Knowledge and Interpersonal Skills to Develop Enhanced Relationships (KINDER): Testing the Efficacy of an Intervention to Prevent Psychological Elder Abuse in Family Caregiving

In the U.S., 7.5 million persons ages 60 and older experience elder abuse (EA) annually. Family caregivers (CGs) are among the most likely to commit EA: one-third to one-half of CGs self-report engaging in EA towards their family member living with Alzheimer’s disease or related dementia (AD/ADRD), an at-risk population. Psychological EA is the most common type of abuse among CGs of those with AD/ADRD, making up 25%-42% of cases. The mental health harms of psychological EA are comparable physical EA: older adults who experience psychological EA are at an increased risk of anxiety, depression, and chronic disease burden. Interventions targeting CGs have gained traction as a promising way to prevent EA. Yet, effective approaches to EA prevention with CGs remain emergent. Interventions targeting risk factors alone (e.g., poor CG mental health) have been unsuccessful, and little is known about effective mechanisms of change to prevent psychological EA. Other fields of family violence have shown success by focusing on relationship dynamics to prevent abuse, yet this is a novel approach to EA. A relationship-focused approach to prevention is supported by observational studies showing relationship strain as a risk factor for EA and low-quality caregiving. Beyond mitigation of relationship strain alone, development of resourcefulness skills is proposed to prevent psychological EA by equipping CGs with skills to manage challenging caregiving scenarios that may precede psychological EA. The Knowledge and Interpersonal Skills to Develop Enhanced Relationships (KINDER) intervention was developed to prevent psychological EA and promote high quality caregiving by lowering relationship strain and developing CG resourcefulness. In a recent pre- and post-test pilot study (N=45), CGs who participated in KINDER reported reduced frequency of psychological EA (p<0.01) and higher quality of caregiving (p<0.03). Investigators also observed reduced relationship strain (p<0.01) and increased resourcefulness (p<0.01). The goal of this two-arm, randomized control trial is to determine the efficacy of KINDER at mitigating psychological EA by family CGs to persons living with AD/ADRD and to describe how the intervention may work to reduce psychological EA. The investigators hypothesize that family CGs exposed to the KINDER intervention will have improvements in psychological EA and quality of caregiving when compared to CGs exposed to an information-only control condition. Further, increased resourcefulness and reduced relationship strain will explain reductions in psychological EA and improved quality of caregiving. The investigators will also assess differences in effects according to time in the caregiving role, kin relationship, as well as CG demographic characteristics. This research responds to the too-common occurrence of psychological EA by family CGs, and may help prevent the destructive effects of psychological EA in a vulnerable and growing population of persons living with AD/ADRD.