Interventions to prevent elder abuse in the community: a mixed-methods systematic review

Sousa, Rute Costa Régis de; Araújo-Monteiro, Gleicy Karine Nascimento de; Souto, Rafaella Queiroga; Santos, Renata Clemente dos; Leal, Cláudia Quézia Amado Monteiro; Nascimento, Neyce de Matos

doi:10.1590/S1980-220X2019033203677

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REVIEW • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2019033203677 copy

Interventions to prevent elder abuse in the community: a mixed-methods systematic review

Intervenções para prevenir o abuso de idosos na comunidade: uma revisão sistemática de métodos mistos

Intervenciones para prevenir el abuso de personas mayores en la comunidad: una revisión sistemática de métodos mixtos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the interventions proposed in the literature aimed at preventing elder abuse among community-residing elders.

Method:

This was a mixed-methods systematic review that followed the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols checklist. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews. We included studies published between January 2004 and December 2019 in the databases: LILACS, IBECS, CUMED, CINAHL, MEDLINE and SciELO. The methodological quality of each study included was performed using the Mixed Methods Appraisal Tool.

Results:

Seven studies formed the final sample. Two groups emerged after the analyses: the primary level intervention group, which used health education and coexisting elder abuse groups; and the secondary intervention level, focused mostly on the mental health care of victims of elder abuse.

Conclusion:

There is still a shortage of intervention studies to prevent elder abuse. All the studies selected had a positive outcome, and all interventions can be implemented in nursing care practice.

Elder Abuse; Violence; Geriatric Nursing; Systematic Review

Database Online Library	Search strategies
LILACS, IBECS and CUMED (via Virtual Library of Health - VHL)	(Idoso OR "Pessoa Idosa" OR "Pessoa De Idade" OR "População Idosa" OR "Terceira Idade") AND ("Educação em Saúde" OR "Ensaio Clínico" OR "Estudo de Intervenção" OR Intervenção OR Educação OR "Intervenção Educativa") AND ("Maus-tratos ao Idoso" OR Violência OR "Violência Doméstica" OR "Violência na Família" OR "Violência Sexual" OR "Abuso Físico" OR Estupro OR Abuso OR Maus-tratos). Filters: language (English, Portuguese and Spanish); publication year (2004 to 2019) and type of document (article).
PubMed	(Aged OR Elderly OR "Older People" OR "Ageing People" OR Ageing OR "Older Adults" OR Age) AND ("Health Education" OR "Clinical Trial" OR "Intervention Studies" OR Interventions) AND ("Sexual Violence" OR "Domestic Violence" OR "Aged Abuse" OR "Elder Neglect" OR "Elder Abuse" OR "Violence" OR " Family Violence" OR "Physical Abuse" OR Rape OR Mistreatment OR "Elderly Victimization" OR "Crime Prevention" OR "Elder Mistreatment" OR "Financial Violence"). Filters: language (English, Portuguese and Spanish); year of publication (2004 to 2019) and type of document (article).
SciELO (via scielo.br)	(Aged OR Elderly OR "Older People" OR "Ageing People" OR Ageing OR "Older Adults" OR Age) AND ("Health Education" OR "Clinical Trial" OR "Intervention Studies" OR Interventions) AND ("Sexual Violence" OR "Domestic Violence" OR "Aged Abuse" OR "Elder Neglect" OR "Elder Abuse" OR "Violence" OR " Family Violence" OR "Physical Abuse" OR Rape OR Mistreatment OR "Elderly Victimization" OR "Crime Prevention" OR "Elder Mistreatment" OR "Financial Violence"). Filters: language (English, Portuguese and Spanish); year of publication (2004 to 2019) and type of document (article).
CINAHL (via Ebsco Host)	(Aged OR Elderly OR "Older People" OR "Ageing People" OR Ageing OR "Older Adults" OR Age) AND ("Health Education" OR "Clinical Trial" OR "Intervention Studies" OR Interventions) AND ("Sexual Violence" OR "Domestic Violence" OR "Aged Abuse" OR "Elder Neglect" OR "Elder Abuse" OR "Violence" OR " Family Violence" OR "Physical Abuse" OR Rape OR Mistreatment OR "Elderly Victimization" OR "Crime Prevention" OR "Elder Mistreatment" OR "Financial Violence" ). Filters: language (English, Portuguese and Spanish); year of publication (2004 to 2019) and type of document (article).

Authors (year)	Aims	Interventions	Outcomes
Holkup et al. (2007)⁽²⁸28 Holkup PA, Salois EM, Tripp-Reimer T, Weinert C. Drawing on wisdom from the past: an elder abuse intervention with tribal communities. Gerontologist. 2007;47(2):248-54. doi: https://dx.doi.org/10.1093/geront/47.2.248 https://dx.doi.org/10.1093/geront/47.2.2... ⁾	Describes an elderly, family-centered and community-based intervention: Family Care Conference (FCC).	The FCC has six steps: referral, screening, family involvement, logistical preparation, family reunion and follow-up.	During the follow-up phase, family meetings are held to evaluate the results achieved by the family, in order to identify any necessary changes to the plan and provide positive encouragement. The number of meetings will depend on how difficult the family found it to implement the proposed plan; of the 10 families that participated in the project, five managed to solve their problems in only one meeting, four had two family meetings, and one had three family meetings.
Sirey et al. (2015)⁽²⁹29 Sirey JA, Berman J, Salamone A, DePasquale A, Halkett A, Raeifar E, et al. Feasibility of integrating mental health screening and services into routine elder abuse practice to improve client outcomes. J Elder Abuse Negl. 2015;27(3):254-69. doi: http://dx.doi.org/10.1080/08946566.2015.1008086 http://dx.doi.org/10.1080/08946566.2015.... ⁾	Examine the feasibility of implementing routine screening for depression and anxiety in a system of elder abuse services; test the acceptability of a mental health intervention called Providing Options to Elderly Clients Together (PROTECT) to improve depression and the outcomes of elder abuse cases; identify the most acceptable format for providing mental health services in the practice of elder abuse.	The PROTECT intervention combines problem-solving psychotherapy with anxiety management techniques. The PROTECT resolution therapy is applied in eight sessions, with (at least) the first session held in person. Each subsequent session is conducted using either face-to-face meeting or face-to-face problem-solving worksheets.	The degree of completion of activities, client satisfaction, response to elder abuse interventions and perceived improvement are documented in session progress notes by the PROTECT therapist. The article did not contain any results on the effectiveness of the intervention strategy used.
Tetterton, Farnsworth (2011)⁽³⁰30 Tetterton S, Farnsworth E. Older women and intimate partner violence: effective interventions. J Interpers Violence. 2011;26(14):2929-42. doi: http://dx.doi.org/10.1177/0886260510390962 http://dx.doi.org/10.1177/08862605103909... ⁾	Increase the understanding of professionals about Interpersonal Violence (IPV) in elder abuse women; discuss barriers faced by this population; describe interventions used when dealing with IPV cases in elder abuse women.	The authors conducted two case studies with elder abuse female victims of IPV and identified three essential positions that should be adopted by professionals when performing any intervention with elder abuse female victims of IPV. These positions were: user embracement and captivation of clients; encouraging and supporting the narration of their stories; and offering assistance in the process of empowerment.	The case study and the research notes provided data that supported the conceptualization of effective interventions for elder abuse women who had experienced IPV. Both women began to regain control by identifying and resolving vulnerabilities that others had used against them for decades. The researchers identified this as "empowerment from within" to recognize the long and hard work that older women themselves must carry out to deal with IPV.
Vinent et al. (2011)⁽³¹31 Despaigne Vinent M, Jimenez Betancourt E, Martinez Despaigne B. Intervención educativa sobre violencia a integrantes de la Universidad del Adulto Mayor "24 de Febrero". Medisan [Internet]. 2011 [citado 2019 Oct. 17];15(1):105-11. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192011000100015&lng=es&nrm=iso&tlng=es http://scielo.sld.cu/scielo.php?script=s... ⁾	To carry out an educational intervention to modify knowledge on elder abuse.	The program of activities was carried out in eight work sessions with themes related to different types of violence and their manifestations, causes and consequences. Two-hour sessions were held twice a week. At the end of each session, there were reflections on what had been covered.	After the educational intervention, the questionnaire was again evaluated with the same initial characteristics, and the knowledge modifications that occurred before and after the intervention were evaluated. At the end of the intervention, all the elder abuse people with inadequate knowledge showed a 100% increase in knowledge levels, with a significance level of p <0.05.
Fernández et al. (2012)⁽³²32 Díaz Hernández S, Camejo Pérez YM, Camejo Pérez YM. Programa de intervención educativa para promover conductas asertivas en el adulto mayor. Mediciego [Internet]. 2012 [citado 2019 Oct. 12];18(2). Disponible en: http://www.revmediciego.sld.cu/index.php/mediciego/article/view/325 http://www.revmediciego.sld.cu/index.php... ⁾	Apply an educational intervention program that promotes assertive behavior in the elder abuse.	The study used an Educational Intervention Program prepared by the group of authors and advisors of this research and validated by expert criteria through the methodology of preference, with a total of 10 experts and a 10% rate of error.	The following methods were used at the beginning and end of the program for diagnosis and evaluation: observation, experience, focus group, interview, and triangulation of techniques (interview and focus group) to obtain the results. Five themes were addressed before and after the intervention: attitude toward old age, daily activities, respect for the elderly, attitude to sexuality in the elderly, and assertive attitude in the elderly. All these aspects changed positively after the intervention, but only the assertive attitude component of the elder abuse resulted in a statistically significant change, p <0.05.
Hernández et al. (2014)⁽³³33 Díaz Hernández Y, Mármol Sóñora L, Oscaña Leal AI, Maldonado Álvarez C, Angulo Ledón YA, Mármol Ocaña L. Diseño de una intervención educativa para prevenir y controlar la violencia contra adultos mayores de una población de Ciego de Ávila. Mediciego [Internet]. 2014 [citado 2019 Oct. 12];20(2). Disponible en: http://www.revmediciego.sld.cu/index.php/mediciego/article/view/156/1483 http://www.revmediciego.sld.cu/index.php... ⁾	Describe an educational intervention to prevent and control elder abuse; characterize the victims of violence according to sociodemographic and sociocultural variables; determine the frequency of elder abuse.	An educational intervention was conceived based on specific teachings intended for the family and the elder abuse victim to prevent elder abuse, based on instructions for healthy lifestyles that promote appropriate interpersonal exchanges between different generations. Manifestations that can be identified as abuse were also discussed.	How the results were evaluated and whether there were positive results as an outcome of the intervention were not described.
Etbsari et al., (2018)⁽³⁴34 Estebsari F, Dastoorpoor M, Mostafaei D, Khanjani N, RahimiKhalifehkandi Z, Rahimi Foroushani A, et al. Design and implementation of an empowerment model to prevent elder abuse: a randomized controlled trial. Clin Interv Aging. 2018;13:669-79. doi: https://dx.doi.org/10.2147/CIA.S158097 https://dx.doi.org/10.2147/CIA.S158097... ⁾	Design and implement an empowering educational intervention to prevent elder abuse.	The content of the educational interventions was based on the dimensions of health promoting behavior and included physical activity, recreation and entertainment, sleep, nutrition, interpersonal relations and social support, responsibility for health, mental health, and older adult stress management. Educational technology methods, such as lectures, questions and answers, and problem-solving were used. The intervention was carried out in twenty 45- to 60-minute training sessions over 6 months.	Knowledge of elder abuse, high self-efficacy, high social support and high health promoting lifestyle was significantly greater in the intervention group; the frequency of elder abuse risk was also significantly lower in the intervention group after the intervention. The intervention had the highest impact on increasing social support and promoting healthy behaviors.

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E-mail: reeusp@usp.br

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[1] Corresponding author: Rafaella Queiroga Souto Universidade Federal da Paraíba Cidade Universitária, s/n - Castelo Branco III, CEP 58051-085 - João Pessoa, PB, Brazil rafaellaqueiroga7@gmail.com