Motivation Interviewing to Reduce Elder Abuse and Neglect: Findings From a Randomized Controlled Trial in Hong Kong.

BACKGROUND: Elder abuse and neglect (EAN) can lead to severe consequences among victims. However, older adults are often reluctant to seek help. This study explored the efficacy of using motivational interviewing (MI), a technique used to resolve ambivalence about behavioral change by strengthening one's motivation, in reducing subsequent EAN among older victims in Hong Kong. METHODS: This prospective, two-arm randomized controlled trial (RCT) enrolled Chinese-speaking community-dwelling older adults (age ≥ 60 years) at risk of EAN from 2022 to 2025. The intervention involved 4 individual sessions utilizing key MI techniques to identify personal goals and evoke motivation for change. The primary outcome was EAN in the past month as assessed with items modified from the Revised Conflict Tactics Scale and the Old Adult Financial Exploitation Measure; whilst secondary outcomes included subjective physical health, psychological well-being, self-efficacy, and social support. All outcomes were assessed at baseline, post-intervention, and 3 months after the intervention. RESULTS: A total of 359 older adults were eligible for the intervention. While 161 refused to participate, the final sample comprised 198 older adults (mean age: 73.6 years; female: 88.9%), of whom 99 received the intervention and the other 99 were wait-list controls. Findings from the mixed-effects model analysis showed that, compared with the control group, the intervention group experienced greater reductions in minor psychological aggression at the 3-month follow-up assessment (Cohen's d = 0.92, p < 0.001) as well as caregiver neglect at the post-intervention assessment (Cohen's d = 0.57, p < 0.05). Similarly, the intervention group showed greater improvements in self-efficacy (Cohen's d = 0.67-0.83, all p < 0.05) and social support over time (Cohen's d = 2.08, p < 0.05). CONCLUSIONS: This study represents one of the first empirical evaluations using MI in EAN interventions. Findings suggest that MI by advocates can be a beneficial approach to help older adults at risk of EAN. TRAIL REGISTRATION: This RCT has been registered under the ISRCTN prior to the beginning of the study. The identifying number is ISRCTN35969462. The study protocol can be accessed at https://www.isrctn.com/ISRCTN35969462.