Addressing the psychological impact of elder mistreatment: Community-based training partnerships and telehealth-delivered interventions

"We Do Not Have a Written Protocol or Flowchart for Intervention": Social Workers' Perceptions and Experiences of Interventions with Older Parents Subjected to Abuse by Adult Offspring with Psychiatric Disorders

One in six older adults worldwide is subjected to abuse (WHO, 2022), with heightened risk among parents of offspring with mental disorders. This qualitative study explores social workers' experiences in addressing elder abuse by these offspring. Two themes emerged: (1) "The snowball rolls: Unfolding mutual dependency and symbiosis," describing abusive offspring's characteristics and dynamics with aging parents, (2) "For every case, you need to match a tailor-made suit," detailing psychosocial and legal interventions. Findings highlight the need for family-focused interventions and providing treatment to the abuser. It is recommended to develop formal guiding principles to address these complex cases effectively.

Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19

OBJECTIVE

There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery.

METHOD

PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT.

RESULTS

PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms.

CONCLUSIONS

PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.

Reducing Depression and Suicidal Ideation Among Elder Abuse Victims Using PROTECT

OBJECTIVE

Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation.

DESIGN

Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.

PARTICIPANTS

A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).

INTERVENTION

PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.

MEASURES

Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment.

RESULTS

There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SI at baseline and 5.7% at end of treatment.

CONCLUSIONS

Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.

Building resilience: A specialty clinic tailored to older adults at risk for violence and abuse

OBJECTIVE

Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adults' access to and engagement with mental health care. These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stressful events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to the needs of older adults.

METHODS

From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for post-traumatic stress disorder, depression, or other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing the tracking of treatment initiation, engagement, completion, and clinical outcomes for all patients.

RESULTS

The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes.

CONCLUSION

These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population.

The impact of elder abuse training on subacute health providers and older adults: study protocol for a randomized control trial

BACKGROUND

Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse.

METHODS

This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses.

DISCUSSION

This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral.

TRIAL REGISTRATION

ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.

Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review

Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse.