title: A staff intervention targeting resident-to-resident elder mistreatment (R-REM) in long-term care increased staff knowledge, recognition and reporting: results from a cluster randomized trial.
abstract: BACKGROUND
  Elder abuse in long-term care has received considerable attention; however, resident-to-resident elder mistreatment (R-REM) has not been well researched. Preliminary findings from studies of R-REM suggest that it is sufficiently widespread to merit concern, and is likely to have serious detrimental outcomes for residents. However, no evidence-based training, intervention and implementation strategies exist that address this issue.
  
  
  OBJECTIVE
  The objective was to evaluate the impact of a newly developed R-REM training intervention for nursing staff on knowledge, recognition and reporting of R-REM.
  
  
  METHODS
  The design was a prospective cluster randomized trial with randomization at the unit level.
  
  
  METHODS
  A sample of 1405 residents (685 in the control and 720 in the intervention group) from 47 New York City nursing home units (23 experimental and 24 control) in 5 nursing homes was assessed. Data were collected at three waves: baseline, 6 and 12 months. Staff on the experimental units received the training and implementation protocols, while those on the comparison units did not. Evaluation of outcomes was conducted on an intent-to-treat basis using mixed (random and fixed effects) models for continuous knowledge variables and Poisson regressions for longitudinal count data measuring recognition and reporting.
  
  
  RESULTS
  There was a significant increase in knowledge post-training, controlling for pre-training levels for the intervention group (p<0.001), significantly increased recognition of R-REM (p<0.001), and longitudinal reporting in the intervention as contrasted with the control group (p=0.0058).
  
  
  CONCLUSIONS
  A longitudinal evaluation demonstrated that the training intervention was effective in enhancing knowledge, recognition and reporting of R-REM. It is recommended that this training program be implemented in long-term care facilities.
authors.affiliation: Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, Riverdale, NY 10471, United States. teresimeas@aol.com
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Mildred
authors.initials: M
authors.lastname: Ramirez
authors.forename: Julie
authors.initials: J
authors.lastname: Ellis
authors.forename: Stephanie
authors.initials: S
authors.lastname: Silver
authors.forename: Gabriel
authors.initials: G
authors.lastname: Boratgis
authors.forename: Jian
authors.initials: J
authors.lastname: Kong
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Karl
authors.initials: K
authors.lastname: Pillemer
authors.forename: Mark S
authors.initials: MS
authors.lastname: Lachs
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016000:Cluster Analysis; D004552:Elder Abuse; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007398:Interpersonal Relations; D008134:Long-Term Care; D009519:New York City; D009735:Nursing Homes; D009740:Nursing Staff / Q000523:psychology*; D011446:Prospective Studies; D000078329:Workforce