Theories and Frameworks in Elder Abuse Interventions in Healthcare Settings: The Role of Social Workers

Background: Elder abuse is common, with nearly 1 in 10 adults over age sixty having experienced some form of it. Many healthcare clinicians report little knowledge surrounding elder abuse and hesitancy to intervene when it is suspected. Given the extent to which older adults interact with the healthcare system, healthcare providers are well-situated to screen and intervene when elder abuse is suspected. Social workers, as part of interdisciplinary care teams, can play an important role in this work. Interventions benefit from theoretical grounding to inform content and aim, but the extent to which current interventions are theory-informed is unclear. In order to guide future work, this literature review focuses on two questions 1) To what extent does current literature on interventions in elder abuse involve interdisciplinary work? and 2) What theories, models, or frameworks inform current interventions in elder abuse?

Methods: Databases used for the literature review included Academic Search Complete, Ageline, Psychinfo, CINAHL Complete, and Global Health. The same search terms were used across databases. Additional articles were sourced from references in included articles, Pubmed, and Google Scholar. The reviewed literature was limited to English language studies published after 1981. Articles that were included in the review met the inclusion criteria of 1) Having a description or proposal for an intervention to address elder abuse 2) used exclusively with adults aged 60 or older 3) initiated from either primary care, emergency department, or an inpatient hospital setting. Articles were coded to indicate the model or framework underlying the intervention, the format of the intervention, and if an interdisciplinary care team was involved in the intervention. After removing duplicates, a total of 950 articles were reviewed. We identified 8 interventions and protocols.

Results: In the interventions or protocols identified in the review, there was a strong focus on multidisciplinary or interdisciplinary practice. Of the eight articles located, six were concerned with interventions from a hospital or emergency department setting, one from a primary care clinic, and one did not specify. Elder abuse research is described as problem focused rather than theory based. Current interventions and models for elder abuse are solution-focused and prioritize ensuring safety. These approaches use some limited theory and frameworks, including caregiver burden theory and role accumulation theory. They share an emphasis on risk factors, causal models, and addressing acute needs. These approaches do not account for how economic and social conditions may lead to abuse and the role of individualized care planning.

Implications: Social workers can play a valuable role by integrating theories described in social science literature into intervention models in interdisciplinary healthcare settings. Future researchers should consider the role of theory when developing and implementing interventions to address elder abuse. Existing theories from other areas of abuse can be adapted to elder abuse intervention research (e.g., intimate partner violence and child maltreatment). Several hopeful approaches to intervention have been proposed and warrant further research such as involving specialized providers from multiple disciplines capable of addressing a range of biopsychosocial needs.