Motivational interviewing reduced psychological aggression and neglect in older adults at risk of abuse

Design

Two-arm randomised controlled trial with wait-list control

Population

198 community-dwelling older adults at risk of abuse in Hong Kong, mean age 74

Primary outcome

Elder abuse and neglect in the past month

Effect

Greater reduction in minor psychological aggression (d 0.92) and caregiver neglect (d 0.57)

A Hong Kong randomised trial enrolled 198 community-dwelling Chinese-speaking adults aged 60 or over at risk of elder abuse or neglect between 2022 and 2025; most (89%) were women, mean age 74. Half received four individual sessions of motivational interviewing from trained advocates, aimed at identifying their own goals and strengthening motivation to act; the other half were wait-listed.

Compared with controls, the intervention group had greater reductions in minor psychological aggression at three months (a large effect, Cohen's d 0.92) and in caregiver neglect immediately after the sessions (d 0.57). Self-efficacy and social support improved more with the intervention.

Almost half of eligible people declined to take part, outcomes were self-reported, the control group received no active intervention, and follow-up was only three months. Financial exploitation and physical abuse effects were not reported in the abstract. Still, this is a rare randomised trial in elder abuse, and the approach, helping older people decide what they want to change rather than telling them, fits a problem in which victims are often reluctant to seek help. It was published on 26 September 2026.

• Consider referral to a trained advocate or social worker using motivational interviewing when an older person is at risk of abuse.
• Focus conversations on the older person's own goals rather than pressing for a particular course of action.
• Expect ambivalence; many victims depend on the person harming them.
• Document concerns and follow local safeguarding procedures in parallel.
• Recheck at follow-up visits; the benefits here were measured over three months.

Why it matters

Elder abuse has few tested interventions, and this one respects the victim's reluctance to act.

Don't overread it

Self-reported outcomes, a wait-list control and three months of follow-up limit how durable the effect is known to be.

The statistics, in plain English

Cohen's d measures the size of a difference in standard deviation units; 0.5 is moderate and 0.8 or more is large. A wait-list control group received nothing during the study, so part of the benefit may come from attention rather than the specific technique.

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