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van Houten ME, Vloet LCM, Rikkert MGMO, van de Kerkhof-van Bon B, de Rooij A, Verhoeven M, Bil WME, Lucke JA, Schoon Y, Berben SAA. ERASE: a feasible early warning tool for elder abuse, developed for use in the Dutch emergency department. BMC Emerg Med 2024; 24:52. [PMID: 38570746 PMCID: PMC10988976 DOI: 10.1186/s12873-024-00971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Elder abuse is a worldwide problem with serious consequences for individuals and society. To effectively deal with elder abuse, a timely identification of signals as well as a systematic approach towards (suspected) elder abuse is necessary. This study aimed to develop and test the acceptability and appropriateness of ERASE (EldeR AbuSE) in the emergency department (ED) setting. ERASE is an early warning tool for elder abuse self-administered by the healthcare professional in patients ≥ 70 years. METHODS A systematic literature review was previously conducted to identify potential available instruments on elder abuse for use in the ED. Furthermore, a field consultation in Dutch hospitals was performed to identify practice tools and potential questions on the recognition of elder abuse that were available in clinical practice. Based on this input, in three subsequent rounds the ERASE tool was developed. The ERASE tool was tested in a pilot feasibility study in healthcare professionals (n = 28) working in the ED in three Dutch hospitals. A semi-structured online questionnaire was used to determine acceptability and appropriateness of the ERASE tool. RESULTS The systematic literature review revealed seven screening instruments developed for use in the hospital and/or ED setting. In total n = 32 (44%) hospitals responded to the field search. No suitable and validated instruments for the detection of elder abuse in the ED were identified. The ERASE tool was developed, with a gut feeling awareness question, that encompassed all forms of elder abuse as starting question. Subsequently six signalling questions were developed to collect information on observed signs and symptoms of elder abuse and neglect. The pilot study showed that the ERASE tool raised the recognition of healthcare professionals for elder abuse. The tool was evaluated acceptable and appropriate for use in the ED setting. CONCLUSIONS ERASE as early warning tool is guided by an initial gut feeling awareness question and six signalling questions. The ERASE tool raised the recognition of healthcare professionals for elder abuse, and was feasible to use in the ED setting. The next step will be to investigate the reliability and validity of the ERASE early warning tool.
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Affiliation(s)
- Miriam E van Houten
- Department of Geriatric Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Research Department of Emergency and Critical Care, School of Health Studies, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
- Trompetter & Partners Social Medical Expertise, Utrechtseweg 75, 3702 AA, Zeist, The Netherlands.
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, School of Health Studies, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, P.O. Box 9101, 114, 6500 HB, Nijmegen, the Netherlands
| | - Marcel G M Olde Rikkert
- Radboudumc Alzheimer Centre, Donders Insititute of Medical Neuroscience, Department of Geriatrics, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | | | | | | | | | - Yvonne Schoon
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 114, 6500 HB, Nijmegen, The Netherlands
| | - Sivera A A Berben
- Research Department of Emergency and Critical Care, School of Health Studies, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, P.O. Box 9101, 114, 6500 HB, Nijmegen, the Netherlands.
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Hasson H, Hedberg Rundgren E, Strehlenert H, Gärdegård A, Uvhagen H, Klinga C, Hedberg Rundgren Å, von Thiele Schwarz U. The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231189198. [PMID: 37790175 PMCID: PMC10392202 DOI: 10.1177/26334895231189198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. Methods The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Results Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Conclusion Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.
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Affiliation(s)
- Henna Hasson
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - Emma Hedberg Rundgren
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Helena Strehlenert
- SOLIID Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Centre, Stockholm, Sweden
| | - Anna Gärdegård
- Stockholm Research and Development, Unit for Social Services (FOU Nordväst), Stockholm, Sweden
| | - Håkan Uvhagen
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU nu), Stockholm Health Care Services, Stockholm, Sweden
- Academic Primary Healthcare Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte Klinga
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU nu), Stockholm Health Care Services, Stockholm, Sweden
| | - Åsa Hedberg Rundgren
- Stockholm Gerontology Research Centre, Stockholm, Sweden
- Ageing Research Center, Karolinska Institutet, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Wiklund N, Ludvigsson M, Nägga K, Simmons J. Elder abuse and life-course victimization in hospitalized older adults in Sweden: prevalence and associations with mental ill-health. BMC Geriatr 2022; 22:929. [PMID: 36460947 PMCID: PMC9716666 DOI: 10.1186/s12877-022-03638-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The prevalence of elder abuse has only rarely been investigated in Sweden and never in a hospital setting. Therefore, the aims of this study were to: 1) Estimate the prevalence of elder abuse and life-course victimization among hospitalized older adults in Sweden, 2) Explore factors associated with elder abuse in the same sample, and 3) Explore the associations between life-course victimization and mental ill-health. METHODS The study was conducted at a university hospital in Sweden. Adults over the age of 65 years admitted to a medical or geriatric acute care ward during spring 2018 were consecutively recruited. The participant rate was 44% (n = 135/306). Participants were assessed via a face-to-face interview about their experiences of elder abuse and abuse earlier in life. Mental ill-health was measured using a self-administered depression assessment (Patient Health Questionnaire-9), along with information about medications and diagnoses retrieved from medical records. RESULTS Altogether, 40.7% (n = 55) of the participants reported some form of abusive experience during their life course. The prevalence of elder abuse was 17.8% (n = 24), and 58% (n = 14) of elder abuse victims also reported victimization earlier in life. Being abused before the age of 65 was the only background factor associated with elder abuse (OR = 5.4; 95% CI 1.9-15.7). Reporting abusive experiences both before and after the age of 65 was associated with current anti-depressant medication (OR = 6.6; 95% CI 1.1-39.2), a PHQ-9 result of 10 or more (OR = 10.4; 95% CI 2.1-51.0), and nine or more symptom diagnoses (OR = 4.0, 95% CI 1.0-16.1). Being abused only before or after the age of 65 was not significantly associated with any mental ill-health outcome measure. CONCLUSIONS Elder abuse and victimization earlier in life are highly prevalent among hospitalized older patients, and our findings underline the importance of a life-course perspective both in research on elder abuse and in clinical practice. Identifying and caring for older adults who have been subjected to abuse should be a priority in health care.
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Affiliation(s)
- Nicolina Wiklund
- Department of Acute Internal Medicine and Geriatrics in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Geriatrics, Örebro University Hospital, Örebro, Sweden
| | - Mikael Ludvigsson
- Department of Acute Internal Medicine and Geriatrics in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katarina Nägga
- Department of Acute Internal Medicine and Geriatrics in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Nandi D, Gulati R, Mitra T, Ranjan P, Janardhanan R. Clinical resource allocation for the mitigation of elder abuse. THE LANCET. HEALTHY LONGEVITY 2022; 3:e649. [PMID: 36202124 DOI: 10.1016/s2666-7568(22)00189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dhruva Nandi
- Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Tamil Nadu 603203, India
| | - Richa Gulati
- Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Tamil Nadu 603203, India
| | - Tridip Mitra
- Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Tamil Nadu 603203, India
| | - Priya Ranjan
- Biju Patnaik University of Technology, Rourkela, India
| | - Rajiv Janardhanan
- Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Tamil Nadu 603203, India.
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Simmons J, Motamedi A, Ludvigsson M, Swahnberg K. Testing an educational intervention to improve health care providers' preparedness to care for victims of elder abuse: a mixed method pilot study. BMC MEDICAL EDUCATION 2022; 22:597. [PMID: 35922855 PMCID: PMC9351204 DOI: 10.1186/s12909-022-03653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Elder abuse is prevalent and associated with ill-health. However, health care providers often lack education about elder abuse and older patients' victimization often remains unknown to them. In this pilot study we performed initial testing of an educational model aiming at improving health care providers' preparedness to care for older adults subjected to abuse, or more specifically their self-reported propensity to ask older patients questions about abuse and perceived ability to manage the response. METHODS The educational model consisted of a full training day about elder abuse, including theory, group discussions and forum theatre. Forum theatre is an interactive form of drama in which participants are not only observers, but rather spect-actors, urged to participate in the scene. They are thereby given the opportunity to discuss and practise difficult health care encounters. Medical interns (intervention group n = 16, control group n = 14) in Sweden participated in the study and a mixed method convergent parallel design was used. Quantitative data was collected at baseline and 6 months post-intervention using a questionnaire (the REAGERA-P). Qualitative interviews were conducted with four of the participants in the intervention group and data was analysed using qualitative content analysis. RESULTS The reported frequency of asking older patients questions about abuse increased in the intervention group (p = 0.047), but not the control group (p = 0.38) post-intervention. Potential mediators for the improvement were an increased awareness of elder abuse and higher self-efficacy for asking questions about elder abuse. Participants also reported a higher perceived ability to manage cases of elder abuse, even though uncertainties concerning how to provide the best possible care remained. The qualitative interviews indicated that learning from each other in group discussions and forum theatre likely was an important contributor to the positive results. CONCLUSION This pilot test indicated that the educational model may be effective in improving health care providers' preparedness to care for older adults subjected to abuse. However, uncertainties about how to handle elder abuse cases remained post-intervention. In a future full-scale test of the model more focus needs to be put on how to manage cases of elder abuse.
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Affiliation(s)
- Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Atbin Motamedi
- Department of Emergency Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ludvigsson
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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Brijnath B, Gahan L, Dow B, Hickey L, Braddy L, Collins M, Antoniades J. When co-design works (sort of): the case of the Australian elder abuse screening instrument. J Elder Abuse Negl 2022; 34:302-313. [PMID: 35818632 DOI: 10.1080/08946566.2022.2098218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Applying co-design methodologies is increasingly recommended for engaging diverse end-users and bridging evidence-practice gaps. Yet, one of the ongoing challenges for research using co-design is the lack of evidence as to whether co-design leads to better outcomes than not using co-design. In this article, we outline how, despite adhering to a time and resource intensive co-design process with strong moral and ethical foundations, its implementation by end-users led to mixed outcomes around improved elder abuse screening. We discuss the implications of these ambiguous results, arguing that "noise" in our data might be inevitable due to the inherent sensitivities associated with elder abuse screening and offer a polemical recommendation about why the Australian Elder Abuse Screening Instrument (AuSI) should nevertheless be rolled out.
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Affiliation(s)
- Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia.,School of Social Sciences, University of Western Australia, Perth, Australia
| | - Luke Gahan
- Defence & Veteran Family Research, Australian Institute of Family Studies, Melbourne, Australia
| | - Briony Dow
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia.,School of Global and Population Health, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Lyndal Hickey
- Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Lisa Braddy
- Department of Social Work, St Vincent's Hospital, Melbourne, Australia
| | - Melinda Collins
- Department of Social Work, St Vincent's Hospital, Melbourne, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
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Simmons J, Wiklund N, Ludvigsson M. Managing abusive experiences: a qualitative study among older adults in Sweden. BMC Geriatr 2022; 22:456. [PMID: 35619083 PMCID: PMC9137123 DOI: 10.1186/s12877-022-03143-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 12/28/2022] Open
Abstract
Background Elder abuse is prevalent, and is associated with poor health outcomes. How an older adult is affected by abusive experiences is dependent on myriad factors, including aspects of the abuse itself, other life circumstances, coping strategies, and what kind of help the older adults receive to manage the experience. In this study, we sought to investigate how older adults themselves describe how they manage abusive experiences. An increased understanding of this could help to tailor society’s response to older adults suffering from abuse. Method Participants (n = 30) were recruited from patients admitted to one acute geriatric and one acute internal medicine ward at a university hospital in Sweden. Patients over the age of 65 who reported experiences of elder abuse or who reported that they were still suffering from abuse that had occurred earlier in life were included. In-depth qualitative interviews were conducted, transcribed verbatim, and analyzed using qualitative content analysis. Results The analysis resulted in five themes, three pertaining to strategies used to manage abusive experiences (self-reliant coping, restoring dignity in relation to others, and needing formal and informal help) and two pertaining to the disclosure process (inner resistance to disclosure, and external barriers and facilitators for disclosure). Conclusion Older adults were found to use a combination of different strategies to manage abusive experiences. Some were self-reliant, but older adults often managed their experiences with the help of others. Health care professionals were generally in a position to facilitate disclosure, but some participants reported poor encounters with health care. The findings indicate a need to facilitate disclosure by, for example, training professionals on issues related to elder abuse and developing more easily navigated response systems that can respond to the complex needs of older adults trying to manage abusive experiences. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03143-y.
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Affiliation(s)
- Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Nicolina Wiklund
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ludvigsson
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Ludvigsson M, Motamedi A, Westerlind B, Swahnberg K, Simmons J. Responding to Elder Abuse in GERiAtric care (REAGERA) educational intervention for healthcare providers: a non-randomised stepped wedge trial. BMJ Open 2022; 12:e060314. [PMID: 35508341 PMCID: PMC9073413 DOI: 10.1136/bmjopen-2021-060314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers' propensity to ask older patients questions about abusive experiences. METHODS AND ANALYSIS Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices.The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care-Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome. ETHICS AND DISSEMINATION The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics. TRIAL REGISTRATION NUMBER NCT05065281.
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Affiliation(s)
- Mikael Ludvigsson
- Department of Psychiatry, and Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Atbin Motamedi
- Department of Emergency Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Björn Westerlind
- Department of Geriatrics, County Hospital Ryhov, Region Jönköping County, Jonkoping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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Ludvigsson M, Wiklund N, Swahnberg K, Simmons J. Experiences of elder abuse: a qualitative study among victims in Sweden. BMC Geriatr 2022; 22:256. [PMID: 35351038 PMCID: PMC8962107 DOI: 10.1186/s12877-022-02933-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elder abuse is underreported and undertreated. Methods for prevention and intervention are being developed, but the knowledge guiding such measures is often insufficiently based on the victims' own voices due to a paucity of studies. The aim of this study was therefore to explore experiences of elder abuse among the victims themselves. METHODS Consecutive inpatients ≥ 65 years of age at a hospital clinic in Sweden were invited to participate, and 24 victims of elder abuse were identified. Semi-structured qualitative interviews were conducted, and transcripts were analyzed using qualitative content analysis. RESULTS The analysis generated four themes that together give a comprehensive picture of elder abuse from the participants' subjective perspectives. The participants' experiences of abuse were similar to previous third-party descriptions of elder abuse and to descriptions of abuse among younger adults, but certain aspects were substantially different. Vulnerability due to aging and diseases led to dependance on others and reduced autonomy. Rich descriptions were conveyed of neglect, psychological abuse, and other types of abuse in the contexts of both care services and family relations. CONCLUSIONS Elder abuse is often associated with an individual vulnerability mix of the aging body, illnesses, and help dependence in connection with dysfunctional surroundings. As individual differences of vulnerability, exposure to violence, and associated consequences were so clear, this implies that components of prevention and intervention should be individually tailored to match the needs and preferences of older victims.
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Affiliation(s)
- Mikael Ludvigsson
- Department of Acute Internal Medicine and Geriatrics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Nicolina Wiklund
- Department of Acute Internal Medicine and Geriatrics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Simmons J, Wenemark M, Ludvigsson M. Development and validation of REAGERA-P, a new questionnaire to evaluate health care provider preparedness to identify and manage elder abuse. BMC Health Serv Res 2021; 21:473. [PMID: 34006271 PMCID: PMC8131191 DOI: 10.1186/s12913-021-06469-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Elder abuse is prevalent and associated with morbidity but often goes unnoticed in health care. Research on the health care response to victims calls for valid measurements. This article describes the development and validation of a questionnaire to evaluate health care provider preparedness to care for older adults subjected to abuse, the REAGERA-P (Responding to Elder Abuse in GERiAtric Care - Provider questionnaire). METHOD REAGERA-P was developed in phase I. The questionnaire includes a case vignette, self-efficacy scales for identifying and managing elder abuse cases and cause for concern as well as organizational barriers when talking with older patients about abuse. Content validity was ensured by a review committee, and cognitive interviews were conducted to ensure face validity and to examine cognitive processes to ensure comprehension. REAGERA-P was then administered to health care providers (n = 154, response rate 99 %) to test for construct validity. Factor analysis was performed, and internal consistency was tested for the self-efficacy scales. Convergent validity was tested by investigating associations between relevant variables. Some items were revised in phase II, and new cognitive interviews were performed. Parts of the questionnaire were tested for responsiveness by administering it to medical interns (n = 31, response rate 80 %) before and after an educational intervention. RESULTS REAGERA-P showed good content and face validity. The factor analysis revealed two factors: one for asking questions about abuse (Cronbach's α = 0.75) and one for managing the response to the questions (Cronbach's α = 0.87). Results suggest good convergent validity for the self-efficacy scales and for questions about cause for concern and organizational barriers. The responsiveness of the self-efficacy scales was good: the mean on the scale for asking questions (range 0-30) was 15.0 before the intervention and 21.5 afterwards, the mean on the scale for managing the response (range 0-50) was 22.4 before the intervention and 32.5 afterwards. CONCLUSION REAGERA-P is a new questionnaire that can be used to evaluate health care provider preparedness to identify and manage cases of elder abuse, including educational interventions conducted among staff to improve health care responses to victims of elder abuse. This initial testing of the questionnaire indicates that the REAGERA-P has good validity.
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Affiliation(s)
- Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Marika Wenemark
- Unit of Public Health and Statistics in Region Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ludvigsson
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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11
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Simmons J, Swahnberg K. Lifetime prevalence of polyvictimization among older adults in Sweden, associations with ill-heath, and the mediating effect of sense of coherence. BMC Geriatr 2021; 21:129. [PMID: 33596824 PMCID: PMC7891035 DOI: 10.1186/s12877-021-02074-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Experiences of violence and abuse is a prominent part of the life history of many older adults and is known to have negative health effects. However, the importance of multiple victimization over the life course, e.g., lifetime polyvictimization, is not well investigated in this age group. The objective of this study was to investigate the prevalence of lifetime physical, emotional, and sexual victimization as well as polyvictimization among older adults in Sweden. We explored background characteristics associated with polyvictimization and hypothesized that violence victimization and especially polyvictimization would be associated with lower health status. To better understand factors that promote health in the aftermath of victimization, we also explored the effect of two resilience factors, sense of coherence (SOC) and social support, on the association between victimization and ill-health. Method Cross-sectional data from a random population sample in Sweden (women n = 270, men n = 337) aged 60–85 was used. Respondents answered questions about exposure to violence, health status, social support, and SOC. Conditional process analysis was used to test if SOC mediates the association between victimization and health outcome, and if social support moderates the association. Results Overall, 24.8% of the women and 27.6% of the men reported some form of lifetime victimization and 82.1% of the female and 62.4% of the male victims were classified as polyvictims, i.e., reported experiences of more than one episode of violence. As hypothesized, we found a negative association between victimization and health status and the association was most prominent for polyvictims. We found moderated mediation for the association between polyvictimization and health status, i.e., polyvictimization was associated with lower SOC and SOC had a positive correlation with health status. Social support moderated the association, i.e., victims without social support had lower health scores. Conclusions Lifetime polyvictimization was common among older adults and associated with lower health status. To help victims of violence recover, or preferably never develop ill-health, a better understanding of what fosters resilience is warranted. This study implies that social support, and especially SOC may be factors to consider in future interventions concerning older adults subjected to violence.
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Affiliation(s)
- Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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