The Use of Evidence-Based Practices for Elder Abuse Programs1
Foundations of Evidence-Based Practice
Evidence-based medicine is “the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions.” Evidence-based medicine arose in order to respond to problems in the provision of health services and to a fundamental problem and pervasive lack of knowledge, including unexplained variations in clinical practice, an increase in diagnostic and therapeutic options, patient empowerment, and decision psychology. The purpose of evidence-based medicine is to move a situation on which there is ignorance to one on which there is knowledge based on something more trustworthy than opinion. The solution is to consult the research literature to assist in making a treatment decision.
Promise of Evidence-Based Practice
Evidence-based programs are those whose intervention results in positive behavioral changes, such as improving dietary habits, increasing exercise, decreasing drug use, stopping elder abuse. These programs are scientifically proven to be effective and beneficial in preventing or changing a targeted outcome. Evidence-based programs are usually multi-faceted, can be modified for a targeted outcome, and contain information on a program’s fidelity, as well as information on costs and cost effectiveness.
Positive outcomes produced by similar evidence-based programs carry the potential to address the problem of elder abuse. If demonstrably effective, they could guide the allocation of resources to replicate, expand, and support a program or series of programs, those geared towards efforts made in a particular direction and following an established line of evidence. In addition and importantly, appropriate and rigorous evaluation using quantitative and qualitative methods to analyze measurable outcomes would ensure that a program is accountable and useful to its program participants.
Challenges in Applying Evidence-Based Practice to the Phenomenon of Elder Abuse
It is simply not enough to have evidence supporting an intervention. What is most important is, if the guidelines are followed, will the program under scrutiny work outside the research setting with the target population?
Challenge 1
The primary challenge for the application of evidence-based practices for elder abuse programming lies in translating research with demonstrated efficacy to real-world successful programs. Four barriers to this translation are:
- Concerns with external and internal validity
- Criteria for a relevant outcome
- Treatment fidelity
- Program reach
Challenge 2
The research methodology, not just the evidence, must be efficacious outside the research setting. The evidence must be replicable in the real world and must also have similar effects. Evidence also needs to be well-informed (i.e., the methodology is sound, results are reliable, and design and findings take into consideration resource availability). By taking into account the levels of implementation from community awareness, professional training, and elder involvement, evidence-based practices have a better chance of translation into real world settings.
Challenge 3
One of the ways evidence-based practices establish efficacy is through demonstrating causal relationships for behaviors. The practice in question should have similar or the same results in the real world. However, elder abuse represents a phenomenon far more heterogeneous than homogeneous. As yet, a good understanding of what causes some people to become abusers and not others in similar situations does not exist.
Moving Toward Evidence-Based Practice for Addressing Elder Abuse
According to the National Council on Aging and the Substance Abuse and Mental Health Services Administration, a successful evidence-based program should incorporate at least three important requirements:
- Evidence-based programs should be grounded in the systematic identification and review of the current body of literature regarding a well-defined question
- Methods and procedures for evaluating the program should be scientifically sound
- Outcome measures must describe and detail how the intervention has changed the characteristics and environment of the targeted population
Evidence-based programs obviously aren’t born overnight. How does an evidence-based program become evidence-based? AoA employs a graduated definition of evidence-based for many of its programs, including the Title III-D Disease Prevention and Health Promotion Services program of the Older Americans Act:
Minimal Criteria
- Demonstrated through evaluation to be effective for improving the health and wellbeing or reducing disease, disability and/or injury among older adults; and
- Ready for translation, implementation and/or broad dissemination by community-based organizations using appropriately credentialed practitioners.
Intermediate Criteria
- Published in a peer-review journal
- Proven effective with older adult population, using some form of a control condition (e.g. pre-post study, case control design, etc.)
- Some basis in translation for implementation by community level organization.
Highest-level Criteria
- Undergone Experimental or Quasi-Experimental Design
- Level at which full translation has occurred in a community site
- Level at which dissemination products have been developed and are available to the public.
To help elder abuse programs begin to think about moving along this continuum towards evidence-based practice, the NCEA has identified a number of domains programs can ask themselves about the interventions and activities they employ. As more organizations begin to identify these components of their programs, we begin to generate the foundations for evidence-based elder abuse programming:
- Whether the program/intervention has identified outcome measures
- The behavior(s) the program/project attempts to change
- Quantified effect(s)/impact(s) of the behavior change
- Theoretical foundation upon which the program is based
- Cost per year per recipient
- Cost savings in a year’s time
- Whether any adverse effects of the intervention have been identified
- Whether the program has been evaluated, and the design of such an evaluation
- Whether the program has been replicated
- Whether the program is participating in a research project of any kind, or if the program would be interested in participating in a research project
Footnotes
1. Summary excerpt from The Use of Evidence-Based Practices for Elder Abuse Programs (PDF) (2011) prepared for the NCEA by The National Committee for the Prevention of Elder Abuse under grant #90-AM-3145. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging or DHHS policy.