Behavioral Activation Therapy May Improve MH in Older People Who Have Been Abused

Psychotherapy based on the principles of behavioral activation may help reduce depressive symptoms and thoughts of suicide in people who have experienced elder abuse, according to a study published today in the American Journal of Geriatric Psychiatry.

Isabel Rollandi, Ph.D., of the Weill Cornell Institute of Geriatric Psychiatry, and colleagues examined data from 158 participants ages 60 or older who had experienced elder abuse. All participants had depressive symptoms as shown by a score of at least 10 on the nine-item Patient Health Questionnaire (PHQ-9) but did not have significant cognitive impairment. The researchers also collected data on the participants’ demographics, abuse history, and thoughts of suicide (PHQ-9 item 9) at baseline. The most prevalent abuse was emotional/psychological abuse, reported by 78.5% of participants, followed by verbal abuse, reported by 67.1%.

All participants completed 10 weeks of PROTECT therapy either in person or on the phone. PROTECT therapy consists of 45-minute sessions as follows:

• One to three sessions that include discussions and psychoeducation about stress and depression, and to formulate the participants’ treatment goals related to the abuse, such as taking steps to promote safety or improving self-care.
• Four to eight sessions to develop action plans to increase engagement in specific pleasurable and socially rewarding activities and meet the goals set.
• Two sessions to discuss how the participant was faring in accomplishing goals and to work on strategies to maintain gains after completing the therapy.

At the end of treatment, scores on the PHQ-9—which was administered at the start of each session—dropped a mean of 5.58 points among participants who reported thoughts of suicide at baseline and 5.25 points among those without thoughts of suicide at baseline. In addition, the percentage of participants who reported thoughts of suicide decreased from 19% at baseline to 5.7%.

“These findings suggest that a brief intervention for depression delivered in the community can significantly contribute to reducing depressive symptoms in elder abuse victims regardless of depression severity and presence of [thoughts of suicide],” Rollandi and colleagues wrote. “Furthermore, it shows that a depression intervention can reduce suicidal ideation frequency, contributing to decreasing mortality risk in this vulnerable population. These results highlight and reaffirm the imperative to address the mental health needs of elder abuse victims and to deliver effective and scalable psychotherapy treatments that can be integrated in the community.”

For related information, see the Psychiatric News article “Abuse of Older People Increases During Pandemic.”

(Image: Getty Images/iStock/Goodboy Picture Company)

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How to Identify, Help Older People in Potentially Abusive Situations

The stresses on older people and their caregivers associated with COVID-19—social isolation, financial hardship, difficulties accessing needed care and supplies, and anxiety about infection—may increase the risk of elder abuse, according to a paper in the American Journal of Geriatric Psychiatry.

An estimated 10% of adults 60 years or older experiences abuse annually in the United States, wrote Lena K. Makaroun, M.D., M.S., core investigator with the VA Pittsburgh Center for Health Equity Research and Promotion, and colleagues. This includes physical, sexual, or psychological abuse, as well as financial exploitation or neglect by caregivers.

Increased financial stress and burdens on caregiver time due to COVID-19 may exacerbate abusive behavior, Makaroun and colleagues continued. “With over 20 million people filing for unemployment in the United States from mid-March to mid-April 2020 ... many caregivers are undoubtedly facing new financial strains.” Insolvency and financial dependence on older people (or their financial dependence on caregivers) can increase strife and the risk for abuse, they added.

These are among the steps that clinicians can take to identify and address elder abuse or potential abuse:

Inquire about patient safety and well-being during telehealth visits. “[A]s health care providers doing telephonic or video visits with our older adult patients, we have a unique chance to observe our patients in their home environment. This is a rare window into how they are living, caring for themselves, and being cared for by others,” the authors wrote. If abuse by a caregiver is suspected and the patient appears reluctant to disclose it when the caregiver is present, health care professionals can make unscheduled calls to the older adult, so that the caregiver cannot plan ahead to be present.

Provide support to caregivers. “Caregivers may be more comfortable disclosing sensitive information related to their ability to provide care when speaking from a home environment,” they wrote. “Health care providers can assess caregiver stress, ability to maintain previous levels of caregiving, and ability to access necessary resources and supplies. Providers can then provide brief counseling, problem-solving strategies, and appropriate referrals.”

Connect older patients and their caregivers to resources in the community. Local and regional aging services are offering a host of services to elders and their caregivers. “Encouraging our older patients to forge new bonds being made possible during this pandemic will be more important than ever. We can [help] older patients connect to neighboring families who can help check on their well-being, to volunteers who can pick up needed groceries, and to local organizations that will donate supplies... .”

Makaroun and colleagues added that the crisis is an opportunity for expanding research, especially on caregiver-related risk factors in abuse. “With many people experiencing caregiving stress … caregivers may be more open to participating in research to share their experiences, even uncomfortable ones.”

They concluded, “Attending to mental health needs, addressing increased risks, and connecting older adults to financial and caregiving resources may all help our patients and their loved ones be safer and avoid abusive and violent situations.”

(Image: iStock/Cecilie_Arcurs)

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