Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
J Am Geriatr Soc. 2024 Jan;72(1):246-257. doi: 10.1111/jgs.18597. Epub 2023 Oct 4.
Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first-of-its-kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia.
We used a double-blind, randomized controlled trial to test a strengths-based person-centered caregiver support intervention, developed from evidence-based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post-test, and 3-month follow-up. The primary outcome was caregiver-reported EM; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. Nonparametric tests (Mann-Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points.
The treatment group had no EM after intervention completion (assessed at 3-month follow-up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010).
In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems.
虐待老年人（EM）会危害个人、家庭、社区和整个社会。然而，干预措施的研究滞后，没有发表任何经过严格证明有效的预防研究。这项初步研究探讨了一种首创的辅导干预措施是否可以减少患有慢性疾病（包括痴呆症）的老年人经历虐待的情况。
我们采用了一项双盲、随机对照试验来测试一种基于优势的、以人为中心的照顾者支持干预措施，该干预措施是从其他类型的家庭暴力中使用的循证方法发展而来的。参与者（n=80）为 Kaiser Permanente 的老年患者的家庭照顾者，在基线、后测和 3 个月随访时完成了调查。主要结果是照顾者报告的 EM；其他近端结果是照顾者负担、生活质量、焦虑和抑郁。非参数检验（Mann-Whitney U、Fisher's Exact、Wilcoxon 符号秩和检验和 McNemar's）用于治疗组和对照组之间以及各时间点之间的比较。
治疗组在干预完成后（在 3 个月随访时评估）没有 EM，发生率明显低于对照组（治疗组=0%，对照组=23.1%，p=0.010）。
在这项初步研究中，我们发现 COACH 照顾者支持干预成功地减少了患有慢性疾病（包括痴呆症）的人的 EM。下一步将包括：（1）在一项充分 powered RCT 中测试干预措施的机制，（2）在各种护理提供系统中测试干预措施的规模。
