Digital Elder Abuse Intervention for Older People Living with Dementia

Abstract Background A growing number of older adults experience elder abuse (EA) each year, and people living with dementia (PLWD) are at higher risk. Emergency departments (EDs) are opportune settings to identify EA and can provide interventions to those at high risk and direct them to appropriate health and social services. There is evidence that PLWD can report abuse despite cognitive challenges, but research is limited regarding self‐administered interventions to detect EA. Method We developed and tested our tablet‐based intervention to increase self‐reporting of EA among PLWD. The VOICES EA intervention combines educational resources, screening, multimedia elements, and brief psychoeducational interviewing to motivate PLWD to self‐identify and self‐report abuse. The goal of our study is to evaluate using VOICES among PLWD (ages 60+ years) at a geriatric memory clinic (N = 30) and the ED setting (N = 101). We previously demonstrated VOICES’ feasibility and efficacy with 1,000 cognitively intact participants (ages 60+) in the ED and wanted to compare patterns of use between users (with or without dementia). Participants were recruited, consented, and enrolled at Yale New Haven Health System in New Haven, Connecticut, USA. We used the Montreal Cognitive Assessment (MoCA) to assess cognition of participants, excluding participants with severe dementia. Result Older adults with MoCA scores between 14 and 25 were able to use VOICES similarly to those without cognitive impairments (i.e., MoCA >25) and were able to complete using the VOICES independently. From the memory clinic, 83% agreed that audio and visual tool aids were helpful, and 87% agreed that the tool’s instructions were easy to follow. In the ED setting, of the 101 participants who started VOICES, 100 completed VOICES independently (99% completion rate). Of participants who completed the post‐use questions (N = 99), 84% were satisfied with their ability to complete VOICES on their own without assistance, and 91% agreed VOICES was appropriate for learning about EA. Conclusion Our results suggest that the VOICES EA intervention is feasible (i.e., acceptable, practical, and satisfactory) for detecting EA in PLWD, specifically those with MoCA scores ranging from 14‐25. This may allow for enhanced early EA detection and intervention in this highly vulnerable population.

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