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Li Y, Ji W, Dong X, Guo J, Cai M, Gong X, Xie X, Hou C, Gao J. Experiences of the Older Adults After Being Abused: A Qualitative Meta-synthesis. TRAUMA, VIOLENCE & ABUSE 2024:15248380241270026. [PMID: 39150088 DOI: 10.1177/15248380241270026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Elder abuse is a global public health problem with severe social costs. Research on elder abuse has gradually increased; however, less attention has been paid to older adults' perceptions and experiences of abuse. This review aimed to integrate older adults' perceptions and experiences of abuse to provide a theoretical basis for developing interventions that meet their authentic needs. Six electronic databases were searched to include qualitative studies examining perceptions and experiences of abuse among adults aged 60 years or older, and 22 studies were included. This study used the Joanna Briggs Institute meta-aggregation approach to integrate the qualitative findings, which identified four themes: (a) changes resulting from elder abuse, (b) causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies. The findings revealed that older adults experience persistent physical and psychological burdens and financial stress following abuse. Multiple factors influence the emergence of abuse and older adults search for help from the outside world, especially social support and perceptions of abuse. Older adults can deal with abuse by accepting the status quo or taking steps to change it. These findings have important implications for helping older adults prevent and cope with abuse experiences.
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Affiliation(s)
- Yue Li
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wenting Ji
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaohui Dong
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Julan Guo
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Mingjin Cai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaoyan Gong
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xuemei Xie
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chaoming Hou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jing Gao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Johansson L, Sandberg J, Ernsth Bravell M, Östlund L. Health and social care staff's recognition of elder abuse perpetrated by family members of persons with dementia: a mixed-method study. Scand J Public Health 2024:14034948241261724. [PMID: 39126210 DOI: 10.1177/14034948241261724] [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: 08/12/2024]
Abstract
BACKGROUND Health and social care staff play a significant role in detecting and reporting abuse among persons with dementia. However, they are often left to their own judgements which can lead to elder abuse not being detected or acted on. The aim was to explore what healthcare and social care staff consider elder abuse, and their experience of elder abuse perpetrated by family members of persons with dementia. METHODS This mixed-method vignette study was conducted in Sweden during the year 2021. In total 39 staff working in dementia care were included. They first answered the Caregiver Scenario Questionnaire and then participated in a group interview. RESULTS An inconsistency was revealed regarding whether a management strategy for behavioural difficulties included in the Caregiver Scenario Questionnaire should be considered an abusive act or not. No participants were able to identify all five abusive behaviour management strategies. Participants described witnessing 101 abusive acts including different types of abuse of a person with dementia, with emotional/psychological abuse and neglect being most common. CONCLUSIONS Health and social care staff who work close to older persons are able to detect abuse perpetrated by family members. However, inconsistency in defining abusive acts demonstrates the uncertainty in identifying abuse. This may lead to abuse not being identified, but it also creates feelings of inadequacy among staff.
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Affiliation(s)
- Linda Johansson
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jonas Sandberg
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Marie Ernsth Bravell
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Dean's Office, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Lena Östlund
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Giraldo-Rodríguez L, Agudelo-Botero M, Rojas-Russell ME. Elder Abuse and Depressive Symptoms: The Mediating Role of Loneliness in Older Adults. Arch Med Res 2024; 55:103045. [PMID: 39067257 DOI: 10.1016/j.arcmed.2024.103045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Elder abuse (EA), depressive symptoms, and loneliness represent a growing risk to the health, well-being, and premature mortality of older adults. However, the role of loneliness in the relationship between EA and depressive symptoms has not yet been examined. AIMS To investigate the associations between these constructs and to explore the possible mediating role of loneliness in the relationship between EA and depressive symptoms in a representative sample of older Mexican people. METHODS A representative community-dwelling survey of older adults aged 60 and older was conducted in two cities in Mexico (Mexico City and Xalapa) in 2018-2019. Measurements of EA, loneliness, depressive symptoms, health, and sociodemographic data were collected. Regression and mediation models were tested to analyze the associations between these variables. RESULTS The prevalence of EA was 16.3%, loneliness was 50%, and depressive symptoms were 25.5%. The odds ratio (OR) for the occurrence of depressive symptoms was 2.7 when the combined effects of EA and loneliness were considered. The proportion of the effect that could explain the mediating role of loneliness was 31%. CONCLUSION To effectively reduce depressive symptoms in older individuals affected by emotional or psychological abuse and neglect, it is crucial to address both the mediating influence of loneliness and EA itself in therapeutic and preventive interventions.
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Affiliation(s)
| | - Marcela Agudelo-Botero
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mario E Rojas-Russell
- Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Duffy A, Browne F, Connolly M. Safeguarding adults: A concept analysis. J Adv Nurs 2024. [PMID: 38943338 DOI: 10.1111/jan.16306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/07/2024] [Accepted: 06/15/2024] [Indexed: 07/01/2024]
Abstract
AIMS This article aimed to examine the concept of safeguarding adults and establish an operational definition for application to practice, research and policy. DESIGN Rodgers' evolutionary and inductive method of concept analysis was used. DATA SOURCES A systematic search was conducted across four electronic databases, CINAHL, PsycINFO, Scopus and PubMed, covering the period from January 2014 to May 2023. This systematic database search aimed to gather a broad spectrum of research and scholarly literature to inform and support the concept analysis. A total of 10 peer-reviewed articles were reviewed using a data chart to identify the context, definitions, antecedents, attributes and consequences of safeguarding adults. RESULTS The analysis of the included articles helped to develop a better understanding of safeguarding adults by offering a practical operational definition tailored to the specific needs of practising nurses. The implications for practice, research and policy are discussed, highlighting the potential for improving the quality of care and ensuring the well-being of adults at risk of abuse. CONCLUSION By employing Rogers' evolutionary concept analysis method, we developed a deeper insight into safeguarding adults in health care. A synthesis of literature revealed the intricate layers and adaptations within safeguarding practices. This concept analysis lays the groundwork for future research, policy development and educational initiatives, enhancing the well-being and safety of adults at risk of abuse within care. IMPACT By undertaking a concept analysis of the term safeguarding adults' nurses can be more prepared to engage in and reinforce the key principles of safeguarding adults, providing guidance to ensure the protection and well-being of adults at risk of abuse. PATIENT OR PUBLIC CONTRIBUTION Not applicable. WHAT THIS PAPER CONTRIBUTES TO THE WIDER BODY OF KNOWLEDGE This concept analysis helps to define and clarify the conceptual term 'safeguarding adults' promoting a shared understanding of the key components of adult protection and providing a comprehensive framework for assessment and management of adults at risk of abuse in this field of practice.
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Affiliation(s)
- Anita Duffy
- UCD School of Nursing, Midwifery and Health Sciences, UCD, Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Freda Browne
- UCD School of Nursing, Midwifery and Health Sciences, UCD, Dublin, Ireland
| | - Michael Connolly
- UCD School of Nursing, Midwifery and Health Sciences, UCD, Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
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Baumann A, Crea-Arsenio M, Smith V, Antonipillai V, Idriss-Wheeler D. Abuse in Canadian long-term care homes: a mixed methods study. BMJ Open Qual 2024; 13:e002639. [PMID: 38834369 PMCID: PMC11163654 DOI: 10.1136/bmjoq-2023-002639] [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: 10/06/2023] [Accepted: 05/19/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To examine reported cases of abuse in long-term care (LTC) homes in the province of Ontario, Canada, to determine the extent and nature of abuse experienced by residents between 2019 and 2022. DESIGN A qualitative mixed methods study was conducted using document analysis and descriptive statistics. Three data sources were analysed: LTC legislation, inspection reports from a publicly available provincial government administrative database and articles published by major Canadian newspapers. A data extraction tool was developed that included variables such as the date of inspection, the type of inspection, findings and the section of legislation cited. Descriptive analyses, including counts and percentages, were calculated to identify the number of incidents and the type of abuse reported. RESULTS According to legislation, LTC homes are required to protect residents from physical, sexual, emotional, verbal or financial abuse. The review of legislation revealed that inspectors are responsible for ensuring homes comply with this requirement. An analysis of their reports identified that 9% (781) of overall inspections included findings of abuse. Physical abuse was the most common type (37%). Differences between the frequency of abuse across type of ownership, location and size of the home were found. There were 385 LTC homes with at least one reported case of abuse, and 55% of these homes had repeated incidents. The analysis of newspaper articles corroborated the findings of abuse in the inspection reports and provided resident and family perspectives. CONCLUSIONS There are substantial differences between legislation intended to protect LTC residents from abuse and the abuse occurring in LTC homes. Strategies such as establishing a climate of trust, investing in staff and leadership, providing standardised education and training and implementing a quality and safety framework could improve the care and well-being of LTC residents.
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Affiliation(s)
- Andrea Baumann
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mary Crea-Arsenio
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Smith
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Valentina Antonipillai
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Berg K, Kjellberg I. Managing reports of trouble: designated officials' responses to reports of mistreatments initiated by service users and relatives. J Elder Abuse Negl 2024; 36:1-24. [PMID: 38126731 DOI: 10.1080/08946566.2023.2297221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Mandatory reporting of elder abuse aims to detect and prevent mistreatment and improve services. Service users and their relatives can raise concerns, but only staff can file mandatory reports. This article examines how the concerns of service users and relatives were managed by designated officials in reports of mistreatments in care for older adults in Sweden. We lean on sociological theories of "interpersonal trouble" and organizational "disputes domains." The thematic analysis is based on 28 incident reports initiated by service users or their relatives. The analysis shows that the reports were managed in one of three ways: asymmetrically, by 1) dismissing or 2) supporting the complainant's position, or symmetrically, by 3) treating complainants' accounts as credible but minimizing their seriousness. There were differences between reports initiated by service users and relatives. Dismissing concerns about abuse, mainly those made by relatives, risks support for service users failing.
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Affiliation(s)
- Karin Berg
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Inger Kjellberg
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
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Santos-Rodrigues RCD, Araújo-Monteiro GKND, Dantas AMN, Beserra PJF, Morais RMD, Souto RQ. Elder abuse: a conceptual analysis. Rev Bras Enferm 2023; 76:e20230150. [PMID: 38055495 DOI: 10.1590/0034-7167-2023-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to analyze the concept of elder abuse and identify its respective antecedents, attributes and consequents. METHODS this is a conceptual analysis according to Walker and Avant's proposition. The search for the concept was mediated by an integrative review in the LILACS, PubMed, CINAHL, Web of Science and BDENF databases. RESULTS as antecedents, female, family member, low social support and low income or socioeconomic conditions stand out. Attributes were threats and/or intimidation, intentional use of physical force, using resources without authorization, unwanted sexual activity, offering low insufficient amount of nutrients for older adults and not meeting older adults' affective/emotional needs. Consequents were psychological disorders, dependence on aggressors, environment of insecurity and damage/loss of human rights or human dignity. FINAL CONSIDERATIONS the phenomenon under discussion is broad and multifaceted, suggesting expansion of studies related to the theme in order to explore it in detail.
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Li Y, Qiu D, Wu Q, Ni A, Tang Z, Xiao S. Family caregivers' abusive behaviour and its association with internalized stigma of people living with schizophrenia in China. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:61. [PMID: 37726337 PMCID: PMC10509261 DOI: 10.1038/s41537-023-00393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
Family caregiving of people living with schizophrenia (PLS) can be burdensome, and some family caregivers may perpetrate abusive behavior that could be harmful to PLS. This study aims to examine the association of family caregivers' abusive behavior with internalized stigma of PLS and draw attention to this problem. PLS were recruited from four cities across China and completed measures of abusive behavior and internalized stigma. Linear regression analyses were used to determine the association between family caregivers' abusive behavior and internalized stigma of PLS. A total of 693 PLS were include in this study. 22.7% of the participants had experienced one or more of the abusive behaviors perpetrated by family caregivers. The most common type of abusive behavior towards PLS was verbal abuse and 4.2% of the participants reported physical abuse. 44.6 % of participants reported a high level of internalized stigma. PLS who experienced any abusive behavior by family caregivers had significantly higher levels of internalized stigma. Family caregivers' abusive behavior is positively associated with alienation and social withdrawal but not with stereotype endorsement and discrimination of PLS. To end all forms of stigma and discrimination against PLS, more attention needs to be paid to the families of PLS.
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Affiliation(s)
- Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Anyan Ni
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Ribeiro D, Carreira L, Salci MA, Marques FRDM, Gallo A, Baccon W, Baldissera V, Laranjeira C. The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers. Geriatrics (Basel) 2023; 8:65. [PMID: 37367097 DOI: 10.3390/geriatrics8030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.
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Affiliation(s)
- Dayane Ribeiro
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Lígia Carreira
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Maria Aparecida Salci
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | | | - Adriana Gallo
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Wanessa Baccon
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Vanessa Baldissera
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua de Santo André-66-68, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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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] [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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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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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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