The effect of an educational intervention on junior doctors' knowledge and practice in detecting and managing elder abuse

Background: Elder abuse is often unreported, undetected, and underestimated by professionals. For the first time, we report the effectiveness of an educational elder abuse intervention over three months and its impact on professionals' practice. Methods: Forty trainee psychiatrists in two London National Health Service trusts completed the KAMA (Knowledge and Management of Elder Abuse) and CSQ (Caregiver Scenario Questionnaire) measuring knowledge about managing and detecting elder abuse, before and immediately after a brief group education session. We asked how often they considered, asked about, detected, and managed elder abuse and their confidence in doing so, at baseline and three months post-intervention. Results: Compared with baseline, participants scored higher on the KAMA (paired t = 3.4, p = 0.002), and identified more definitely abusive (t = 3.0, p = 0.003) and possibly abusive (t = 2.1, p = 0.043) items immediately post-intervention. At three-month follow up, 24 (60%) participants reported higher confidence in managing abuse (Wilcoxon signed ranks test z = 3.7, p < 0.001) and considered it more frequently (z = 2.8, p = 0.006), but did not ask older people and their carers about abuse more frequently (z = 1.2, p = 0.24). Two (5%, 95% confidence interval 2%-17%) participants detected abuse in the three months before the intervention, compared with 2 (8%, 2%-26%) in the same period afterward. Conclusions: This brief educational intervention increased trainee psychiatrists' knowledge and vigilance for abuse immediately and after three months. They remained reluctant to ask about abuse for reasons including fear of causing offence or harming the therapeutic relationship and being unsure how to ask people with dementia. We postulate that changing doctors' behavior may require a more complex intervention, focusing on communication skills.