Du Mont Janice, Macdonald Sheila, Kosa Daisy, Elliot Shannon, Spencer Charmaine, Yaffe Mark
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Ontario, Canada.
PLoS One. 2015 May 4;10(5):e0125105. doi: 10.1371/journal.pone.0125105. eCollection 2015.
Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review.
Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation.
The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1) addressed a response (e.g., an intervention) to elder abuse, 2) contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3) were available in English.
The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics.
649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser;
physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations.
To address the lack of evidence to support the recommendations extracted in this review, in a future study, a group of experts will formally evaluate each recommendation for its inclusion in a comprehensive hospital-based response.
虐待老年人是一个全球性的人权问题，会带来许多负面后果。然而，在大多数司法管辖区，没有基于医院的全面干预措施来应对虐待老年人问题，以满足受虐老年人在心理、身体、法律和社会方面的全部需求。作为制定此类干预措施的第一步，我们进行了一项系统的范围综述。
我们的主要目标是系统地提取和综合关于基于医院的多学科跨部门虐待老年人干预措施各组成部分的可行且适用的建议。次要目标是总结所审查对策的特点，包括制定和验证方法。
系统检索灰色文献和学术文献，由两名独立评审员进行标题、摘要和全文筛选。如果文件符合以下条件，则被认为有资格纳入：1）涉及对虐待老年人问题的对策（如干预措施）；2）包含针对受虐老年人的应对建议，这些建议可能与基于医院的多学科跨部门虐待老年人干预措施相关；3）为英文版本。
整理、编码并分类提取的护理建议，形成主题，并进一步审查其与基于医院的全面应对措施的相关性。使用描述性统计总结对策的特点。
从68种不同的虐待老年人应对措施中提取了649条建议，其中149条被认为相关，并分为5个主题：初次接触；能力与同意；与老年人、照顾者、间接联系人及/或疑似施虐者面谈；评估：身体/法医、心理、社会心理和环境/功能；以及护理计划。只有6种应对措施经过了评估，这表明建议的制定与实施之间存在显著差距。
为了解决缺乏证据支持本综述中提取的建议这一问题，在未来的研究中，一组专家将正式评估每条建议是否应纳入基于医院的全面应对措施中。
