Evaluating the Effectiveness of I-NEED Program: Improving Nurses' Detection and Management of Elder Abuse and Neglect-A 6-Month Prospective Study.

Elder abuse and neglect (EAN) goes largely unrecognized and underreported globally by health care professionals. Despite acknowledging their role to intervene elder abuse, health care professionals lacked knowledge and skills in this issue. This is a single-blinded, three-armed, cluster randomized controlled trials aimed to evaluate the effectiveness of the face-to-face Improving Nurses' dEtection and managEment of elDer abuse and neglect (I-NEED) intensive training program and I-NEED educational video in improving primary care nurses' knowledge, attitude, and confidence to intervene EAN; 390 primary care nurses were randomized equally into two intervention groups-ITP group (intensive training program) and ITP+ group (intensive training program and educational video)-and a control group. The knowledge, attitudes, and confidence to intervene EAN were measured using questionnaires at four intervals during 6-month follow-up. A total of 269 primary care nurses participated in this study. There was a significant increase in knowledge, attitude, and confidence to intervene EAN immediately post intervention observed in both intervention groups compared to the control group (p < .001). At the end of sixth month, there was an increase of knowledge favoring ITP group than the ITP+ group (p < .001). There is, however, no significant difference in attitude score between ITP and ITP+ group. There is a significant difference of confidence to intervene among the participants between both intervention groups with ITP+ participants reporting higher scores post intervention (p < .05). An intensive training module improved the knowledge, attitude, and confidence to intervene EAN. Other co-existing barriers for abuse victims getting help, resources, policy, and law of EAN need further highlights.

Primary care nurses' challenges, opportunities, and facilitators of elder abuse intervention in Malaysia.

OBJECTIVES: To explore the views of nurses on challenges, perceived roles and improvement strategies concerning elder abuse intervention in Malaysia. DESIGN AND SAMPLE: Eleven focus group discussions were conducted using a semi-structured interview based on the socio-ecological framework. The data were analyzed using a multistep process of thematic analysis. RESULTS: Three themes emerged from the data analysis: (1) The predicament: being unwilling or not able to intervene (2) Bridging the older people and health system gap (3) Getting to grips with the barriers. There are multifactorial contributors identified at the individual, interpersonal, organizational, community and policy levels in each theme. These factors interact across the levels to influence nurses' capability to intervene in elder abuse. CONCLUSION: A framework is needed to articulate Malaysian nurses' role in elder abuse intervention in terms of personal and professional development through culturally sensitive education and the establishment of clinical guidelines in the primary care setting. Strengthening organizational support and the institution of national policy and permissive reporting laws of elder abuse will empower the primary care nurses to address elder abuse in primary care settings and communities.

Supporting family doctors to address elder abuse: a quasi-experimental study in Malaysia.

This quasi-experimental study examined the effect of Supporting Family Doctors to Address Elder Abuse (SAFE) educational intervention among family doctors practicing at public primary care clinics in Malaysia. SAFE is an intensive, multimodal, locally tailored, and culturally sensitive face-to-face educational intervention on elder abuse. A significant mean score improvement of knowledge [Baseline: 5.33 (SD:1.33) to 6-month post-intervention: 6.45 (SD: 1.35); p<0.001] and perceived behavioral control [Baseline: 50.83 (SD: 8.87) to six-month post-intervention: 56.16 (SD: 9.56); p<0.001] observed in the intervention group compared to the control group. No significant difference in attitude, subjective norm, and practice scores between the two groups over time. SAFE educational intervention for family doctors was effective to improve but not sustainable knowledge and perceived behavioral control toward elder abuse identification and management. We recommend SAFE educational intervention as part of the continuous medical education for family doctors supplemented with a change in organization and national policy.

Clinical recognition of elder maltreatment and intention to report among primary care doctors.

This study aimed to determine the primary care doctors' ability to recognize elder maltreatment and their intentions to report on such conditions. About 358 primary care doctors participated in this study. Outcomes were assessed using a validated five context-relevant clinical vignettes. Primary care doctor's recognition of sexual abuse was highest (91.0%); while the lowest (70.2%) in case signifying physical abuse. Despite being able to ascertain elder maltreatment, the intention to report the event is generally low even for cases exemplifying physical abuse, emotional abuse and neglect. However, intentions to report cases of sexual and financial abuse are 86.9% and 73.5% respectively. Findings highlighted the uncertainties of primary care doctors in distinguishing the clinical findings of non-accidental injuries and injuries due to acts of maltreatment. This provides support for educational intervention and guidelines or policies to improve the knowledge and skills of primary care doctors to intervene in elder maltreatment.

Mortality among elder abuse victims in rural Malaysia: A two-year population-based descriptive study.

Our study aims at describing mortality among reported elder abuse experiences in rural Malaysia. This is a population-based cohort study with a multistage cluster sampling method. Older adults in Kuala Pilah (n = 1,927) were interviewed from November 2013 to May 2014. Mortality was traced after 2 years using the National Registration Department database. Overall, 139 (7.2%) respondents died. Fifteen (9.6%) abuse victims died compared to 124 (7.0%) not abused. Mortality was highest with financial abuse (13%), followed by psychological abuse (10.8%). There was a dose-response relationship between mortality and clustering of abuse: 7%, 7.7%, and 14.0% for no abuse, one type, and two types or more, respectively. Among abuse victims, 40% of deaths had ill-defined causes, 33% were respiratory-related, and 27% had cardiovascular and metabolic origin. Results suggest a link between abuse and mortality. Death proportions varied according to abuse subtypes and gender.

A cluster randomized trial on improving nurses' detection and management of elder abuse and neglect (I-NEED): study protocol.

AIM: The aim of this study was to describe a trial protocol of an educational intervention for nurses to improve their awareness and practice in detecting and managing elder abuse and neglect. BACKGROUND: Knowledgeable and skilful nurses are crucial amidst the growing numbers of maltreated older patients. DESIGN: This trial is a multi-site, three-armed, community-based cluster randomized controlled trial with 6-months follow-up. METHODS: This study will involve 390 community and registered nurses from government health clinics in Negeri Sembilan, Malaysia (protocol approved in October 2013). This three-phased study, premised on the Precede-Proceed Model, comprises baseline focus group discussion and survey (Phase 1), development of training module (Phase 2) and implementation and evaluation of the training (Phase 3). Eligible participants will be randomized to the control group (continuous nursing education), intervention group A (face-to-face intensive training programme) or group B (face-to-face intensive training programme and an educational video). Outcome measures include improvement in knowledge and awareness on elder abuse and neglect and the number of cases identified and managed during follow-up. Data will be collected at baseline, immediate postintervention, 3- and 6-month follow-up. CONCLUSION: Findings from this study will provide empirical support for the development of a training module for nurses on the detection and management of elder abuse and neglect, towards improving healthcare delivery and the well-being of vulnerable older adults. This study is funded by the University of Malaya Research Grant (RP001C-13HTM), (FL002-13SBS) and University of Malaya Grand Challenge (PEACE) Grant (GC001C-14HTM) awarded in May 2013, July 2013 and September 2014.