Elder abuse is an emerging public health and safety issue for communities of high-income countries.

The most recent data from Australia’s National Elder Abuse Prevalence Study, which surveyed 7,000 older people living in the community, found one in six self-reported being a victim of some form of abuse. But this did not include older people living in residential aged care or those with cognitive impairment, such as dementia – so is likely an underestimate.

This week the Australian government announced a multi-million dollar advertising campaign it hopes will address this serious and abhorrent abuse.

But is investing in community awareness of elder abuse the best use of scarce resources?

What is elder abuse?

The World Health Organization (WHO) defines elder abuse as

[…] a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.

Australia usually defines older people as those over 65. The exact age varies between countries depending on the overall health status of a nation and its vulnerable population groups. The WHO definitions of an older adult for sub-Saharan Africa, for example, is over 50. And there are communities with poorer health status and shorter lifespans within country borders, including our First Nations people.

Elder abuse can take on many different forms including physical, sexual, psychological, emotional, or financial abuse and neglect.

Living longer and wealthier

The number of older people in our society is greater than it has ever been. Around 17% Australians are aged 65 and over. By 2071, older Australians will make up between 25% and 27% of the total population.

People are living longer, accumulating substantial wealth and are vulnerable to abuse due to cognitive, physical or functional limitations.

Longer lifespans increase the time of possible exposure to abuse. Australian men aged 65 can expect to live another 20.2 years, while women aged 65 are likely to live another 22.8 years. (Life expectancy for First Nations men and women remains significantly shorter.)

Australian men are now 143 times more likely to reach the age of 100 than they were in 1901. Women are 82 times more likely.

Older people hold a large proportion of our nation’s wealth, making them vulnerable to financial abuse. Recent research by the Australian Council of Social Service and UNSW Sydney reveals older households (with people over 65) are 25% wealthier than the average middle-aged household and almost four times as wealthy as the average under-35 household.

Finally, older people have higher levels of impairment in their thinking, reasoning and physical function. Cognitive impairment, especially dementia, increases from one in 67 Australians under 60 to almost one in two people aged over 90.

Over half of Australians aged 65 years and over have disability. A particularly vulnerable group are the 258,374 older Australians who receive government-funded home care.

Who perpetrates elder abuse?

Sadly, most of the perpetrators of elder abuse are known to their victims. They are usually a member of the family, such as a life partner, child or grandchild.

Elder abuse causes significant illness and even early death. Financial abuse (across all ages) costs the community billions of dollars. Specific data for financial elder abuse is limited but indicates massive costs to individual survivors and the community.

Despite this, the level of awareness of elder abuse is likely to be much lower than for family violence or child abuse. This is partly due to the comparatively recent concept of elder abuse, with global awareness campaigns only developed over the past two decades.

Is an advertising campaign the answer?

The federal government has allocated A$4.8 million to an advertising campaign on television, online and in health-care clinics to reach the broader community. For context, last year the government spent $131.4 million on all media campaigns, including $32.6 million on the COVID vaccination program, $2 million on Japanese encephalitis and $3.2 million on hearing health awareness.

The campaign will likely benefit a small number of people who may be victims and have the capacity to report their perpetrators to authorities. It will generate some heartbreaking anecdotes. But it is unlikely to achieve broad community or systemic change.

There is little research evidence to show media campaigns alter the behaviour of perpetrators of elder abuse. And suggesting the campaign raises awareness of the issue for older people who are survivors of abuse sounds more like blaming victims than empowering them.

We don’t know how the government will judge the success of the campaign, so taxpayers won’t know whether a reasonable return on this investment was achieved. There may also be opportunity costs associated with the initiative – that is, lost opportunities for other actions and strategies. It could be more effective and efficient to target high-risk subgroups or to allocate funding to policy, practice reform or research that has direct tangible benefits for survivors. https://www.youtube.com/embed/DeK2kaqplTI?wmode=transparent&start=0 The Australian Human Rights Commission’s campaign from last year.

But the campaign can’t hurt, right?

Actually, the dangers that could come with an advertising campaign are two-fold.

First it may well oversimplify a highly complex issue. Identifying and managing elder abuse requires an understanding of the person’s vulnerabilities, their decision-making capacity and ability to consent, the will and preferences of victim and the role of perpetrator in the older person’s life. Abuse happens in the context of family and social networks. And reporting abuse can have consequences for the victim’s quality of life and care.

Consider the complexities of a case where an older person declines to have her grandson reported to police for stealing her money and medication because of her fear of becoming socially isolated. She might even feel responsible for the behaviour having raised the grandson and not want him to have a criminal record.

Secondly, a public campaign can create the illusion government and our institutions have the matter “in hand”. This might slow the opportunity for real change.

Ideally, the campaign will strengthen the argument for better policies, reporting procedures, policing, prosecution and judgements that are aligned. But these ends will also need investment in more research to build better communities that take good care of older people.

Joseph Ibrahim, Professor, Aged Care Medical Research Australian Centre for Evidence Based Aged Care, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

While many people maintain positive emotional wellbeing as they age, around half of older Australians living in residential aged care have significant levels of depression. Symptoms such as low mood, lack of interest or pleasure in life and difficulty sleeping are common.

Rates of depression in aged care appear to be increasing, and without adequate treatment, symptoms can be enduring and significantly impair older adults’ quality of life.

But only a minority of aged care residents with depression receive services specific to the condition. Less than 3% of Australian aged care residents access Medicare-subsidised mental health services, such as consultations with a psychologist or psychiatrist, each year.

Instead, residents are typically prescribed a medication by their GP to manage their mental health, which they often take for several months or years. A recent study found six in ten Australian aged care residents take antidepressants.

While antidepressant medications may help many people, we lack robust evidence on whether they work for aged care residents with depression. Researchers have described “serious limitations of the current standard of care” in reference to the widespread use of antidepressants to treat frail older people with depression.

Given this, we wanted to find out whether psychological therapies can help manage depression in this group. These treatments address factors contributing to people’s distress and provide them with skills to manage their symptoms and improve their day-to-day lives. But to date researchers, care providers and policy makers haven’t had clear information about their effectiveness for treating depression among older people in residential aged care.

The good news is the evidence we published today suggests psychological therapies may be an effective approach for people living in aged care.

We reviewed the evidence

Our research team searched for randomised controlled trials published over the past 40 years that were designed to test the effectiveness of psychological therapies for depression among aged care residents 65 and over. We identified 19 trials from seven countries, including Australia, involving a total of 873 aged care residents with significant symptoms of depression.

The studies tested several different kinds of psychological therapies, which we classified as cognitive behavioural therapy (CBT), behaviour therapy or reminiscence therapy.

CBT involves teaching practical skills to help people re-frame negative thoughts and beliefs, while behaviour therapy aims to modify behaviour patterns by encouraging people with depression to engage in pleasurable and rewarding activities. Reminiscence therapy supports older people to reflect on positive or shared memories, and helps them find meaning in their life history.

The therapies were delivered by a range of professionals, including psychologists, social workers, occupational therapists and trainee therapists.

In these studies, psychological therapies were compared to a control group where the older people did not receive psychological therapy. In most studies, this was “usual care” – the care typically provided to aged care residents, which may include access to antidepressants, scheduled activities and help with day-to-day tasks.

In some studies psychological therapy was compared to a situation where the older people received extra social contact, such as visits from a volunteer or joining in a discussion group.

What we found

Our results showed psychological therapies may be effective in reducing symptoms of depression for older people in residential aged care, compared with usual care, with effects lasting up to six months. While we didn’t see the same effect beyond six months, only two of the studies in our review followed people for this length of time, so the data was limited.

Our findings suggest these therapies may also improve quality of life and psychological wellbeing.

Psychological therapies mostly included between two and ten sessions, so the interventions were relatively brief. This is positive in terms of the potential feasibility of delivering psychological therapies at scale. The three different therapy types all appeared to be effective, compared to usual care.

However, we found psychological therapy may not be more effective than extra social contact in reducing symptoms of depression. Older people commonly feel bored, lonely and socially isolated in aged care. The activities on offer are often inadequate to meet their needs for stimulation and interest. So identifying ways to increase meaningful engagement day-to-day could improve the mental health and wellbeing of older people in aged care.

Some limitations

Many of the studies we found were of relatively poor quality, because of small sample sizes and potential risk of bias, for example. So we need more high-quality research to increase our confidence in the findings.

Many of the studies we reviewed were also old, and important gaps remain. For example, we are yet to understand the effectiveness of psychological therapies for people from diverse cultural or linguistic backgrounds.

Separately, we need better research to evaluate the effectiveness of antidepressants among aged care residents.

What needs to happen now?

Depression should not be considered a “normal” experience at this (or any other) stage of life, and those experiencing symptoms should have equal access to a range of effective treatments. The royal commission into aged care highlighted that Australians living in aged care don’t receive enough mental health support and called for this issue to be addressed.

While there have been some efforts to provide psychological services in residential aged care, the unmet need remains very high, and much more must be done.

The focus now needs to shift to how to implement psychological therapies in aged care, by increasing the competencies of the aged care workforce, training the next generation of psychologists to work in this setting, and funding these programs in a cost-effective way.

Tanya Davison, Adjunct professor, Health & Ageing Research Group, Swinburne University of Technology and Sunil Bhar, Professor of Clinical Psychology, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.