Motivational interviewing reduced some forms of abuse in at-risk older adults

Design

Two-arm randomised controlled trial with wait-list control

Population

198 community-dwelling adults aged 60 or over 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 or neglect are often reluctant to seek help. A Hong Kong trial randomised 198 community-dwelling Chinese-speaking adults aged 60 or over who were at risk of abuse (mean age 74, 89% women) to four individual motivational interviewing sessions with trained advocates, or to a wait list.

Compared with controls, the intervention group had larger falls 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 also improved.

Of 359 eligible people, 161 declined, the control was a wait list, and follow-up was only three months, so effects may be overestimated and their durability is unknown. Still, the approach — helping the older person identify their own goals rather than directing them — fits settings, including Indian families, where removing the person from the household is rarely an option.

• Ask older patients privately about feeling unsafe, threatened or neglected at home.
• Consider referral to services offering motivational, goal-focused support when abuse is suspected.
• Respect the older person's own goals where they have capacity to decide.
• Assess decision-making capacity when abuse involves finances or care arrangements.

Why it matters

It offers an approach for victims who will not leave or report the person harming them.

Don't overread it

Wait-list control and three-month follow-up cannot show lasting reductions in abuse.

The statistics, in plain English

Cohen's d of 0.92 is a large effect and 0.57 a moderate one, but large effects in small trials with wait-list controls often shrink in later studies.

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