The impact of elder abuse training on subacute health providers and older adults: Study protocol for a randomized control trial

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Cavuoto, Simona Markusevska, Catriona Stevens, Patricia Reyes, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3891479/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Introduction: Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful or otherwise reticent to disclose abuse; and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers’ recognition, response, and referral of elder abuse. Methods: This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e., clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training program for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are health providers’ knowledge of responding to elder abuse; and older people’s quality of life. We will include all inpatients at participating sites, aged 65+ (or aged 50+ if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses. Results: Recruitment will commence in October 2023. Discussion: This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral. Trial registration: ANZCTR, ACTRN12623000676617p. Registered 22 June 2023, https://www.anzctr.org.au/ACTRN12623000676617p.aspx elder abuse training older people subacute intervention co-design pragmatic trial Figures Figure 1 Key points Underreporting of elder abuse is significant due to barriers to disclosure Health providers may not feel confident in asking about or responding to elder abuse Hospital based health providers are in a unique position to detect and respond to elder abuse We report our protocol for No More Shame, a pragmatic cluster randomised control trial that aims to train health providers to recognise and respond to elder abuse Our outcomes include health providers knowledge and management of elder abuse, older people’s quality of life and sense of safety, and rates of elder abuse detection and referrals at hospital sites Introduction Elder abuse refers to harm caused to an older person by a single or repeated act within a relationship of trust. It can include financial, physical, psychological, sexual abuse and neglect [ 1 , 2 ], and is commonly perpetrated by adult children [ 3 ]. Elder abuse is associated with increased morbidity and mortality including higher rates of depression, anxiety, fear, stress, substance dependence, social isolation, poorer physical health, and suicide [ 4 – 7 ]. Community prevalence is around 15% [ 1 ], although rates of underreporting are high [ 8 ]. Specialised health, aged care, community, and legal services directly involved in care for older people experiencing abuse hold valuable expertise about recognising and responding to elder abuse [ 9 ]. However, many frontline health providers do not recognise elder abuse, do not report suspected cases, and often lack the time, confidence, and knowledge to respond [ 10 , 11 ]. Additionally, ageist attitudes among health providers, may impede older people’s care [ 12 ]. Ageism is a recognised driver of elder abuse as it perpetuates notions that older people are dependent, an economic burden, and have less relevance, which in turn lead to greater tolerance of abuse [ 13 ]. Reviews [ 14 , 15 ] consistently identify the most effective interventions to stop and prevent further occurrence of elder abuse include educating health providers, and involving multidisciplinary services. The few randomised control trials (RCTs) in this area mostly focus on one of these interventions, demonstrating that training health providers, can improve awareness and knowledge elder abuse response [ 16 , 17 ], and improve how student practitioners detect financial elder abuse [ 18 ]. Evidence regarding the impact of training on health providers’ attitudes, detection and reporting rates within health services is sparse [ 11 , 19 , 20 ]. We aim to test whether a multimodal intervention combining health provider training, provision of a screening tool, and a site champion improves health providers’ knowledge and management of abuse, and older people’s sense of safety over nine months, compared to no additional training or support in Australian subacute hospitals. Subacute hospitals provide multidisciplinary care to optimise functioning and quality of life, including rehabilitation, geriatric evaluation and management, psychogeriatric care [ 21 ], and often involve longer stays to manage complex health conditions before discharge. This provides an important opportunity for clinicians to build trust [ 9 ]. This may be the only time an older person experiencing abuse leaves their home for a prolonged period, spending time away from the perpetrator. Indeed, the abuse itself may precipitate or prolong their hospital stay [ 22 ]. Aims and hypotheses Our primary aim is to test the hypothesis that health providers in the intervention arm will show greater knowledge of responding to elder abuse at 4-months relative to the control arm; and that older adults in the intervention arm will show greater quality of life at 4-months than those in the control arm. Methods Methods Design and theory This is a pragmatic, cluster RCT. The intervention is guided by the Theory of Change [23], which seeks to create a safe and inclusive relationship between health providers and older people (see Figure 1). Participants and setting Sites Subacute hospitals providing inpatient care in New South Wales; South Australia; Victoria; and Western Australia. Health providers We aim to recruit inpatient subacute clinical staff providing direct care to older people, including medical, nursing, or allied health. We will exclude staff who do not expect to be working at the site for at least 12 months post-baseline. Older people We will include all inpatients at participating sites, aged 65+ (or aged 50+ if Aboriginal or Torres Strait Islander), who are willing to participate and individually capable of providing informed consent. Exclusion criteria for older people are: i) receiving palliative care, ii) lack of decision-making capacity. Intervention This intervention comprises 3 components: Training: Health provider participants will be asked to complete training via an online Learning Management System (Acorn) hosted by the National Ageing Research Institute (NARI). The training takes ~60 minutes to complete, is self-paced, and participants will have access to it over a two-month period. It has four modules on: knowledge of abuse; drivers of abuse; screening for abuse (including how to administer the Australian Elder Abuse Screening Instrument [AUSI]) [24]; and management of elder abuse (further details available through the online trial registry anzctr.org.au, registration #ACTRN12623000676617p). This training was co-designed through workshops, interviews and user-testing with health providers, family carers, older people, and elder abuse survivors. Site champions will promote completion of the training, with the aim of at least 60% of eligible health providers on participating wards completing the training over a 2-month period. Screening tool: Intervention sites will be provided with the AUSI screening tool, which has content validity [24]; and has been demonstrated to increase staff confidence in screening for abuse, and the proportion of cases of suspected abuse that provoked multidisciplinary responses [25]. Following the training, health providers will be asked to screen all patients for elder abuse, and to manage detected cases as per usual practice, including referrals to outside agencies, but with support from the site champion where required. Site champion: Each site will recruit an on-site clinician (senior social worker or other staff with commensurate experience) as a site champion, who will support other hospital staff in screening and managing elder abuse. They will be trained by the research team and work one day per week supporting the intervention. Site champions will encourage uptake of the training and the AUSI, and regularly contact staff to assess concerns and/or challenges encountered with screening. Site champions will be contacted every 2–3 weeks via email/phone by the research team to proactively support them and build a national peer-support network [26]. Control The control arm will be waitlisted and given access to the training after nine months. Control arm sites will also recruit site champions, who will be trained and support in data collection. They will encourage completion of the outcome measures for health providers, recruit older people and collect data, and collect deidentified site data but will not provide further input beyond their normal clinical role. Outcome assessments All health provider participants will complete baseline assessment prior to site randomisation. Outcomes will be assessed at baseline (t0), 4 months follow-up (t1), and 9 months follow-up (t2). Sites Site champions will obtain summary statistics routinely collected by hospitals such as general site characteristics (size of workplace, location, subacute services offered), characteristics of patients admitted to participating wards (age, gender, country of birth, English proficiency; reason for subacute stay). They will also ascertain the number of eligible health providers to enable the calculation of the percentage who complete the training. Elder abuse detection and referral data will be collected from the 9 months preceding the trial to the end of the trial (i.e., at completion of 9-month outcomes). Specifically, site champions will screen medical records of all inpatients on participating wards during that time to ascertain i) number of records screened, ii) number of cases that identified elder abuse and the types, iii) referrals made to social work, iv) the frequency of interventions and referrals (e.g., legal referral, safety planning) using a standardised template that will be provided. In the intervention arm, the number of times the AUSI screening tool is administered and not administered will also be collected, however, the responses on the AUSI will not be collected. Health providers Health providers will complete a demographic survey (age, gender, profession, years of experience in profession, and whether they have completed elder abuse training prior to the trial). They will also complete the adapted Knowledge and Management of Abuse (KAMA) [27] (primary outcome) adapted for an Australian subacute care setting, the Australian adaptation of the Caregiver Scenario Questionnaire (CSQ) [28, 29], and Carolina Opinions on Care of Older Adults (COCOA) survey [30] (secondary outcomes) via online survey in REDCap. Older people Older people will complete a demographic survey (age, gender, education, postcode, country of birth, language/s spoken, English language skills, First Nations status, reason for admission and underlying health risk factors for elder abuse (e.g., dementia, mobility)), the Adult Social Care Outcomes Toolkit (ASCOT)[31] (primary outcome), the Short Form Survey-12 (SF-12v2)[32], and an adapted Resource Utilisation in Dementia lite (a-RUD-lite) (secondary outcomes) via online/paper/telephone survey. Site champions will support older people where required, and record the older person’s length of admission once discharged. Process evaluation We will conduct a multi-method process evaluation on how the intervention works in practice. Training completion rates will be monitored using the NARI Learning Management System. In addition to monitoring uptake of the screening tool, a researcher will visit each intervention site for 2-3 days approximately 3 months after implementation of the screening tool. We will observe how the screening and referrals are conducted, interview site champions, and 20-25 health providers across the sites. This evaluation will mobilise WHO guidance for scaling up health service innovations [33] as we seek to understand: intervention uptake, potential facilitators/barriers and solutions; whether the essential features of the intervention are being adhered to in practice (and if not, what remedial action can or should be taken); and whether the intervention improved elder abuse detection and response, impacted practice, and provider satisfaction. Table 1. Trial Registration Data Set Data category Information Primary registry and trial identifying number ANZCTR ACTRN12623000676617 Date of registration in primary registry 22 June 2023 Secondary identifying numbers MRFF Application ID: 2015995 Source(s) of monetary or material support Department of Health and Aged Care, Medical Research Future Fund (MRFF) Dementia Ageing and Aged Care Mission Primary sponsor Department of Health and Aged Care, Medical Research Future Fund (MRFF) Dementia Ageing and Aged Care Mission Email: [email protected] . Mail: Department of Health and Aged Care GPO Box 9848 Canberra ACT 2601 Australia Secondary sponsor(s) None Contact for public queries BB [email protected] Contact for scientific queries BB [email protected] Public title No More Shame: Investigating the effect of changing health providers recognition and response to elder abuse on associated stigma Scientific title No More Shame: Investigating the effect of changing health providers recognition and response to elder abuse on associated stigma Countries of recruitment Australia Health condition(s) or problem(s) studied Elder abuse, Public Health, Health promotion/education Intervention(s) Sub-acute health providers that work at participating hospital sites will be given access to a multicomponent intervention ("No More Shame") comprising a screening tool, online training focused on elder abuse, and a site champion. Key inclusion and exclusion criteria Ages eligible for study: ≥18 years Sexes eligible for study: Both Accepts healthy volunteers: No Inclusion criteria: Sub-acute health providers: either medical, nursing, or allied health staff, work in sub-acute care, work directly with older people, come from one of our hospital site partners; their place of work (the site) must also be able to nominate a site coordinator to champion the intervention in the intervention arm as well as collect site data (both arms). Older people: patients at the site, aged 65+ (or aged 50+ if Aboriginal or Torres Strait Islander), capable of consent. Exclusion criteria: Sub-acute health providers: who do not expect to be working at the site for at least 12 months post-baseline, and have participated in co-designing the training. Older people: receiving palliative care, or lack decision-making capacity in any domain. Consent will not be sought by proxies (e.g. families, carers) as they might include perpetrators of abuse. Study type Interventional Allocation: Randomised controlled trial. Randomisation using minimisation, stratifying by state. Primary purpose: Educational / counselling / training Phase not applicable Date of first enrolment n/a Target sample size 709 Recruitment status Not yet recruiting Primary outcome(s) Primary outcome [1] Change in sub-acute health providers recognition and response to elder abuse, as measured by scores on the adapted Knowledge and Management of Abuse Instrument (KAMA). Timepoint [1] Baseline, 4 months (primary timepoint) and 9 months after baseline. Primary outcome [2] Change in older people's sense of safety, as measured by Personal Safety domain score on the Adult Social Care Outcomes Toolkit (ASCOT). Timepoint [2] Baseline, 4 months (primary timepoint) and 9 months after baseline. Primary outcome [3] Change in older people's quality of life, as measured by the overall quality of life composite score on the Adult Social Care Outcomes Toolkit (ASCOT). Timepoint [3] Baseline, 4 months (primary timepoint) and 9 months after baseline. Key secondary outcomes Secondary outcome [1] Change in sub-acute health providers recognition and response to elder abuse, as measured by scores on the Caregiver Scenario Questionnaire (CSQ). Timepoint [1] Baseline, 4 months and 9 months after baseline. Secondary outcome [2] Change in sub-acute health providers ageist attitudes, as measured by scores on the Carolina Opinions on Care of Older Adults (COCOA). Timepoint [2] Baseline, 4 months and 9 months after baseline. Secondary outcome [3] Change in older people's mental health status, as measured by scores on the 12-item Short-Form Health Survey (SF-12v2). Timepoint [3] Baseline, 4 months and 9 months after baseline. Secondary outcome [4] Change in total health and social care costs (combined) per patient to trial end based on patient-level data from the adapted Resource Utilisation index lite (a-RUD-lite). Timepoint [4] Baseline, 4 months and 9 months after baseline. Secondary outcome [5] A multi-method process evaluation of the multicomponent training intervention. A member of the research team will visit the intervention sites for a duration of 2-3 days to conduct the process evaluation. The researcher will collect qualitative data about the multicomponent training intervention by observing how the screening tool works in practice, and by interviewing the site champion and 2-3 health provider participants per site. Timepoint [5] Approximately 3 months after implementation of the intervention. Secondary outcome [6] Cost-analysis of the training intervention for improving the safety, quality of life and mental health of older people based on SF-12, ASCOT, and a-RUD-lite. Timepoint [6] Baseline, 4 months and 9 months after baseline. Secondary outcome [7] Sub-acute hospital sites' number of elder abuse cases detected via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [7] 9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline. Secondary outcome [8] Sub-acute hospital sites' number of elder abuse cases referred via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [8] 9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline. Secondary outcome [9] Sub-acute hospital sites' number of referral types (e.g. Social Work, Safety planning, etc.) via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [9] 9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline. Secondary outcome [10] Sub-acute hospital sites' total cases for each specific type of abuse detected (e.g. financial abuse) via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [10] 9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline. Table 2 . Procedure timeline Procedures Assessment/Procedure Screening Baseline 4-month Follow-up 9-month Follow-up Health Providers Informed Consent x Demographic Information x a-KAMA questionnaire x x x COCOA questionnaire x x x Older Adults Informed Consent x Demographic Information x ASCOT questionnaire x x x SF-12v2 questionnaire x x x a-RUD-lite questionnaire x x x Has patient attended another hospital in trial during study period x x x Administrative/Site Data 9-months prior to Baseline Baseline Baseline to 4-months 4-months to 9-months Elder abuse cases x x x x Elder abuse referrals x x x x Nature of referral x x x x Number of eligible clinicians (total and by profession) x x Number of clinicians who have completed the training (total and by profession) x x Number of times the screening tool was administered / not administered x x x Sample size As health providers are not anticipated to be systemically different based on location (clusters), we have not accounted for ICC for health providers; therefore, we calculated that 60 health providers would be sufficient to detect a medium effect (Cohen's d of 0.5) on the KAMA at a power of 80% and a significance level of 1%. This difference is similar to that reported by our previous research, and the sample size calculation uses a standard deviation of 4.8 as previously reported [34]. We calculated that we need 10 clusters (5 intervention, 5 control) with 40 older people in each cluster to detect a medium effect on the ASCOT at a power of 80% and a significance level of 5%. As responses to elder abuse vary across jurisdictions, an ICC of 0.1 is assumed for older people with the standard deviation of 0.2 reported by others [35], calculated using the Shiny Calculator for Sample size for Cluster Randomised Trials[36]. Assuming 53% refusal rate to participate/unable to consent as observed in our group’s prior work in the UK [37, 38] the total sample size is 92 health providers and 612 older people (~60 older people/site). Recruitment Site champions will recruit health providers and older people in intervention and control arms. They will promote the study to subacute staff, during staff meetings, through posters and emails targeting relevant staff. A QR code will link to further information about the study. For the 4- and 9-month follow-up, site champions will remind staff up to 3 times verbally or by email. Site champions will prospectively recruit all older patients who meet eligibility criteria, as identified through staff meetings, medical files, and discussion with patients. They will provide each eligible participant with an invitation letter and PICF. Older people can choose to complete paper-based surveys with a reply-paid envelope provided; or a text-message or email link with the necessary information, as we have successfully used in prior research [39]. Older people will be recruited once the health providers in the intervention arm have completed the training and use of the screening tool has been implemented at the site, therefore, the baseline, 4-month, and 9-month time points for older people will be slightly later. Based on stakeholder consensus, we aim for 60% of eligible staff to complete the training prior to commencing the implementation of the screening tool to maximise patient exposure. It is possible that an older adult participant in the intervention arm will receive clinical care from someone who has not completed the training. Thus, we will also capture the “dose” for each site as a percentage of eligible staff who have completed the training. Group allocation Stratified randomisation will allocate clusters (subacute sites) to either intervention or wait-list control using a minimisation procedure. State (VIC, NSW, SA, WA) is a stratification factor. This is a single-blinded study where the statistician and outcome assessors will be blinded to allocation. It is not possible to blind participants to group allocation when collecting the post-intervention scores. During the assessment period, we will ask health provider participants not to discuss the study outside their site. Data collection and management For health providers, outcome questionnaires will take approximately 30-40 minutes to complete through the NARI-hosted REDCap database. For older people, questionnaires will take approximately 40 minutes. Outcomes will be entered into an electronic database by the research team and stored on a secure server. Participants will not be identifiable from any data that is published or otherwise publicly released. Promoting retention and follow-up Intervention and control sites will receive a gift hamper at each timepoint to encourage survey completion. Survey reminder notices will be posted at all sites’ staffrooms with a QR code for survey completion; at each of the three assessment points those completing the survey will enter a draw for a $250 gift card. A poster benchmarking the site’s progress in survey completion against other sites (de-identified) and study promotion materials will also be placed in staff lunchrooms. Analysis Primary and secondary RCT outcomes The primary analysis will be performed according to intention to treat, including all clusters and participants in the allocated groups. Between group difference for both primary outcomes (health provider and older people) will be analysed using mixed effects regression models with a fixed effect for the intervention group and random effect for participants to account for repeated measures. Cluster site will also be added as a random effect. Due to the likelihood of differences across sites, a number of baseline covariates will be controlled for in the analyses (as listed in Table 3). Table 3. List of covariates to be used in analysis and source. Health Provider Outcomes Older Adult Outcomes Self-reported profession, age, gender, years in the role age, sex, ethnicity, location, educational and economic attainments, country of birth, English proficiency, reason for subacute stay, and admission to any other hospital in the trial Reported by Site Champion based on data routinely collected by hospitals, or case records general characteristics of the site (size of workplace, location, subacute services offered), average characteristics of older patient cohorts admitted to the participating wards (age, gender, country of birth, English proficiency; reason for subacute stay), and elder abuse cases (number of suspected elder abuse cases p/month, number, and sources of referral) to enable the evaluation and statistical control of differences between sites length of hospital admission, length of admission on participating ward; number of eligible clinicians (total and by profession), and number of clinicians who have completed the training (total and by profession) to provide a measure of “dose” We will similarly analyse secondary outcomes. Continuous outcomes will be analysed using mixed effects linear regression models and adjustment for baseline values. Statistics will be reported with their respective 95% confidence intervals and P values. Per protocol analyses will also be performed, omitting participants with predefined protocol deviations (e.g., allocated intervention not received, violated inclusion/exclusion criteria). The trial results will be reported in line with the CONSORT extension for cluster trials. Fidelity and acceptability Fidelity/adherence data will be derived from training completion rates and the process evaluation. Acceptability of the intervention is pre-specified as >70% of health provider participants rating the intervention ‘completely acceptable’ at 9 months [40]. Process analysis Qualitative data collected during the process analysis interviews and observations will be thematically analysed using an inductive and reflexive coding approach to iteratively revise and define semantic themes [41] and managed through NVivo. Revisions to the Theory of Change will be iteratively discussed by the research team, and a final determination of the Theory of Change will be reached by team consensus. Economic analysis We will undertake a trial-based analysis to describe the additional costs (savings) and consequences arising from our intervention as compared to our usual care control condition. The cost-effectiveness analysis will capture two types of costs 1) participant direct medical (primary and allied care, medications, acute and subacute admissions) and social care costs (paid and unpaid home care and transitions to residential care) estimated from an adapted RUD-lite [42] plus supplementary self-report at baseline, 4 months and 9 months; and 2) costs associated with implementing the intervention and control conditions estimated from administrative and fidelity data. We will relate cost per participant to patient-level measures of safety, quality of life and mental health. In line with the main analysis, the primary outcome for the economic evaluation will be social care quality adjusted life-years (QALYs) to final follow-up calculated based on ASCOT scores [31, 43] at baseline, 4 months and 9 months. The secondary outcome for the economic evaluation will be health QALYs to final follow-up calculated based on SF12v2-based SF6D scores [44] at baseline, 4-month and 9-month data. Following recent recommendations [45], results will be expressed as (i) cost per ASCOT-based social care QALY, and (ii) cost per SF6D-based health QALY. We will summarise sampling error and decision uncertainty using the bootstrap acceptability method to calculate confidence intervals and generate cost-effectiveness acceptability curves [46]. Oversight and monitoring A 6 monthly project Stakeholder Advisory Group will provide oversight and advice of the project. This will include those with lived experience of elder abuse, older people, family carers, and clinicians, service providers, educators, and advocacy groups experienced in elder abuse responses. This project has been ethically reviewed and approved by Austin Health Human Research through the National Mutual Acceptance Scheme with governance approval to be provided by each hospital site. Discussion There is a need for high-quality trials with adequate statistical power and appropriate study characteristics to determine what is effective in preventing or reducing elder abuse [ 47 ]. Addressing this call, this will be one of the few multi-component elder abuse RCTs in the world. Our pragmatic approach aims to improve elder abuse knowledge, screening, and response in as many subacute health providers as possible rather than to provide extensive, specialised, or advanced training to fewer health providers who are under increasing demands due to pressures on the health care system. Our rationale is that upskilling more healthcare providers will result in increased detection of elder abuse, and better response and management with beneficial flow-on effects to older people. As both the training and screening tool have been co-designed, we expect high rates of acceptability amongst health providers. However, our multi-method process evaluation will allow us to determine what refinements are needed prior to national implementation. Limitations We will exclude patients who receive subacute care at home, despite this being an increasingly popular model of care. This minimises the risk of screening in the presence of a perpetrator, which would reduce the likelihood of disclosing abuse and may pose risks to the older person and/or care staff. Second, we will exclude older adults without the capacity to consent to research participation to avoid seeking proxy consent from a substitute decision maker, which could include a perpetrator of abuse. Finally, the recruitment of older people by site champions after randomisation introduces a risk of bias as site champions will know whether they are in the intervention or control arm. This common problem with cluster RCTs will be managed in the analytic strategy (e.g., through difference-in-differences techniques). Trial Status Protocol version 3, 17/01/2024. Recruitment has not yet started. The approximate date when recruitment will be completed is 04/03/2024. Conclusions Elder abuse often goes unreported and undetected. Older people may not feel comfortable to disclose it; and health providers may not know how to screen for or respond to it. Our work is a valuable first step to improving the health provider response to addressing this pernicious social issue. Declarations Ethics approval and consent to participate Austin Health Human Research Ethics Committee (HREC), HREC/92279/Austin-2023. Written, informed consent to participate will be obtained from all participants. Consent for publication Not applicable. Availability of data and material All members of the research team will have access to the final dataset. Access to the de-identified datasets will be available from the Project Lead Investigator on request. Competing interests BB declares receiving funding for elder abuse research from the Attorney-General’s Department and serves on the advisory board for a Victorian legal service. No other authors have conflicts of interest to declare. Funding This project has received funding from the 2021 Medical Research Future Fund (MRFF) Dementia Ageing and Aged Care Mission. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors’ contributions All authors (BB, MC, SM, CS, PR, GR, MDP, BD, PF, AG, EM, DM, JE, CC, JA, BA, SN, MO, JO, ME, CD) contributed to the conception and design of the work; and drafting and reviewing of the manuscript. Acknowledgements We would like to acknowledge in-kind support from: Sir Charles Gairdner Osborne Park Health Care Group, St John of God Mt Lawley Hospital, Uniting War Memorial Hospital, St Vincent’s Health Sydney, Western Health, Barwon Health, Peninsula Health, Central Adelaide Local Health Network and Bentley Health Service as part of the Royal Perth Group. References Qu L, Kaspiew R, Carson R, Roopani D, De Maio J, Harvey J, et al. National elder abuse prevalence study: Australian Institute of Family Studies; 2021. World Health Organization. Abuse of Older People. 2008; Available from: https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people. Brijnath B, Gartoulla P, Joosten M, Feldman P, Temple J, Dow B. A 7-year trend analysis of the types, characteristics, risk factors, and outcomes of elder abuse in community settings. Journal of Elder Abuse & Neglect. 2021;33(4):270-87. Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, et al. 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The effectiveness of educational intervention in improving primary health-care service providers’ knowledge, identification, and management of elder abuse and neglect: A systematic review. Trauma, Violence, & Abuse. 2021;22(4):944-60. Australian Institute of Health and Welfare. Australia’s health 2014. Australia's Health Series, Australian Institute of Health and Welfare (AIHW), Canberra, Australia. 2014. Collins M, Posenelli S, Cleak H, O'Brien M, Braddy L, Donley E, et al. Elder abuse identification by an Australian Health Service: A five-year, social-work audit. Australian Social Work. 2020;73(4):462-76. Stein D, Valters C. Understanding theory of change in international development. 2012. Gahan L, Gaffy E, Dow B, Brijnath B. Advancing methodologies to increase end-user engagement with complex interventions: The case of co-designing the Australian elder abuse screening instrument (AuSI). Journal of elder abuse & neglect. 2019;31(4-5):325-39. Brijnath B, Gahan L, Dow B, Hickey L, Braddy L, Collins M, et al. When co-design works (sort of): the case of the Australian elder abuse screening instrument. Journal of Elder Abuse & Neglect. 2022;34(4):302-13. Hernandez-Tejada MA, Skojec T, Frook G, Steedley M, Davidson TM. Addressing the psychological impact of elder mistreatment: Community-based training partnerships and telehealth-delivered interventions. Journal of Elder Abuse & Neglect. 2021;33(1):96-106. Richardson B, Kitchen G, Livingston G. Developing the KAMA instrument (knowledge and management of abuse). Age and Ageing. 2003;32(3):286-91. Selwood A, Cooper C, Livingston G. What is elder abuse—who decides? International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences. 2007;22(10):1009-12. Hempton C, Dow B, Cortes‐Simonet E, Ellis K, Koch S, LoGiudice D, et al. Contrasting perceptions of health professionals and older people in Australia: what constitutes elder abuse? International Journal of Geriatric Psychiatry. 2011;26(5):466-72. Hollar D, Roberts E, Busby-Whitehead J. COCOA: A new validated instrument to assess medical students' attitudes towards older adults. Educational Gerontology. 2011;37(3):193-209. Netten A, Burge P, Malley J, Potoglou D, Towers AM, Brazier J, et al. Outcomes of social care for adults: developing a preference-weighted measure. Health technology assessment (Winchester, England). 2012;16(16):1-166. Cheak-Zamora NC, Wyrwich KW, McBride TD. Reliability and validity of the SF-12v2 in the medical expenditure panel survey. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2009 Aug;18(6):727-35. World Health Organization. Practical guidance for scaling up health service innovations. Geneva: World Health Organization; 2009. Cooper C, Huzzey L, Livingston G. The effect of an educational intervention on junior doctors' knowledge and practice in detecting and managing elder abuse. International psychogeriatrics. 2012 Sep;24(9):1447-53. van Leeuwen KM, Bosmans JE, Jansen AP, Hoogendijk EO, van Tulder MW, van der Horst HE, et al. Comparing measurement properties of the EQ-5D-3L, ICECAP-O, and ASCOT in frail older adults. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2015 Jan;18(1):35-43. Hemming K, Kasza J, Hooper R, Forbes A, Taljaard M. A tutorial on sample size calculation for multiple-period cluster randomized parallel, cross-over and stepped-wedge trials using the Shiny CRT Calculator. International journal of epidemiology. 2020 Jun 1;49(3):979-95. Cooper C, Barber J, Griffin M, Rapaport P, Livingston G. Effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial. International psychogeriatrics. 2016 Jun;28(6):881-7. Livingston G, Barber J, Marston L, Stringer A, Panca M, Hunter R, et al. Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial. The Lancet Psychiatry. 2019 03/01;6. Manias E. Complexities of pain assessment and management in hospitalised older people: a qualitative observation and interview study. International journal of nursing studies. 2012;49(10):1243-54. Perski O, Short CE. Acceptability of digital health interventions: embracing the complexity. Translational Behavioral Medicine. 2021;11(7):1473-80. Terry G, Hayfield N, Clarke V, Braun V. Thematic analysis. The SAGE Handbook of Qualitative Research in Psychology. Second Ed. ed. London: SAGE; 2017. p. 17-37. Wimo A. Evaluation of the resource utilization and caregiver time in Anti-dementia drug trials-a quantitative battery. The health economics of dementia. 1998. Malley JN, Towers A-M, Netten AP, Brazier JE, Forder JE, Flynn T. An assessment of the construct validity of the ASCOT measure of social care-related quality of life with older people. Health and quality of life outcomes. 2012;10(21):1-14. Brazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Medical Care. 2004;42(9):851-9. Bulamu NB, Kaambwa B, Ratcliffe J. A systematic review of instruments for measuring outcomes in economic evaluation within aged care. Health and quality of life outcomes. 2015 Nov 9;13:179. Glick HA, Doshi JA, Sonnad SS, Polsky D. Economic Evaluation in Clinical Trials. Second Ed. ed. Oxford: Oxford University Press; 2014. Baker PR, Francis DP, Hairi NN, Othman S, Choo WY. Interventions for preventing abuse in the elderly. Cochrane Database of Systematic Reviews. 2016(8). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3891479","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286813034,"identity":"853c2c8e-9675-453e-81ca-370d4bfb8a7b","order_by":0,"name":"Marina G. 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Brijnath","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYBACewb+AwwJPECWBPMBEAnECfi1GDbwJIC18EiwJRCnxeAAjwGYwSMBZRBjS9qHBzJ35O2le749+LnHgoGfPceA4WcbXr8cnpHA88ywR+bsdsOeZxIMkj1vDBh78WgB2pIM9Mthxh6J3G0SPAckGAxuAG3hxaMF6BdjkBb7HomcZ5J/gFrsgVoY/xKhJRGohU0abItEjgEzPlsMmyEOS+65kWYmLXNAgkfizLOCwzLn8Hifvf8w48+ew7btM5KfSb45UCfH35688eGbMtxaGJiBmLEHwQclBIYDeDRAwQ/CSkbBKBgFo2AEAwBQb0w/D/r33QAAAABJRU5ErkJggg==","orcid":"","institution":"National Ageing Research Institute Inc","correspondingAuthor":true,"prefix":"","firstName":"Bianca","middleName":"","lastName":"Brijnath","suffix":""}],"badges":[],"createdAt":"2024-01-23 15:43:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3891479/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3891479/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54154130,"identity":"0310b8f2-c073-4c2e-a0c7-698782bb33a2","added_by":"auto","created_at":"2024-04-05 11:30:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55784,"visible":true,"origin":"","legend":"\u003cp\u003eOur intervention is guided the Theory of Change [23]. We conceptualise stigma as an interpersonal, social phenomenon. Our intervention reduces this stigma by creating a safe and inclusive relationship between health providers and older people. Through staff training, educating and modelling; implementation of a screening tool; and champions to sustain processes; we create, measure, and sustain practice change.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3891479/v1/cae941815d0d2ccde719109a.jpg"},{"id":54154436,"identity":"526458d2-d151-4bc8-a3e9-bf034707f027","added_by":"auto","created_at":"2024-04-05 11:38:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":603083,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3891479/v1/c9694d48-1b51-47c4-9de1-ae675a0fa740.pdf"},{"id":54154131,"identity":"95300dcc-f89b-417a-bfb8-8884057acefe","added_by":"auto","created_at":"2024-04-05 11:30:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39196,"visible":true,"origin":"","legend":"","description":"","filename":"SPIRITchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-3891479/v1/e504ee223d45a3e785e446d2.docx"}],"financialInterests":"","formattedTitle":"The impact of elder abuse training on subacute health providers and older adults: Study protocol for a randomized control trial","fulltext":[{"header":"Key points","content":"\u003cul\u003e\n \u003cli\u003eUnderreporting of elder abuse is significant due to barriers to disclosure\u003c/li\u003e\n \u003cli\u003eHealth providers may not feel confident in asking about or responding to elder abuse\u003c/li\u003e\n \u003cli\u003eHospital based health providers are in a unique position to detect and respond to elder abuse\u003c/li\u003e\n \u003cli\u003eWe report our protocol for No More Shame, a pragmatic cluster randomised control trial that aims to train health providers to recognise and respond to elder abuse\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOur outcomes include health providers knowledge and management of elder abuse, older people\u0026rsquo;s quality of life and sense of safety, and rates of elder abuse detection and referrals at hospital sites\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eElder abuse refers to harm caused to an older person by a single or repeated act within a relationship of trust. It can include financial, physical, psychological, sexual abuse and neglect [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and is commonly perpetrated by adult children [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Elder abuse is associated with increased morbidity and mortality including higher rates of depression, anxiety, fear, stress, substance dependence, social isolation, poorer physical health, and suicide [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Community prevalence is around 15% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], although rates of underreporting are high [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSpecialised health, aged care, community, and legal services directly involved in care for older people experiencing abuse hold valuable expertise about recognising and responding to elder abuse [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, many frontline health providers do not recognise elder abuse, do not report suspected cases, and often lack the time, confidence, and knowledge to respond [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, ageist attitudes among health providers, may impede older people\u0026rsquo;s care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Ageism is a recognised driver of elder abuse as it perpetuates notions that older people are dependent, an economic burden, and have less relevance, which in turn lead to greater tolerance of abuse [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eReviews [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] consistently identify the most effective interventions to stop and prevent further occurrence of elder abuse include educating health providers, and involving multidisciplinary services. The few randomised control trials (RCTs) in this area mostly focus on one of these interventions, demonstrating that training health providers, can improve awareness and knowledge elder abuse response [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and improve how student practitioners detect financial elder abuse [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Evidence regarding the impact of training on health providers\u0026rsquo; attitudes, detection and reporting rates within health services is sparse [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe aim to test whether a multimodal intervention combining health provider training, provision of a screening tool, and a site champion improves health providers\u0026rsquo; knowledge and management of abuse, and older people\u0026rsquo;s sense of safety over nine months, compared to no additional training or support in Australian subacute hospitals.\u003c/p\u003e \u003cp\u003eSubacute hospitals provide multidisciplinary care to optimise functioning and quality of life, including rehabilitation, geriatric evaluation and management, psychogeriatric care [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and often involve longer stays to manage complex health conditions before discharge. This provides an important opportunity for clinicians to build trust [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This may be the only time an older person experiencing abuse leaves their home for a prolonged period, spending time away from the perpetrator. Indeed, the abuse itself may precipitate or prolong their hospital stay [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eAims and hypotheses\u003c/h3\u003e\n\u003cp\u003e \u003cem\u003eOur primary aim is to test the\u003c/em\u003e hypothesis that health providers in the intervention arm will show greater knowledge of responding to elder abuse at 4-months relative to the control arm; and that older adults in the intervention arm will show greater quality of life at 4-months than those in the control arm.\u003c/p\u003e \u003cp\u003eMethods\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDesign and theory\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a pragmatic, cluster RCT. The intervention is guided by the Theory of Change [23], which seeks to create a safe and inclusive relationship between health providers and older people (see Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants and setting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eSites\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSubacute hospitals providing inpatient care in New South Wales; South Australia; Victoria; and Western Australia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eHealth providers\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe aim to recruit inpatient subacute clinical staff providing direct care to older people, including medical, nursing, or allied health. We will exclude staff who do not expect to be working at the site for at least 12 months post-baseline.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eOlder people\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe will include all inpatients at participating sites, aged 65+ (or aged 50+ if Aboriginal or Torres Strait Islander), who are willing to participate and individually capable of providing informed consent.\u003c/p\u003e\n\u003cp\u003eExclusion criteria for older people are: i) receiving palliative care, ii) lack of decision-making capacity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIntervention\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis intervention comprises 3 components:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eTraining:\u003c/strong\u003e Health provider participants will be asked to complete training via an online Learning Management System (Acorn) hosted by the National Ageing Research Institute (NARI).\u0026nbsp;The training takes ~60 minutes to complete, is self-paced, and participants will have access to it over a two-month period. It has four modules on: knowledge of abuse; drivers of abuse; screening for abuse (including how to administer the Australian Elder Abuse Screening Instrument [AUSI])\u0026nbsp;[24]; and management of elder abuse (further details available through the online trial registry anzctr.org.au, registration #ACTRN12623000676617p). This training was co-designed through workshops, interviews and user-testing with health providers, family carers, older people, and elder abuse survivors. Site champions will promote completion of the training, with the aim of at least 60% of eligible health providers on participating wards completing the training over a 2-month period.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eScreening tool:\u003c/strong\u003e Intervention sites will be provided with the AUSI screening tool, which has content validity\u0026nbsp;[24]; and has been demonstrated to increase staff confidence in screening for abuse, and the proportion of cases of suspected abuse that provoked multidisciplinary responses\u0026nbsp;[25]. Following the training, health providers will be asked to screen all patients for elder abuse, and to manage detected cases as per usual practice, including referrals to outside agencies, but with support from the site champion where required.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSite champion:\u003c/strong\u003e Each site will recruit an on-site clinician (senior social worker or other staff with commensurate experience) as a site champion, who will support other hospital staff in screening and managing elder abuse. They will be trained by the research team and work one day per week supporting the intervention. Site champions will encourage uptake of the training and the AUSI, and regularly contact staff to assess concerns and/or challenges encountered with screening. Site champions will be contacted every 2\u0026ndash;3 weeks via email/phone by the research team to proactively support them and build a national peer-support network\u0026nbsp;[26].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eControl\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe control arm will be waitlisted and given access to the training after nine months. Control arm sites will also recruit site champions, who will be trained and support in data collection. They will encourage completion of the outcome measures for health providers, recruit older people and collect data, and collect deidentified site data but will not provide further input beyond their normal clinical role.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOutcome assessments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll health provider participants will complete baseline assessment prior to site randomisation. Outcomes will be assessed at baseline (t0), 4 months follow-up (t1), and 9 months follow-up (t2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eSites\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSite champions will obtain summary statistics routinely collected by hospitals such as general site characteristics (size of workplace, location, subacute services offered), characteristics of patients admitted to participating wards (age, gender, country of birth, English proficiency; reason for subacute stay). \u0026nbsp;They will also ascertain the number of eligible health providers to enable the calculation of the percentage who complete the training. Elder abuse detection and referral data will be collected from the 9 months preceding the trial to the end of the trial (i.e., at completion of 9-month outcomes). Specifically, site champions will screen medical records of all inpatients on participating wards during that time to ascertain i) number of records screened, ii) number of cases that identified elder abuse and the types, iii) referrals made to social work, iv) the frequency of interventions and referrals (e.g., legal referral, safety planning) using a standardised template that will be provided. In the intervention arm, the number of times the AUSI screening tool is administered and not administered will also be collected, however, the responses on the AUSI will not be collected. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eHealth providers\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHealth providers will complete a demographic survey (age, gender, profession, years of experience in profession, and whether they have completed elder abuse training prior to the trial). They will also complete the adapted Knowledge and Management of Abuse (KAMA)\u0026nbsp;[27]\u0026nbsp;(primary outcome) adapted for an Australian subacute care setting, the Australian adaptation of the Caregiver Scenario Questionnaire (CSQ)\u0026nbsp;[28, 29], and Carolina Opinions on\u003cbr\u003e\u0026nbsp;Care of Older Adults (COCOA) survey\u0026nbsp;[30]\u0026nbsp;(secondary outcomes) via online survey in REDCap.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eOlder people\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOlder people will complete a demographic survey (age, gender, education, postcode, country of birth, language/s spoken, English language skills, First Nations status, reason for admission and underlying health risk factors for elder abuse (e.g., dementia, mobility)), the Adult Social Care Outcomes Toolkit (ASCOT)[31] (primary outcome), the Short Form Survey-12 (SF-12v2)[32], and an adapted Resource Utilisation in Dementia lite (a-RUD-lite) (secondary outcomes) via online/paper/telephone survey. Site champions will support older people where required, and record the older person\u0026rsquo;s length of admission once discharged.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eProcess evaluation\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe will conduct a multi-method process evaluation on how the intervention works in practice. Training completion rates will be monitored using the NARI Learning Management System. In addition to monitoring uptake of the screening tool, a researcher will visit each intervention site for 2-3 days approximately 3 months after implementation of the screening tool. We will observe how the screening and referrals are conducted, interview site champions, and 20-25 health providers across the sites. This evaluation will mobilise WHO guidance for scaling up health service innovations [33] as we seek to understand: intervention uptake, potential facilitators/barriers and solutions; whether the essential features of the intervention are being adhered to in practice (and if not, what remedial action can or should be taken); and whether the intervention improved elder abuse detection and response, impacted practice, and provider satisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. \u003cem\u003eTrial Registration Data Set\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eData category\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eInformation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ePrimary registry and trial identifying number\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eANZCTR\u003c/p\u003e\n \u003cp\u003eACTRN12623000676617\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eDate of registration in primary registry\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003e22 June 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSecondary identifying numbers\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eMRFF Application ID: 2015995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSource(s) of monetary or material support\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eDepartment of Health and Aged Care, Medical Research Future Fund (MRFF) Dementia Ageing and Aged Care Mission\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ePrimary sponsor\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eDepartment of Health and Aged Care, Medical Research Future Fund (MRFF) Dementia Ageing and Aged Care Mission\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEmail: [email protected].\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMail:\u003c/p\u003e\n \u003cp\u003eDepartment of Health and Aged Care\u003c/p\u003e\n \u003cp\u003eGPO Box 9848\u003c/p\u003e\n \u003cp\u003eCanberra ACT 2601\u003c/p\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSecondary sponsor(s)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eContact for public queries\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eBB [email protected]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eContact for scientific queries\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eBB [email protected]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ePublic title\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eNo More Shame: Investigating the effect of changing health providers recognition and response to elder abuse on associated stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eScientific title\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eNo More Shame: Investigating the effect of changing health providers recognition and response to elder abuse on associated stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eCountries of recruitment\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eHealth condition(s) or problem(s) studied\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eElder abuse, Public Health, Health promotion/education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eIntervention(s)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eSub-acute health providers that work at participating hospital sites will be given access to a multicomponent intervention (\u0026quot;No More Shame\u0026quot;) comprising a screening tool, online training focused on elder abuse, and a site champion.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eKey inclusion and exclusion criteria\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eAges eligible for study: \u0026ge;18 years\u003c/p\u003e\n \u003cp\u003eSexes eligible for study: Both\u003c/p\u003e\n \u003cp\u003eAccepts healthy volunteers: No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eInclusion criteria:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSub-acute health providers: either medical, nursing, or allied health staff, work in sub-acute care, work directly with older people, come from one of our hospital site partners; their place of work (the site) must also be able to nominate a site coordinator to champion the intervention in the intervention arm as well as collect site data (both arms).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOlder people: patients at the site, aged 65+ (or aged 50+ if Aboriginal or Torres Strait Islander), capable of consent.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eExclusion criteria:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSub-acute health providers: who do not expect to be working at the site for at least 12 months post-baseline, and have participated in co-designing the training.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOlder people: receiving palliative care, or lack decision-making capacity in any domain. Consent will not be sought by proxies (e.g. families, carers) as they might include perpetrators of abuse.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStudy type\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eInterventional\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eAllocation: Randomised controlled trial. Randomisation using minimisation, stratifying by state.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary purpose: Educational / counselling / training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePhase not applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eDate of first enrolment\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eTarget sample size\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003e709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eRecruitment status\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eNot yet recruiting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ePrimary outcome(s)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary outcome [1] Change in sub-acute health providers recognition and response to elder abuse, as measured by scores on the adapted Knowledge and Management of Abuse Instrument (KAMA).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTimepoint [1] \u0026nbsp;Baseline, 4 months (primary timepoint) and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePrimary outcome [2] \u0026nbsp; Change in older people\u0026apos;s sense of safety, as measured by Personal Safety domain score on the Adult Social Care Outcomes Toolkit (ASCOT).\u003c/p\u003e\n \u003cp\u003eTimepoint [2] \u0026nbsp;Baseline, 4 months (primary timepoint) and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePrimary outcome [3] Change in older people\u0026apos;s quality of life, as measured by the overall quality of life composite score on the Adult Social Care Outcomes Toolkit (ASCOT).\u0026nbsp;Timepoint [3] Baseline, 4 months (primary timepoint) and 9 months after baseline.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.945091514143094%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eKey secondary outcomes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.0549084858569%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary outcome [1] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Change in sub-acute health providers recognition and response to elder abuse, as measured by scores on the Caregiver Scenario Questionnaire (CSQ).\u003c/p\u003e\n \u003cp\u003eTimepoint [1] \u0026nbsp;Baseline, 4 months and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [2] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Change in sub-acute health providers ageist attitudes, as measured by scores on the Carolina Opinions on Care of Older Adults (COCOA). Timepoint [2] \u0026nbsp;Baseline, 4 months and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [3] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Change in older people\u0026apos;s mental health status, as measured by scores on the 12-item Short-Form Health Survey (SF-12v2). Timepoint [3] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Baseline, 4 months and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [4] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Change in total health and social care costs (combined) per patient to trial end based on patient-level data from the adapted Resource Utilisation index lite (a-RUD-lite). Timepoint [4] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Baseline, 4 months and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [5] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; A multi-method process evaluation of the multicomponent training intervention. A member of the research team will visit the intervention sites for a duration of 2-3 days to conduct the process evaluation. The researcher will collect qualitative data about the multicomponent training intervention by observing how the screening tool works in practice, and by interviewing the site champion and 2-3 health provider participants per site. Timepoint [5] \u0026nbsp;Approximately 3 months after implementation of the intervention.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [6] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Cost-analysis of the training intervention for improving the safety, quality of life and mental health of older people based on SF-12, ASCOT, and a-RUD-lite. Timepoint [6] \u0026nbsp; \u0026nbsp; \u0026nbsp;Baseline, 4 months and 9 months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [7] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sub-acute hospital sites\u0026apos; number of elder abuse cases detected via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [7] \u0026nbsp; \u0026nbsp;9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [8] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sub-acute hospital sites\u0026apos; number of elder abuse cases referred via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [8] \u0026nbsp; \u0026nbsp;9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [9] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sub-acute hospital sites\u0026apos; number of referral types (e.g. Social Work, Safety planning, etc.) via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [9] 9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary outcome [10] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sub-acute hospital sites\u0026apos; total cases for each specific type of abuse detected (e.g. financial abuse) via discussion with multidisciplinary team (prospective cases), review of electronic or paper-based medical records (prospective and retrospective cases). Timepoint [10] \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;9 months prior to the trial until baseline, baseline, 4 months and 9-months after baseline.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTable 2\u003cem\u003e.\u003c/em\u003e \u003cem\u003eProcedure timeline\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.985024958402661%\" rowspan=\"17\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eProcedures\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.11148086522463%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment/Procedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.475873544093178%\"\u003e\n \u003cp\u003e\u003cstrong\u003eScreening\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.144758735440933%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4-month Follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e9-month Follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eHealth Providers\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003ea-KAMA questionnaire\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOCOA questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eOlder Adults\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eASCOT questionnaire\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-12v2 questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003ea-RUD-lite questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas patient attended another hospital in trial during study period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eAdministrative/Site Data\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-months prior to Baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline to 4-months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4-months to 9-months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eElder abuse cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eElder abuse referrals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.38025594149909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNature of referral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.904936014625228%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.442413162705668%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636197440585008%\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.985024958402661%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.11148086522463%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of eligible clinicians (total and by profession)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.475873544093178%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.144758735440933%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.985024958402661%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.11148086522463%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of clinicians who have completed the training (total and by profession)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.475873544093178%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.144758735440933%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.985024958402661%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.11148086522463%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of times the screening tool was administered / not administered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.475873544093178%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.144758735440933%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.141430948419302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample size\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs health providers are not anticipated to be systemically different based on location (clusters), we have not accounted for ICC for health providers; therefore, we calculated that 60 health providers would be sufficient to detect a medium effect (Cohen\u0026apos;s d of 0.5) on the KAMA at a power of 80% and a significance level of 1%. This difference is similar to that reported by our previous research, and the sample size calculation uses a standard deviation of 4.8 as previously reported\u0026nbsp;[34]. We calculated that we need 10 clusters (5 intervention, 5 control) with 40 older people in each cluster to detect a medium effect on the ASCOT at a power of 80% and a significance level of 5%. As responses to elder abuse vary across jurisdictions, an ICC of 0.1 is assumed for older people with the standard deviation of 0.2 reported by others\u0026nbsp;[35], calculated using the Shiny Calculator for Sample size for Cluster Randomised Trials[36]. Assuming 53% refusal rate to participate/unable to consent as observed in our group\u0026rsquo;s prior work in the UK\u0026nbsp;[37, 38]\u0026nbsp;the total sample size is 92 health providers and 612 older people (~60 older people/site).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRecruitment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSite champions will recruit health providers and older people in intervention and control arms. They will promote the study to subacute staff, during staff meetings, through posters and emails targeting relevant staff. A QR code will link to further information about the study. For the 4- and 9-month follow-up, site champions will remind staff up to 3 times verbally or by email.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSite champions will prospectively recruit all older patients who meet eligibility criteria, as identified through staff meetings, medical files, and discussion with patients. They will provide each eligible participant with an invitation letter and PICF. Older people can choose to complete paper-based surveys with a reply-paid envelope provided; or a text-message or email link with the necessary information, as we have successfully used in prior research\u0026nbsp;[39]. Older people will be recruited once the health providers in the intervention arm have completed the training and use of the screening tool has been implemented at the site, therefore, the baseline, 4-month, and 9-month time points for older people will be slightly later.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on stakeholder consensus, we aim for 60% of eligible staff to complete the training prior to commencing the implementation of the screening tool to maximise patient exposure. It is possible that an older adult participant in the intervention arm will receive clinical care from someone who has not completed the training. Thus, we will also capture the \u0026ldquo;dose\u0026rdquo; for each site as a percentage of eligible staff who have completed the training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGroup allocation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStratified randomisation will allocate clusters (subacute sites) to either intervention or wait-list control using a minimisation procedure. State (VIC, NSW, SA, WA) is a stratification factor. This is a single-blinded study where the statistician and outcome assessors will be blinded to allocation. It is not possible to blind participants to group allocation when collecting the post-intervention scores. During the assessment period, we will ask health provider participants not to discuss the study outside their site.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData collection and management\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor health providers, outcome questionnaires will take approximately 30-40 minutes to complete through the NARI-hosted REDCap database. For older people, questionnaires will take approximately 40 minutes. Outcomes will be entered into an electronic database by the research team and stored on a secure server. Participants will not be identifiable from any data that is published or otherwise publicly released. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePromoting retention and follow-up\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntervention and control sites will receive a gift hamper at each timepoint to encourage survey completion.\u0026nbsp;Survey reminder notices will be posted at all sites\u0026rsquo; staffrooms with a QR code for survey completion; at each of the three assessment points those completing the survey will enter a draw for a $250 gift card. A poster benchmarking the site\u0026rsquo;s progress in survey completion against other sites (de-identified) and study promotion materials will also be placed in staff lunchrooms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnalysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003ePrimary and secondary RCT outcomes\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary analysis will be performed according to intention to treat, including all clusters and participants in the allocated groups. Between group difference for both primary outcomes (health provider and older people) will be analysed using mixed effects regression models with a fixed effect for the intervention group and random effect for participants to account for repeated measures. Cluster site will also be added as a random effect. Due to the likelihood of differences across sites, a number of baseline covariates will be controlled for in the analyses (as listed in Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. \u003cem\u003eList of covariates to be used in analysis and source.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eHealth Provider Outcomes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOlder Adult Outcomes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSelf-reported\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eprofession, age, gender, years in the role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eage, sex, ethnicity, location, educational and economic attainments, country of birth, English proficiency, reason for subacute stay, and admission to any other hospital in the trial\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eReported by Site Champion based on data routinely collected by hospitals, or case records\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003egeneral characteristics of the site (size of workplace, location, subacute services offered), average characteristics of older patient cohorts admitted to the participating wards (age, gender, country of birth, English proficiency; reason for subacute stay), and elder abuse cases (number of suspected elder abuse cases p/month, number, and sources of referral)\u0026nbsp;to enable the evaluation and statistical control of differences between sites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003elength of hospital admission, length of admission on participating ward; number of eligible clinicians (total and by profession), and number of clinicians who have completed the training (total and by profession) to provide a measure of \u0026ldquo;dose\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe will similarly analyse secondary outcomes. Continuous outcomes will be analysed using mixed effects linear regression models and adjustment for baseline values. Statistics will be reported with their respective 95% confidence intervals and P values. Per protocol analyses will also be performed, omitting participants with predefined protocol deviations (e.g., allocated intervention not received, violated inclusion/exclusion criteria). The trial results will be reported in line with the CONSORT extension for cluster trials.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eFidelity and acceptability\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFidelity/adherence data will be derived from training completion rates and the process evaluation. Acceptability of the intervention is pre-specified as \u0026gt;70% of health provider participants rating the intervention \u0026lsquo;completely acceptable\u0026rsquo; at 9 months\u0026nbsp;[40].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eProcess analysis\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data collected during the process analysis interviews and observations will be thematically analysed using an inductive and reflexive coding approach to iteratively revise and define semantic themes\u0026nbsp;[41]\u0026nbsp;and managed through NVivo. Revisions to the Theory of Change will be iteratively discussed by the research team, and a final determination of the Theory of Change will be reached by team consensus.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eEconomic analysis\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe will undertake a trial-based analysis to describe the additional costs (savings) and consequences arising from our intervention as compared to our usual care control condition. The cost-effectiveness analysis will capture two types of costs 1) participant direct medical (primary and allied care, medications, acute and subacute admissions) and social care costs (paid and unpaid home care and transitions to residential care) estimated from an adapted RUD-lite\u0026nbsp;[42]\u0026nbsp;plus supplementary self-report at baseline, 4 months and 9 months; and 2) costs associated with implementing the intervention and control conditions estimated from administrative and fidelity data. We will relate cost per participant to patient-level measures of safety, quality of life and mental health. In line with the main analysis, the primary outcome for the economic evaluation will be social care quality adjusted life-years (QALYs) to final follow-up calculated based on ASCOT scores\u0026nbsp;[31, 43]\u0026nbsp;at baseline, 4 months and 9 months. The secondary outcome for the economic evaluation will be health QALYs to final follow-up calculated based on SF12v2-based SF6D scores\u0026nbsp;[44]\u0026nbsp;at baseline, 4-month and 9-month data. Following recent recommendations\u0026nbsp;[45], results will be expressed as (i) cost per ASCOT-based social care QALY, and (ii) cost per SF6D-based health QALY. We will summarise sampling error and decision uncertainty using the bootstrap acceptability method to calculate confidence intervals and generate cost-effectiveness acceptability curves\u0026nbsp;[46].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOversight and monitoring\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 6 monthly project Stakeholder Advisory Group will provide oversight and advice of the project. This will include those with lived experience of elder abuse, older people, family carers, and clinicians, service providers, educators, and advocacy groups experienced in elder abuse responses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis project has been ethically reviewed and approved by Austin Health Human Research through the National Mutual Acceptance Scheme with governance approval to be provided by each hospital site.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere is a need for high-quality trials with adequate statistical power and appropriate study characteristics to determine what is effective in preventing or reducing elder abuse [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Addressing this call, this will be one of the few multi-component elder abuse RCTs in the world.\u003c/p\u003e \u003cp\u003eOur pragmatic approach aims to improve elder abuse knowledge, screening, and response in as many subacute health providers as possible rather than to provide extensive, specialised, or advanced training to fewer health providers who are under increasing demands due to pressures on the health care system. Our rationale is that upskilling more healthcare providers will result in increased detection of elder abuse, and better response and management with beneficial flow-on effects to older people.\u003c/p\u003e \u003cp\u003eAs both the training and screening tool have been co-designed, we expect high rates of acceptability amongst health providers. However, our multi-method process evaluation will allow us to determine what refinements are needed prior to national implementation.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWe will exclude patients who receive subacute care at home, despite this being an increasingly popular model of care. This minimises the risk of screening in the presence of a perpetrator, which would reduce the likelihood of disclosing abuse and may pose risks to the older person and/or care staff.\u003c/p\u003e \u003cp\u003eSecond, we will exclude older adults without the capacity to consent to research participation to avoid seeking proxy consent from a substitute decision maker, which could include a perpetrator of abuse.\u003c/p\u003e \u003cp\u003eFinally, the recruitment of older people by site champions after randomisation introduces a risk of bias as site champions will know whether they are in the intervention or control arm. This common problem with cluster RCTs will be managed in the analytic strategy (e.g., through difference-in-differences techniques).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eTrial Status\u003c/h2\u003e \u003cp\u003eProtocol version 3, 17/01/2024. Recruitment has not yet started. The approximate date when recruitment will be completed is 04/03/2024.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eElder abuse often goes unreported and undetected. Older people may not feel comfortable to disclose it; and health providers may not know how to screen for or respond to it. Our work is a valuable first step to improving the health provider response to addressing this pernicious social issue.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAustin Health Human Research Ethics Committee (HREC), HREC/92279/Austin-2023. Written, informed consent to participate will be obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll members of the research team will have access to the final dataset. Access to the de-identified datasets will be available from the Project Lead Investigator on request. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBB declares receiving funding for elder abuse research from the Attorney-General’s Department and serves on the advisory board for a Victorian legal service. No other authors have conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project has received funding from the 2021 Medical Research Future Fund (MRFF) Dementia Ageing and Aged Care Mission. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors (BB, MC, SM, CS, PR, GR, MDP, BD, PF, AG, EM, DM, JE, CC, JA, BA, SN, MO, JO, ME, CD) contributed to the conception and design of the work; and drafting and reviewing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge in-kind support from: Sir Charles Gairdner Osborne Park Health Care Group, St John of God Mt Lawley Hospital, Uniting War Memorial Hospital, St Vincent’s Health Sydney, Western Health, Barwon Health, Peninsula Health, Central Adelaide Local Health Network and Bentley Health Service as part of the Royal Perth Group.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eQu L, Kaspiew R, Carson R, Roopani D, De Maio J, Harvey J, et al. 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Influence of health personnel\u0026apos;s attitudes and knowledge in the detection and reporting of elder abuse: an exploratory systematic review. Psychosocial Intervention. 2017;26(2):73-91.\u003c/li\u003e\n\u003cli\u003eMohd Mydin FH, Yuen CW, Othman S. The effectiveness of educational intervention in improving primary health-care service providers\u0026rsquo; knowledge, identification, and management of elder abuse and neglect: A systematic review. Trauma, Violence, \u0026amp; Abuse. 2021;22(4):944-60.\u003c/li\u003e\n\u003cli\u003eAustralian Institute of Health and Welfare. Australia\u0026rsquo;s health 2014. Australia\u0026apos;s Health Series, Australian Institute of Health and Welfare (AIHW), Canberra, Australia. 2014.\u003c/li\u003e\n\u003cli\u003eCollins M, Posenelli S, Cleak H, O\u0026apos;Brien M, Braddy L, Donley E, et al. Elder abuse identification by an Australian Health Service: A five-year, social-work audit. Australian Social Work. 2020;73(4):462-76.\u003c/li\u003e\n\u003cli\u003eStein D, Valters C. Understanding theory of change in international development. 2012.\u003c/li\u003e\n\u003cli\u003eGahan L, Gaffy E, Dow B, Brijnath B. Advancing methodologies to increase end-user engagement with complex interventions: The case of co-designing the Australian elder abuse screening instrument (AuSI). Journal of elder abuse \u0026amp; neglect. 2019;31(4-5):325-39.\u003c/li\u003e\n\u003cli\u003eBrijnath B, Gahan L, Dow B, Hickey L, Braddy L, Collins M, et al. When co-design works (sort of): the case of the Australian elder abuse screening instrument. Journal of Elder Abuse \u0026amp; Neglect. 2022;34(4):302-13.\u003c/li\u003e\n\u003cli\u003eHernandez-Tejada MA, Skojec T, Frook G, Steedley M, Davidson TM. Addressing the psychological impact of elder mistreatment: Community-based training partnerships and telehealth-delivered interventions. Journal of Elder Abuse \u0026amp; Neglect. 2021;33(1):96-106.\u003c/li\u003e\n\u003cli\u003eRichardson B, Kitchen G, Livingston G. Developing the KAMA instrument (knowledge and management of abuse). Age and Ageing. 2003;32(3):286-91.\u003c/li\u003e\n\u003cli\u003eSelwood A, Cooper C, Livingston G. What is elder abuse\u0026mdash;who decides? International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences. 2007;22(10):1009-12.\u003c/li\u003e\n\u003cli\u003eHempton C, Dow B, Cortes‐Simonet E, Ellis K, Koch S, LoGiudice D, et al. Contrasting perceptions of health professionals and older people in Australia: what constitutes elder abuse? International Journal of Geriatric Psychiatry. 2011;26(5):466-72.\u003c/li\u003e\n\u003cli\u003eHollar D, Roberts E, Busby-Whitehead J. COCOA: A new validated instrument to assess medical students\u0026apos; attitudes towards older adults. Educational Gerontology. 2011;37(3):193-209.\u003c/li\u003e\n\u003cli\u003eNetten A, Burge P, Malley J, Potoglou D, Towers AM, Brazier J, et al. Outcomes of social care for adults: developing a preference-weighted measure. Health technology assessment (Winchester, England). 2012;16(16):1-166.\u003c/li\u003e\n\u003cli\u003eCheak-Zamora NC, Wyrwich KW, McBride TD. Reliability and validity of the SF-12v2 in the medical expenditure panel survey. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2009 Aug;18(6):727-35.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Practical guidance for scaling up health service innovations. Geneva: World Health Organization; 2009.\u003c/li\u003e\n\u003cli\u003eCooper C, Huzzey L, Livingston G. The effect of an educational intervention on junior doctors\u0026apos; knowledge and practice in detecting and managing elder abuse. International psychogeriatrics. 2012 Sep;24(9):1447-53.\u003c/li\u003e\n\u003cli\u003evan Leeuwen KM, Bosmans JE, Jansen AP, Hoogendijk EO, van Tulder MW, van der Horst HE, et al. Comparing measurement properties of the EQ-5D-3L, ICECAP-O, and ASCOT in frail older adults. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2015 Jan;18(1):35-43.\u003c/li\u003e\n\u003cli\u003eHemming K, Kasza J, Hooper R, Forbes A, Taljaard M. A tutorial on sample size calculation for multiple-period cluster randomized parallel, cross-over and stepped-wedge trials using the Shiny CRT Calculator. International journal of epidemiology. 2020 Jun 1;49(3):979-95.\u003c/li\u003e\n\u003cli\u003eCooper C, Barber J, Griffin M, Rapaport P, Livingston G. Effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial. International psychogeriatrics. 2016 Jun;28(6):881-7.\u003c/li\u003e\n\u003cli\u003eLivingston G, Barber J, Marston L, Stringer A, Panca M, Hunter R, et al. Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial. The Lancet Psychiatry. 2019 03/01;6.\u003c/li\u003e\n\u003cli\u003eManias E. Complexities of pain assessment and management in hospitalised older people: a qualitative observation and interview study. International journal of nursing studies. 2012;49(10):1243-54.\u003c/li\u003e\n\u003cli\u003ePerski O, Short CE. Acceptability of digital health interventions: embracing the complexity. Translational Behavioral Medicine. 2021;11(7):1473-80.\u003c/li\u003e\n\u003cli\u003eTerry G, Hayfield N, Clarke V, Braun V. Thematic analysis. The SAGE Handbook of Qualitative Research in Psychology. Second Ed. ed. London: SAGE; 2017. p. 17-37.\u003c/li\u003e\n\u003cli\u003eWimo A. Evaluation of the resource utilization and caregiver time in Anti-dementia drug trials-a quantitative battery. The health economics of dementia. 1998.\u003c/li\u003e\n\u003cli\u003eMalley JN, Towers A-M, Netten AP, Brazier JE, Forder JE, Flynn T. An assessment of the construct validity of the ASCOT measure of social care-related quality of life with older people. Health and quality of life outcomes. 2012;10(21):1-14.\u003c/li\u003e\n\u003cli\u003eBrazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Medical Care. 2004;42(9):851-9.\u003c/li\u003e\n\u003cli\u003eBulamu NB, Kaambwa B, Ratcliffe J. A systematic review of instruments for measuring outcomes in economic evaluation within aged care. Health and quality of life outcomes. 2015 Nov 9;13:179.\u003c/li\u003e\n\u003cli\u003eGlick HA, Doshi JA, Sonnad SS, Polsky D. Economic Evaluation in Clinical Trials. Second Ed. ed. Oxford: Oxford University Press; 2014.\u003c/li\u003e\n\u003cli\u003eBaker PR, Francis DP, Hairi NN, Othman S, Choo WY. Interventions for preventing abuse in the elderly. Cochrane Database of Systematic Reviews. 2016(8).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"trials","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"trls","sideBox":"Learn more about [Trials](http://trialsjournal.biomedcentral.com/)","snPcode":"13063","submissionUrl":"https://www.editorialmanager.com/trls","title":"Trials","twitterHandle":"MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"elder abuse, training, older people, subacute, intervention, co-design, pragmatic trial","lastPublishedDoi":"10.21203/rs.3.rs-3891479/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3891479/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful or otherwise reticent to disclose abuse; and many health providers are not confident in asking about it. In the \u003cem\u003eNo More Shame\u003c/em\u003e study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers’ recognition, response, and referral of elder abuse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e., clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training program for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are health providers’ knowledge of responding to elder abuse; and older people’s quality of life. \u0026nbsp;We will include all inpatients at participating sites, aged 65+ (or aged 50+ if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Recruitment will commence in October 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u0026nbsp;\u003c/strong\u003eANZCTR, ACTRN12623000676617p. Registered 22 June 2023, https://www.anzctr.org.au/ACTRN12623000676617p.aspx\u003c/p\u003e","manuscriptTitle":"The impact of elder abuse training on subacute health providers and older adults: Study protocol for a randomized control trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-05 11:30:50","doi":"10.21203/rs.3.rs-3891479/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-04-02T21:03:55+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-02T21:02:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-09T09:19:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Trials","date":"2024-01-22T20:11:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"trials","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"trls","sideBox":"Learn more about [Trials](http://trialsjournal.biomedcentral.com/)","snPcode":"13063","submissionUrl":"https://www.editorialmanager.com/trls","title":"Trials","twitterHandle":"MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7062c088-f026-42e2-9ed3-923f4b11f294","owner":[],"postedDate":"April 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-07T07:16:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-05 11:30:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3891479","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3891479","identity":"rs-3891479","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}