CTF Structured Abstract: Secondary prevention of elder abuse

Canadian Task Force on Preventive Health Care

Structured Abstract

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Secondary Prevention of Elder Abuse

Prepared by Christopher Patterson, MD, FRCPC, Professor and Head, Division of Geriatric Medicine, McMaster University, Hamilton, Ontario

These recommendations were finalized by the Task Force in June 1993

Objective
Burden of Suffering
Options
Outcomes

Evidence
Values
Benefits, Harms, and Costs
Recommendations

Validation
Sponsors
Selected References

Objective

To make recommendations about secondary prevention of elder abuse in Canada. Elder abuse is defined as "any act of commission or omission that results in harm to an elderly person".

Burden of Suffering

Elder abuse may be simply defined as "any act of commission or omission that results in harm to an elderly person". The Department of National Health and Welfare has categorized abuse and neglect as follows: physical abuse (e.g., assault), psychosocial abuse (e.g., verbal assault), financial abuse (misuse of money or property), and neglect (can lead to any of the three types of abuse).

Studies of elder abuse have reported prevalence rates from 1% to 4%. However, estimates as high as 10% have been claimed. Of a random sample of staff from a New Hampshire nursing home, 36% reported witnessing physical abuse in the preceding year, while psychological abuse had been witnessed by 81%. Risk factors for abuse in the victim include dependency, lack of close family ties, a culture of family violence, lack of financial resources, lack of community support and factors such as low pay and poor working conditions in institutions.

Options

Detection measures included questionnaires and direct questions such as "Has anyone at home ever hurt you?". Interventions included mandatory reporting, a team approach utilizing principles of problem recognition, provision of information, assessment of decision-making skills and facilitating choices.

Outcomes

No specific outcomes were discussed.

Evidence

MEDLINE was searched for 1980 to March 1993 using the major MeSH heading "elder abuse" with subheading "epidemiology"; a separate search was conducted using the MeSH heading "elder abuse" with publication type "clinical trials". Other data sources included standard reference works and their bibliographies and consultations with experts.

Recommendations were graded as:

A Good evidence to support the recommendation that the condition be specifically considered in a PHE.

B Fair evidence to support the recommendation that the condition be specifically considered in a PHE.

C Poor evidence regarding inclusion or exclusion of the condition in a PHE, but recommendations may be made on other grounds.

D Fair evidence to support the recommendation that the condition be specifically excluded from consideration in a PHE.

E Good evidence to support the recommendation that the condition be specifically excluded from consideration in a PHE.

Quality of evidence was rated according to 5 levels:

I Evidence from at least 1 properly randomized controlled trial (RCT).

II-1 Evidence from well-designed controlled trials without randomization.

II-2 Evidence from well-designed cohort or case-control analytic studies, preferably from more than 1 centre or research group.

II-3 Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments could also be included here.

III Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees.

Values

The 13-member Task Force of experts in family medicine, geriatric medicine, pediatrics, psychiatry and epidemiology used an evidence-based method for evaluating the effectiveness of preventive health care interventions. Recommendations were not based on cost-effectiveness of options. Patient preferences were not discussed.

Background papers providing critical appraisal of the evidence and tentative recommendations prepared by the chapter author were pre-circulated to the members. Evidence for this topic was presented and deliberated upon in 1- to 2-day meetings, 2 to 3 times per year from January 1993 to June 1993. Consensus was reached on final recommendations.

Benefits, Harms, and Costs

There is little agreement about the definition and categories of elder abuse. A review of elder abuse identification measures reported that assessment protocols were conceptually and operationally suboptimal and had not undergone empirical testing. Few items measured types of abuse other than physical and the effects of disease were not distinguished from those of potential abuse.

No rigorous studies have evaluated the effectiveness of interventions for elder abuse. Results from case series have been disappointing.

Recommendations

Recommendation grade [A, B, C, D, E] and level of evidence [I, II-1, II-2, II-3, III] are indicated after each recommendation. Citations in support of individual recommendations are identified in the guideline text.

There is insufficient evidence to include or exclude (in the PHE) routine use of questionnaires to detect elder abuse [C, III]. Physicians should be alert for indicators of elder abuse.

Validation

This report was externally peer reviewed. This report was externally peer-reviewed. The American Medical Association recommends screening in daily practice. The 1989 U.S. Preventive Services Task Force did not recommend routine screening.

Selected References

Source Document

Patterson C. Secondary prevention of elder abuse. In: Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Ottawa: Health Canada, 1994; 922-9.

Link to Full Text of this review

Link to Summary Table of Recommendations of this review

Link to Selected References list of this review

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A	Good evidence to support the recommendation that the condition be specifically considered in a PHE.
B	Fair evidence to support the recommendation that the condition be specifically considered in a PHE.
C	Poor evidence regarding inclusion or exclusion of the condition in a PHE, but recommendations may be made on other grounds.
D	Fair evidence to support the recommendation that the condition be specifically excluded from consideration in a PHE.
E	Good evidence to support the recommendation that the condition be specifically excluded from consideration in a PHE.

I	Evidence from at least 1 properly randomized controlled trial (RCT).
II-1	Evidence from well-designed controlled trials without randomization.
II-2	Evidence from well-designed cohort or case-control analytic studies, preferably from more than 1 centre or research group.
II-3	Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments could also be included here.
III	Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees.