Responding to Elder Abuse in GERiAtric Care: Educational Intervention (REAGERA edu)

Responding to Elder Abuse in GERiAtric Care Educational Intervention for Healthcare Providers: a Non-randomised Stepped Wedge Trial.

The prevalence of elder abuse has been reported between 10-15% in international studies. Elder abuse may include both physical, emotional, sexual and financial abuse as well as neglect and it occurs at the hand of both professionals and family members, including adult children and intimate partners. Elder abuse has been associated with psychological ill-health, disability, increased hospitalization, emergency department use and admission to nursing facilities. Elder abuse is however often unknown to health care providers. Older adults are hesitant to disclose abuse and health care providers are often reluctant to ask questions.

In this study an interactive educational model for health care professionals about elder abuse will be tested. The model consist of theoretical lectures, brief films showing patient encounters, group discussions and forum play, a form of participatory theater. Both group discussions and forum play will be using case scenarios as a cornerstone.

The validated questionnaire REAGERA-P will be used for self-reported measures

Study Overview

• Status: Completed
• Conditions: Healthy
• Intervention / Treatment: Other: Education

Detailed Description

Please refer to the uploaded study protocol for a detailed description of the study.

• Study Type: Interventional
• Enrollment (Actual): 554
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Eksjö, Sweden
    • Region Jönköpings län
  • Jönköping, Sweden
    • Region Jönköpings län
  • Linköping, Sweden
    • Region Östergötland
  • Norrköping, Sweden
    • Region Östergötland

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Employee at one of the clinics participating in the trial
• Work tasks involves direct patient contact, at least part time
• Participation at the training sessions

Exclusion Criteria:

• Only administrative work and no direct patient contact
• Not participating at the training session

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Education; Participants that have undergone the educational intervention	Other: Education; Training for health care professionals on how to identify and manage cases of elder abuse among their patients
No Intervention: Waitlist; Participants still waiting to cross over to intervention arm

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change between baseline and follow up concerning asking questions about abuse, as reported in the questionnaire REAGERA-P	Self-report measure of asking older patients about abusive experience. Will be measure both as a dichotomous value (have ever asked questions during the last 6 months) as well as a frequency measure where participants report how often they have asked patients questions about abuse during the last 6 months (on a scale from 0 to 10 or more)	Baseline, 6 month follow up, 12 month follow up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change between baseline and follow up concerning awareness of elder abuse and sense of responsibility for identifying victims, as reported in the questionnaire REAGERA-P	Self-reported perceived lack of awareness of elder abuse as a barrier toward identifying victims.; Self reported sense of responsibility for asking questions about abuse (own responsibility, professions' responsibility, health care services responsibility)	Baseline, Immediate post-intervention (number 2), 6 month follow up, 12 month follow up
Change between baseline and follow up concerning level of awareness of abuse in contact with patients, as reported in the questionnaire REAGERA-P	Patient case ("Vignette") with indicators of abuse and participants self-report if they think they would have asked the patient questions about abuse	Baseline, 6 or 12 month follow up (different for different clusters)
Change between baseline and follow up concerning perceived ability to ask questions about abuse, as reported in REAGERA-P	Self-reported self-efficacy for asking questions about elder abuse.; Self-reported cause for concern that asking questions will a) lead to a negative reaction from the patient b) negatively impact the patient-provider relationship	Baseline, Immediate post-intervention, 6 month follow up, 12 month follow up
Change between baseline and follow up concerning perceived preparedness to manage cases of elder abuse, as reported in REAGERA-P	Self-reported self-efficacy for managing cases of elder abuse.; Self-reported cause for concern of not being able to offer the patient a good follow up.; Self-reported collegial support, i.e., knowing which colleague to ask for help if needed when managing cases of elder abuse.; Self-reported knowledge about proper documentation routines; Self-reported knowledge about judicial concerns	Baseline, Immediate post-intervention (number 1and 2), 6 months follow up, 12 months follow up
Change between baseline and follow up concerning preparedness at the clinic to care for older adults subjected to abuse, as reported in REAGERA-P	Self-reported evaluation of: Routines for managing cases of elder abuse at the clinic; Preparedness at the clinic and in society to care for victims of elder abuse.	Baseline, 6 months follow up, 12 months follow up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change between baseline and follow up concerning number of elder abuse victims identified at the clinics included in the study, as reported in the medical records	Anonymous data from the medical records counting the number of older patients treated at each clinic that have been identified as victims of abuse during the last 6 months	Baseline, 6 month follow up, 12 month follow up
Change between baseline and follow up concerning adequate follow up, as reported in the questionnaire REAGERA-P	Frequency of respondents reporting that identified cases of elder abuse were given adequate follow up	Baseline, 6 month follow up, 12 month follow up
Change between baseline and follow up concerning self-reported hesitancy for asking questions about elder abuse, as reported in the questionnaire REAGERA-P	Frequency of respondents reporting that they have suspected cases of elder abuse but refrained from asking questions	Baseline, 6 month follow up, 12 month follow up
Degree of changed practice as reported in the questionnaire REAGERA-P	Frequency of participants self-reporting that they have changed their working practices as a result of the educational intervention	6 month follow up

Collaborators and Investigators

• Sponsor: Region Östergötland
• Collaborators: Linkoeping University; Region Jönköping County; Kamprad Family Foundation; Linnaeus University; Medical Research Council of Southeast Sweden
• Investigators: Principal Investigator: Johanna Simmons, MD, PhD, Region Östergötland

Publications and helpful links

General Publications

• Simmons J, Wenemark M, Ludvigsson M. Development and validation of REAGERA-P, a new questionnaire to evaluate health care provider preparedness to identify and manage elder abuse. BMC Health Serv Res. 2021 May 19;21(1):473. doi: 10.1186/s12913-021-06469-2.
• Ludvigsson M, Motamedi A, Westerlind B, Swahnberg K, Simmons J. Responding to Elder Abuse in GERiAtric care (REAGERA) educational intervention for healthcare providers: a non-randomised stepped wedge trial. BMJ Open. 2022 May 4;12(5):e060314. doi: 10.1136/bmjopen-2021-060314.

Helpful Links

• Study Protocol

Study record dates

Study Major Dates

• Study Start (Actual): September 16, 2021
• Primary Completion (Actual): November 18, 2024
• Study Completion (Actual): November 18, 2024

Study Registration Dates

• First Submitted: September 15, 2021
• First Submitted That Met QC Criteria: September 28, 2021
• First Posted (Actual): October 4, 2021

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: December 13, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: RÖ-786

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: There is a plan to make anonymous participant data that underlie results in publications available. However, we are still waiting on final guidelines from the sponsor concerning sharing data and in the unlikely case that the new guidelines prohibit sharing data it will not be shared.
• IPD Sharing Time Frame: Data will become available alongside publications.
• IPD Sharing Access Criteria: Will be made available from the researcher upon reasonable request or made available from a public depository.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No