Interventions and Services which Address Elder Abuse: An Integrated Review

Transcription

1 Interventions and Services which Address Elder Abuse: An Integrated Review Dr Deirdre O Donnell, Dr Amanda Phelan and Prof. Gerard Fealy National Centre for the Protection of Older People (NCPOP) deirdre.odonnell@ucd.ie

2 Complexity of Intervention Public Health Human Rights Intervention Protective legislation Social Policy

3 The case management approach to elder abuse A dedicated and specialist adult protection coordinator who works with vulnerable adults experiencing abuse Multidisciplinary intervention Health Social Legal Financial

4 Theoretical basis of case management approach Theoretical basis for case management approach Client autonomy Empowerment Person-centred decision-making Case managers are advocates, educators and facilitators with the goal of maintaining the highest possible level of client independence and autonomy

5 The case management approach to elder abuse in Ireland Response to elder abuse in Ireland managed by HSE Guided by Protecting Our Future (2002) Since 2007 specialist and dedicated service providing a co-ordinated multi-disciplinary approach

6 International Approaches Ireland s programme identified as an example of international best practice for a national policy response to elder abuse Dedicated case management approach increasingly being adopted in USA Majority of states employ protection workers to work with all adults vulnerable to abuse or neglect Specialist multidisciplinary teams increasingly involved in complex cases of elder abuse (e.g. FAST) In UK responsibility for managing elder abuse placed on local authorities Vulnerable adult protection services Deal with abuse of all vulnerable adults Few examples of specialist teams dealing specifically with elder abuse

7 Evidence-based intervention practice Demand for up-to-date, reliable evidence for effective health and social care intervention for older people at risk of abuse Prevention Service delivery Cost efficiency Long-term sustainability Need to evaluate claims of research reports in the context of methodologies used Accumulation of reliable research foundation for effective practice

8 Overview of Elder Abuse Interventions Variety of approaches identified in the literature Detection and referral Investigation and assessment Case management Monitoring Support services (victims and perpetrators) Systematic reviews highlight a lack of empirically validated evidence (Alt et al., 2011, Chalk & King, 1998, Daly et al., 2011, Ploeg et al., 2009)

9 Systematic reviews of elder abuse interventions Ploeg et al., 2009 Insufficient evidence to support any particular intervention Called for further more methodologically robust studies evaluating evidence for practice Alt et al., 2011 Existing evaluations and reports of educational programmes to improve recognition and reporting of elder abuse limited by weak research design Daly et al., 2011 Reviewed studies reporting on development, implementation and evaluation of elder abuse preventative interventions A limited degree of efficacy found for interventions targeting education of caregivers, adult protective service personnel and health care personnel Overall, limited evidence to support any intervention to prevent elder abuse called for more rigorous research.

10 Overview of research into elder abuse interventions Increasing amount of research and policy literature dedicated to elder abuse and mistreatment Dominance of descriptive and observational designs Few intervention trials Insufficient research by which to undertake metaanalysis Knowledge concerning nature and management of elder abuse primarily derived from descriptive quantitative studies (e.g. prevalence) limited involvement of older people

11 Review Aim To synthesise and critically appraise peerreviewed research papers evaluating the efficacy of interventions and protective practice in the field of elder abuse.

12 Search Strategy Systematic search in four databases: Search terms used: EBSCO PubMed Web of Science OvidSP Elder, old, intervention, prevention, care and service in combination with MeSH terms for elder abuse Search timeframe of Jan 2000-Oct 2013 Supplemented by ancestral and manual searching of bibliographies Inclusion and exclusion criteria: Published in peer-reviewed English language publications Only relevant to protection of older people from elder abuse/mistreatment Interventions targeting community dwelling or domiciled older people as well as those in residential settings Interventions targeting professionals and practitioners working with older people also included

13 Search Results References retrieved from initial search (N=7,170) Review of titles and abstracts (n=1,753) Excluded as not relevant elder abuse intervention or sample not eligible (n=5,417) Excluded as not meeting inclusion criteria (n=1,545) Review of full text for inclusion/exclusion criteria (n=208) Excluded as not meeting inclusion criteria (n=104) Papers meeting inclusion criteria (n=104) Descriptive evaluations (n=67) Experimental evaluations (n=37)

14 Ecological framework for elder abuse intervention (Bronfenbrenner, 1979)

15 Classification of retrieved papers Classification of 98 interventions identified in the literature (n=104) Experimental Descriptive (N=37) (N=67) Total Micro-system Meso-system Exo-system Macro-system Total

16 Micro-System Interventions Experimental Evaluations Descriptive Evaluations Educational material Geriatric assessment programme Advocacy programme Social support development programme Reviews of EA cases Review of specific aspects of EA cases (e.g. financial abuse, gender etc.)

17 Meso-System Interventions Experimental Evaluations Descriptive Evaluations Support groups for older people Interventions targeting perpetrators Interventions targeting caregivers (professional and non-professional) Evaluation of service models: MDT teams, APS Financial abuse Case management Gender-based

18 Exo-System Interventions Experimental Evaluations Descriptive Evaluations Community level public education programme Compulsory training for mandated reporters Financial abuse forensic centre Evaluation of systems and service delivery MDT collaboration Ethos in case intervention Family-based interventions Typology based service interventions Criminal justice System process improvement

19 Macro-System Interventions Experimental Evaluations Descriptive Evaluations General public educational programme targeting attitudes and perceptions Systemic legal perspectives Legislative reform Restorative justice Administration and resource governance Staffing and financing

20 Conclusions Evaluation methodology: Paucity of robust evidence supporting elder abuse intervention. Evaluation studies are limited in terms of design, outcome measurement and transferability The complexity of elder abuse presents enormous methodological challenges to robust and trustworthy intervention evaluation

21 Conclusions Systems level responses to elder abuse Require stronger evidence for any intervention across all four systems level Need for greater focus of intervention on micro and macro systems Interventions need to include older person experiencing abuse as the key stakeholder in terms of outcome measurement

22 Conclusions A person-centred approach to elder abuse Evaluation designs should measure personcentred primary outcomes Limited evidence for interventions targeting perpetrators Interventions need to be tailored to specific nuances of individual at heart of case Gender, cognitive status, functional impairment, cultural acceptability