Motivational interviewing reduced some forms of elder abuse in a Hong Kong trial

Design

Randomised controlled trial with wait-list control

Population

198 community-dwelling adults ≥60 years at risk of abuse, Hong Kong

Primary outcome

Elder abuse and neglect in the past month

Effect

Minor psychological aggression d = 0.92 at 3 months; caregiver neglect d = 0.57 post-intervention

Older people experiencing abuse are often reluctant to seek help. A Hong Kong trial randomised 198 community-dwelling Chinese-speaking adults aged 60 or over at risk of abuse — most of them women — to four individual motivational interviewing sessions or a waiting list.

Compared with controls, the intervention group had greater reductions in minor psychological aggression at three months and in caregiver neglect immediately after the sessions, and larger gains in self-efficacy and social support. Of 359 eligible people, 161 declined to take part.

The trial is small, outcomes were self-reported, and the comparison was a waiting list rather than an active control. But it suggests a structured conversation that respects the older person's ambivalence — rather than pushing for immediate action — can reduce some forms of harm. In India, where abuse is often by family members on whom the person depends, that approach may suit the reality better than referral alone.

• Ask older patients privately and directly about mistreatment, neglect and financial exploitation.
• Expect ambivalence; many will not want to act against a family member immediately.
• Consider a motivational approach that explores the person's own goals rather than insisting on a plan.
• Know the local routes for support and safeguarding before you ask.

Why it matters

Elder abuse is under-detected partly because clinicians do not know what to offer once it is disclosed.

Don't overread it

A small wait-list-controlled trial with self-reported outcomes; effects on serious physical abuse were not shown.

The statistics, in plain English

Cohen's d is a standardised effect size: 0.5 is moderate and 0.8 large. The reduction in minor psychological aggression (d = 0.92) was large, but in a small sample such estimates can be inflated.

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