse. All the studies selected had a positive outcome, and all interventions can be implemented in nursing care practice.

Examining nurses' role in Adult Protective Services related to safeguarding older people

Aim

To examine the role of Adult Protective Services' (APS's) nurses in helping abused, neglected and exploited older people, this study investigated how nurses' contribution differs from social workers. Though the majority of APS' workforce is staffed by social workers, some programmes also employ nurses.

Design

Secondary data analysis using convergent parallel mixed‐method design was conducted.

Methods

Using survey data from the National Adult Protective Services Association, 99 nurses' responses between October 2014 and August 2015 were analysed to examine their agency characteristics, training and qualities, job responsibilities and interprofessional collaboration.

Results

The majority of nurses work with social workers or other professionals using a multidisciplinary team (MDT) approach. Among those carrying a caseload, 69% (49 out of 71) of nurses work in conjunction with social workers. Out of all nurses, 64% (63 out of 99) indicated participation in at least one MDT. While the responsibilities nurses provided were similar to social workers, nurses were also able to provide healthcare related services, in their professional competencies, without referral.

Conclusion

Nurses in APS are in a privileged position to investigate mistreatment and provide/coordinate direct care for victims.

Impact

Not much was known about nurses who directly investigate elder mistreatment and provide services to victims. This study was the first to highlight the nursing workforce in APS, and described the nurses' unique contribution to the field. Nurses functioned as both social workers and healthcare professionals in APS. Since victims of elder mistreatment often suffer from negative physical, psychological and social consequences, having nurses in APS benefits victims to receive and the programmes in providing better care and services.

Do interventions to prevent or stop abuse and neglect among older adults work? A systematic review of reviews

Abuse and neglect among older adults impact everyone and are recognized internationally as significant and growing public health issues. A systematic review of reviews was conducted to identify effective strategies and approaches for preventing abuse and neglect among older adults. Eligible reviews were systematic or meta-analyses; focused on the older population as reported in the publications; reviewed prevention interventions; included relevant violence and abuse outcomes; written in English; and published in a peer-reviewed journal between January 2000 and May 2020. Eleven unique reviews (12 publications) met the eligibility criteria, including one meta-analysis. Included reviews mainly focused on general abuse directed toward older adults; and educational interventions for professional and paraprofessional caregivers, multidisciplinary teams of health care and legal professionals, and families. Interventions were implemented in a variety of community and institutional settings and addressed primary, secondary, and tertiary prevention. The reviews indicated weak or insufficient evidence of effectiveness in preventing or reducing abuse, yet several promising practices were identified. Future research is needed to evaluate emerging and promising strategies and approaches to prevent abuse among older adults. Effective interventions are also needed to prevent or reduce abuse and neglect among older adults.

Intervenções fisioterapêuticas direcionadas à pessoa idosa em situação de violência: uma revisão de escopo

Resumo Objetivo Identificar as intervenções fisioterapêuticas direcionadas à pessoa idosa em situação de violência. Método Trata-se de uma revisão de escopo, em que foram acessadas as seguintes bases de dados/bibliotecas/buscadores e literatura cinzenta: BVS, PubMed, Web of Science, Scopus, CINAHL, PEDro, BDTD, OpenGrey, OpenThesis, RCAAP, Portal de Teses e Dissertações da CAPES, DART-Europe E-theses Portal e Theses Canada Portal. As buscas utilizaram os descritores e palavras-chave, que foram combinados por meio dos operadores booleanos OR e AND: Fisioterapeutas, Fisioterapia, “Physical Therapists”, Physiotherapy, “Physical Therapy”, “Physical Therapy Specialty”, “Physical Therapy Modalities”, Rehabilitation, Reabilitação, “Elder Abuse”, “Maus-tratos ao Idoso”, “Physical Abuse”, “Elder Neglect”, “Aged Abuse” e “Elder Mistreatment”. Resultados Dos 601 registros encontrados, 46 foram excluídos por serem duplicados, sendo selecionados 555 para leitura dos respectivos títulos e resumos. Foram excluídas 548 publicações por não se adequarem aos critérios de inclusão, sendo pré-selecionados 7 trabalhos. Pela estratégia Snowballing um foi identificado, originando um resultado final de 8 estudos. Conclusão As intervenções fisioterapêuticas direcionadas à pessoa idosa em situação de violência compreendem: educação em saúde, medidas no estresse do cuidador, recursos comunitários, rastreamento/triagem, avaliação, identificação, plano terapêutico/reabilitação e denúncia. Diante dos achados, observa-se que, apesar da lacuna no conhecimento dessa temática, o fisioterapeuta desempenha um papel imprescindível na condução de casos de violência contra a pessoa idosa.

Preventing The Abuse Of Residents With Dementia Or Alzheimer's Disease In The Long-Term Care Setting: A Systematic Review

Purpose

The main objective of this study was to investigate abuse of residents with either dementia or Alzheimer’s disease in long-term care settings, to identify facilitators and barriers surrounding implementation of systems to prevent such occurrences, and to draw conclusions on combating the issue of abuse.

Patients and methods

A systematic review was conducted using the Medline, CINAHL, and Academic Search Ultimate databases. With the use of key terms via Boolean search, 30 articles were obtained which were determined to be germane to research objectives. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Residents with dementia or Alzheimer’s disease are at greater risk of abuse. The growing population could increase this problem exponentially. The most common facilitators were the introduction of policies/programs in the facility, education, and working conditions. The most cited barriers were poor training, lack of research, and working conditions in the long-term care setting.

Conclusion

The examples given would be useful in minimizing the potential for abuse in the long-term care setting. Leadership can take an active role in the prevention of abuse of the elderly through their actions, education of employees, and changes in the work environment.

Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed

BACKGROUND

Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones.

OBJECTIVE

To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation.

DESIGN

Systematic review.

SETTING

Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL.

MEASUREMENTS

We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available.

RESULTS

We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute-care hospital, 43% had high potential to work in low-resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high-quality study design.

CONCLUSION

Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high-quality study design. Many have the potential to work in low-resource environments. Acute-care hospitals were infrequently integrated into programs.