From suspicion to intervention: improving responsiveness to abuse of the elderly in acute and sub-acute healthcare

Abstract

Background: Elder abuse is a recognised form of family violence. It is an act of harm towards an older person by someone known to them - usually within their family network or trusted social environment. Because of the private nature of elder abuse, it remains a hidden problem. Hospitalisation has been identified as offering a “window of opportunity” (Joubert & Posenelli, 2009) to support older people at risk of abuse however very few health professionals have received any training alerting them to issues of elder abuse (Dow et al., 2013). For this reason, health professionals need to be equipped with the required knowledge to be both confident and competent in supporting older people at risk of abuse.

Thesis Aims: This thesis is nested with an Australian Council Linkage Grant study - number LP0989536. The aims of the research are: • To identify the barriers to health professionals’ identifying and responding to suspected elder abuse • To examine current knowledge on elder abuse and to describe models, approaches and frameworks for identifying and/or responding to elder abuse, including the education and training of health professionals • To develop an evidence informed elder abuse training intervention for health professionals working with older people in an acute, sub-acute and Emergency Department setting • To implement the training intervention and evaluate its impact on the awareness, knowledge and confidence of health professionals working at the study site, in facilitating their responsiveness to suspected elder abuse

Methodology: This research has applied a sequential, mixed methods design (Creswell, 2003); across four interrelated phases. The explanatory sequential design (Plano Clark, 2011) was fixed in that it was predetermined and planned at the commencement of the research to collect analyse, and interpret both quantitative and qualitative data in a single study to investigate the same underlying phenomenon (in this case elder abuse) and training targeted health professionals to identify and respond.

Phase 1: involved an extensive examination of both peer reviewed and grey literature to scope key themes - elder abuse and the health context; theoretical perspectives, the models and frameworks in place in hospital contexts for responding to elder abuse as well as effective training strategies and approaches for health professionals. The phase involved further inquiry to identify the barriers to responding to elder abuse and how these might be addressed as part of this study. A descriptive design was used and included feedback from health professionals with different roles and years of experience at the study site to obtain their perspectives via a confidential online staff survey, focus groups and in-depth interviews (n =300).

Phase 2: considered the key components needed for the training intervention – the content, the targeting or selection of trainees and effective strategies or methods for delivering the training. This phase entailed conceptualisation and decision-making in relation to the knowledge, ideas and insights generated by the findings of Phase 1 to inform the development of the training intervention.

Phase 3: focused on application of the knowledge synthesis and decisions made in Phase 2 to inform development of the tools and products for the training package at the study site. In this phase, consideration was given to relevant features of the policy context. This phase describes the outcomes achieved at the study site which includes a governance framework relating to the protection of vulnerable older people which was developed and implemented to support the roll out of the training intervention as part of this study.

Phase 4: applied a pre - post test to determine the effectiveness of the training intervention. The training intervention was evaluated by measuring changes in knowledge and confidence to act on suspected elder abuse in a hospital setting for a targeted group of experienced health professionals. This phase used a quasi – experimental design to test the effectiveness of the training intervention.

Results: The outcomes of this study have resulted in identifying and analysing the perceptions, barriers and knowledge of health professionals regarding the problem of elder abuse. This has included targeted training through a competence based framework and the development of a governance framework, hospital wide policy and a model of care. The findings from the evaluation of the training intervention demonstrate that the training package which included an evidenced informed training DVD was successful in increasing the participants’ level of suspicion and the level of confidence to deal with suspected elder abuse cases. There have been several other unintended outcomes of this research. While the training package was developed to meet the aims of this study there have been significant changes in clinical practice at the study site. Training health professions in relation to indenting and responding to elder abuse has been embedded into practice and has resulted in significant systems change including ongoing data collection at the study site relating to cases of suspected elder abuse.