Motivational interviewing for 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 elder abuse in Hong Kong

Primary outcome

Elder abuse and neglect in the past month

Effect

Reduced psychological aggression at 3 months (d 0.92) and caregiver neglect post-intervention (d 0.57)

Older people experiencing abuse or neglect are often reluctant to seek help. This Hong Kong trial randomised 198 community-dwelling Chinese-speaking adults aged 60 or over at risk of abuse to four individual motivational interviewing sessions with an advocate, or to a wait-list. Most participants were women, with an average age of 74.

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

Almost half of those eligible declined to take part, outcomes were self-reported, and the control was a wait-list, so expectation effects are possible. Follow-up was short.

Motivational interviewing is a skill many clinicians already have. The study supports using it to help an older person weigh their options when abuse is suspected, alongside safeguarding steps.

• Ask older patients privately about feeling safe at home and about money being taken
• Use motivational interviewing to help an at-risk older adult consider their options
• Follow local safeguarding procedures when abuse is disclosed or suspected
• Watch for caregiver neglect: missed medicines, poor hygiene, untreated pressure areas

Why it matters

It gives clinicians a practical approach when an older person is reluctant to act on abuse.

Don't overread it

Self-reported outcomes against a wait-list control may overstate the benefit.

The statistics, in plain English

Cohen's d is a standardised effect size; 0.5 is moderate and 0.8 large. These are sizeable effects, but self-reported outcomes against a wait-list control tend to inflate them.

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