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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester

Elder abuse in residential care settings. - A multi-method study on abuse and neglect of older patients in Norwegian nursing homes

Alternative title: En multimetodestudie om vold og overgrep av eldre pasienter i norske sykehjem

Awarded: NOK 15.0 mill.

Elder abuse can take many forms and can be described as: physical, psychological, financial, sexual or neglect. According to World Health Organization, at least 3-5% of the population 65+ are exposed to one or more types of abuse. This is a major threat to public health. Still elder abuse is a hidden and under researched problem. The aim of this project was to reduce abuse and neglect in nursing homes, through developing new knowledge on the extent and nature of abuse, and to identify mechanisms at individual, organizational and structural level leading to abuse and neglect in nursing homes. The research was organized in three sub-studies. The first comprised a national survey on abuse of nursing home patients among the staff to estimate the occurrence and causes of abuse and neglect. The second sub-study explored the role of leadership to promote patient safety in nursing homes. This was done through document studies of deficiency reports in combination with interviews with nursing home leaders. The third sub-study explored relatives' experiences of abuse and neglect of nursing home patients. Data was gathered through focus group discussions. The unique contribution of the current study is a broad approach, including a spectre of methods, and investigating several factors associated with abuse. Dissemination of results has included informing local and national health authorities. Results has been published in international peer reviewed journals and presented at scientific conferences. The project emphasizes broad user involvement in all phases of the research, thereby enabling high level of implementation of research results. At the formal closure of the project (31.03.21), seven scientific articles have been published in international, peer-reviewed journals. The first sub-study showed that elder abuse and neglect constitutes an overlooked patient safety issue. About 60 % of nursing staff reported that they had perpetrated violence/abuse/neglect, 89 % had observed others do such acts and 89 % had observed resident-to-resident aggression. Risk factors among staff for perpetrating such acts were: employees with health science background, reduced mental health, desire to quit the job, and negative attitudes towards residents. The second sub-study revealed that leaders/managers are not well informed about the concepts violence/abuse/neglect. Incidents are explained as negative/damaging but at the same time rationalised and excused. Follow-up of incidents are done at individual, group and organisational levels. Internal and external factors combined with perceived powerlessness in taking action, as well as lack of tools to handle incidents, influence negatively on follow-up of incidents. The third sub-study revealed that next-of-kin perceived violence/abuse/neglect as a central problem in nursing homes. They expressed the view that such incidents were related to low competence among staff, too few staff, weak management, a work culture embossed by fear and loyalty to employer or colleagues, and lack of individualised nursing. Next-of-kin further experience themselves to be violated by the nursing home when they expressed their concern for their family member. Next-of-kin described experiencing stress, anxiety and distrust towards the nursing home and experienced the collaboration with the nursing home as a kind of battle. As distrust increased, they started compensating with spending much time at the nursing home to ensure, and partly control, that the treatment provided to their elderly family member was adequate and that they were not exposed to any form of abuse. Next-of-kin want to be involved as real partners to the nursing home and with a joint ambition to provide individualised nursing. Next-of-kin have a key role as the voice of the residents. To include next-of-kin in a partnership with services is a valuable way of reducing the risk for abuse in nursing homes.

Elder abuse is recognized internationally as a hidden problem. Nursing homes are identified as one context where elder abuse takes place. Research in this field is however both limited and inconclusive. The etiology of abuse is a complex interaction between personal, social and organizational factors which needs to be further investigated. The aim of this project is to reduce abuse and neglect in nursing homes, through generation of new knowledge on the extent and nature of abuse, and to identify mechanisms at individual, organizational and structural level leading to abuse and neglect in nursing homes, and in the longer run eliminating elder abuse and neglect. The research is organized in three intertwined Work Packages. WP1 comprises a national survey on abuse of nursing home patients among the staff to estimate prevalence and analyze predictors of abuse and neglect. WP2 takes into account that leadership is identified as a key consideration in building a culture of patient safety. The sub-study explores the role of leadership to promote patient safety in nursing homes through document studies of deficiency reports in combination with qualitative interviews with nursing home leaders. WP3 explores relatives' experiences of abuse and neglect of nursing home patients. Data will be gathered through focus group discussions among next of kin to nursing home patients. Family members may act as effective proxies due to their insight in the patients' situation. Contrary to the current fragmented research, the unique contribution of this proposal is a comprehensive approach, including a broad specter of explanatory factors into one research study. Dissemination of results includes informing local and national health authorities. Results will be published in international peer review journals and presented at scientific conferences.The project emphasize broad user involvement in all phases of research, thereby enabling high level of implementation of research results.

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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester